Ask the doctor - skin conditions

Click here for the main Ask the doctor page, with questions and answers from our magazine doctors on 25 health topics

I’ve heard that most people have low levels of vitamin D, increasing the risk of bone problems, multiple sclerosis and bowel cancer. Don’t our bodies supply it?
You can only make vitamin D in your skin when the UV index is greater than three which, in the UK, is during spring and summer. Even then, using high-factor sunscreen reduces the amount of vitamin D our bodies produce. So during autumn and winter, vitamin D supplements are a good bet. Now it’s May you could also expose your skin to sunlight by exercising outdoors for 15 to 20 minutes a day (avoiding the hours around noon when burning is more likely), before covering up or applying lotion. Food sources include oily fish, liver, fortified margarine, eggs, butter and fortified milk. If you don’t eat much of these, supplements are a worthwhile option. Try Super Strength Vitamin D3 25mcg (£9.95 for 240 tablets from www.healthspan.co.uk) or Boots General Health Vitamin D, 25mcg (£5.10 for 90 tablets from www.boots.com).
Dr Sarah Brewer, Prima (May 12)

My month-old baby has small yellow spots on her chin and nose. They don’t seem to bother her – should she see a doctor?
Babies often get spots as their skin adapts to the presence of normal bacteria. Red, blotchy spots with yellow centres can form during the first few weeks of life because pores are not yet working properly. They don’t need treatment and gradually stop appearing. Tiny white spots on the nose – so-called milk spots – are due to enlarged oil glands and disappear on their own, too. However, if your baby develops red, angry septic spots that come to a head filled with pus, see your doctor. Never squeeze spots, as this encourages spread of infection.
Dr Sarah Brewer, Prima (Apr 12)

I get eczema when drinking cows’ milk. I’ve tried goats’, sheep and soya milk products and wonder what else is available? Can I still take a probiotic fermented milk drink each day?

A number of non-dairy milks are available from wholefood and health-food shops (and, increasingly, supermarkets) including rice milk, pea milk, oat milk and almond, hazelnut, coconut and other nut milks. Oats are high in cholesterol-lowering soluble fibre, and are popular as they have beneficial effects on the bowel. Some people with milk allergies can tolerate fermented milk drinks, but you can also obtain beneficial probiotic digestive bacteria in the form of capsules and tablets. More information on food intolerance is available from Allergy UK. Visit www.allergyuk.org or call 01322 619898.
Dr Sarah Brewer, Prima (Mar 12)

I can't be the only woman with bigger boobs who gets skin irritation underneath them – any tips for relief?
You’re right, it’s a very common problem, and one of the most likely culprits is a fungal infection called intertrigo – caused by the same yeasts that give rise to athlete’s foot and vaginal thrush. Intertrigo usually causes a red, sore and itchy rash, often with a creamy deposit and sometimes small blisters. If you think you have intertrigo, a fungal cream from your chemist may settle the problem. To reduce the risk of it coming back, dry really well after washing. Pat rather than rub with a dry towel – ideally not the one you use for the rest of your body – or use a hairdryer to get the area really dry. Then apply unscented talcum powder to absorb sweat. There’s no evidence that underwired bras make this condition better or worse – what’s more important is that your bra is made of cotton rather than synthetic fibre, and that you stick to wearing loose clothing made from natural fibres, which let the skin breathe. If you get recurrent fungal skin infections, see your GP to ask about getting a test for diabetes.
Dr Sarah Jarvis, Good Housekeeping (Sept 11)

The hard skin on the soles of my feet makes it painful to walk. Are there any home treatments, or do I need to see a chiropodist?
Calluses develop to protect areas subjected to pressure or friction from badly fitting shoes or socks, thin-soled shoes and high heels. Extensive calluses can be removed surgically by a podiatrist, but you can often treat the problem at home with creams that moisturise and dissolve hardened skin, such as Flexitol Callus Remover Cream (£8.99 from Boots). To help prevent calluses, wear comfortable socks and shoes, preferably with in-built cushioning – or use a gel insert. Go barefoot around the home when you can, and vary your footwear to avoid rubbing friction in the same areas.
Dr Sarah Brewer, Prima (Sept 11)

I’ve always had white patches of vitiligo on my legs and hip. Can anything get rid of them?
There is no ‘cure’ for vitiligo but a number of treatments can help toimprove its appearance. Skin-camouflage creams are helpful for exposed areas, and are available from pharmacies, or from www.covercream.co.uk. Tacrolimus cream can restore skin colour – your GP can advise. Narrowband UVB phototherapy, which involves exposing the skin to UVB rays, may be available on the NHS. Private laser treatment is also available but results are not guaranteed. For more information, visit www.vitiligosociety.org.uk.
Dr Sarah Brewer, Prima (May 11)

I have tried arnica gel for skin irritation and bruising without much success. Is there anything else to try?
Make sure you are using a herbal Arnica gel (try Atrogel £6.35 for 50ml from www.avogel.co.uk) rather than a homeopathic version which does not contain any measurable amount of arnica. I find the herbal versions are much more effective. Another option is Heal Skin Therapy gel (£33.50 for 30ml from www.healgelshop.com), which was originally developed by surgeons to heal skin after cosmetic surgery. It has an anti-inflammatory formula that combines arnica with silicone and other active ingredients to reduce redness, itching and bruising. It’s expensive, but effective.
Dr Sarah Brewer, Prima (Apr 11)

I’ve had eczema since childhood but, after a decade without any symptoms, it has recently flared up again. Have any new treatments appeared in the last few years?
Like other allergic conditions, eczema does seem to be getting more common. Moisturisers, such as the Derma Care range (from £2.49 from Boots) and corticosteroid creams or ointments are still the mainstay of treatment, but must be used sparingly. New prescription treatments have become available for those who don’t respond to conventional corticosteroids. These include tacrolimus ointment (Protopic) and, for those with severe, long-term hand eczema, alitretinoin capsules (Toctino). Chlorine in water can irritate skin and using a bath or shower water filter that removes chlorine and softens water can help enormously (£35.25 from sensitiveskincareco.com).

Dr Sarah Brewer, Prima (Mar 11)

I’ve heard chickenpox is doing the rounds again. Is it very infectious? What’s the best way to treat it?
Chickenpox spreads through coughing or direct contact with the blister-like spots, known as vesicles. It is highly infectious from two days before the rash appears until about a week after, when all spots are scabbed over. Symptoms take two to three weeks to develop after infection and include fever, headache, dry cough and clusters of small, red blisters. The best cure for itching is ViraSoothe gel (£7.99 from Boots), which cools, soothes and hydrates the skin. Keep fingernails short to discourage scratching and irritating further, which may lead to bacterial infection and scarring. Adults who have never had chickenpox – especially pregnant women – should avoid contact with anyone who has chickenpox or shingles (from which you can also catch chickenpox). If contact does occur, seek medical advice. For more information, visit itchi.co.uk.
Dr Sarah Brewer, Prima (Mar 11)

I have a keloid on my chest following removal of a cyst, which is visible when I wear a swimsuit. Can it be removed and allowed to heal again?
A keloid is a thickened area of scar tissue caused by an overactive healing process. If the scar is removed, it usually just re-forms. Most keloids can be improved by applying an adhesive, silicone gel sheet such as Boots Scar Reduction Patches (£19.99 for 21 patches) or Cica-Care (£22.95 from amazon.co.uk) that flatten, soften and fade red and raised scars. Have your blood pressure checked regularly, as people with a tendency towards keloids are twice as likely to develop high blood pressure in later life. This is because the protein that stimulates excess production of collagen is also involved in blood-pressure control.
Dr Sarah Brewer, Prima (Feb 11)

I have a brown scaly lump on my ear. My GP says it’s not skin cancer and doesn’t need removing, but that I should come back if I get more. Why should I need to if this lump is nothing serious?
It sounds as if you have a very common skin growth called a solar keratosis. These are up to an inch across, raised above the skin surface, feel rough and scaly, and vary from pink/red, to brown or skin coloured. They aren’t dangerous in themselves, and up to one in four disappear on their own within a year. However, they are a sign your skin has been exposed to a lot of sun (they most commonly occur in places that get a lot of sun, such as ears, face, shoulders, backs of hands or patches of scalp). The more sun exposure you have over a lifetime, the higher your chance of developing skin cancer. There is also a small chance that, over a number of years and especially if you have several, a solar keratosis can turn cancerous. So be on the lookout for any new skin growths and avoid the sun as much as possible.
Dr Sarah Jarvis, Good Housekeeping (Feb 11)

I get regular cold sores and put patches on them, but is it true that you can apply lipstick over the patches to help disguise them?
You can apply make-up, lipstick or sunscreen on top of coldsore patches but not underneath them, which would reduce their stickiness. The latest patch both hides and treats cold sores. It also dissolves, so you don’t have to rip it off to replace it. Algopain-Eze Dissolving Cold Sore Patch (£8.99 for eight patches from independent pharmacies) contains zinc sulphate to boost healing, beta-glucan to stimulate immunity (a good idea, as sores often appear due to reduced immunity when you are run-down), and an algae extract to reduce inflammation and viral activity.
Dr Sarah Brewer, Prima (Jan 11)

What’s the difference between anti-ageing creams that protect against UVA and those that protect against UVB? Should I be using them all through the winter and, if so, which is best against wrinkles?
UVA rays are present all year round, even on cloudy days, and protection is just as important in winter as it is in summer. Creams that contain an SPF (sun protection factor) screen out varying amounts of UVB light. These rays make up around five per cent of the sun’s UV (ultraviolet) wavelengths and are associated with sunburn and some signs of skin ageing. The other 95 per cent of the ultraviolet wavelengths are UVA rays. These penetrate more deeply into the skin and can cause skin sagging, deep wrinkles and more obvious signs of premature ageing. As UVA rays can pass through glass, we’re even exposed to them when sitting by an office window or when in a car, and skin experts now recommend the use of products with five-star UVA-rated protection (such as No7 Protect & Perfect Day Cream, £20.50 for 50ml from Boots), all year round.
Dr Sarah Brewer, Prima (Jan 11)

I have athlete’s foot round my little toes. I use cream but it keeps coming back. Help!
To stop it coming back, you need to continue treating the fungus that causes it. With most creams, that means applying it one to three times a day, which can be easy to forget. If this is the problem, you could try Lamisil Once (£9.99 from Boots). As its name suggests, it only has to be applied once but penetrates and stays in the skin, continuing to work for almost two weeks. Another point of difference is that you apply half the contents of the tube on one foot, then use the remaining half of the tube on your second foot even if there are no signs of infection. This helps to eradicate the fungus from your skin, and the rate of re-infection within three months is low. If symptoms do not improve within a week, seek medical advice. Your doctor can send off a swab to confirm the infection is fungal, and not bacterial, which may need antibiotic treatment.
Dr Sarah Brewer, Prima (Nov 10)

I’ve noticed patches of dark skin on the undersides of my breasts. They appeared suddenly, but aren’t painful and I can’t feel any lumps. Should I be worried?
Uneven darkening or patchiness can occur in a variety of skin conditions, including eczema, psoriasis, pityriasis versicolor (a fungal skin infection) and as a result of long-term exposure to the sun, which is unlikely, unless you regularly sunbathe topless or use a sun bed. More permanent darkening of skin patches can also be due to increased pigment production in freckles and moles. Occasionally, dark patches are due to hormone changes, such as pregnancy. See your doctor to find out the most likely cause.
Dr Sarah Brewer, Prima (Sept 10)

I have very red, sensitive skin and have been told that a product containing rosa mosqueta oil may help. What does it do?
Rosa mosqueta oil is pressed from the seeds of the wild rose, rosa rubiginosa. Exceptionally rich in linoleic and linolenic essential fatty acids needed for healthy skin regeneration, it's traditionally used to reduce scarring, repair sun damage and is anti-ageing. Another option, designed for dry or sensitive skin, is Jane Scrivner's Rose Gold Skin Attar, which combines organic jojoba oil with Bulgarian rose otto (1ml of this essential oil is made using over 2000 rose flower heads). It quickly penetrates the skin to promote constriction of dilated capillaries (thread veins) and reduce redness. Although it is expensive, it lasts for ages and is excellent for treating red, blotchy skin (£49 for 50ml from janescrivner.com).
Dr Sarah Brewer, Prima (Aug 10)

My two-year-old daughter has a small round patch on her arm. The doctor isn't sure if it's ringworm or eczema. What's the difference?
Although the lesions look similar, eczema is an allergic reaction, while ringworm is a fungal infection. It's not always easy to tell them apart, but the combination treatment Daktacort, works well. This contains an anti-fungal drug (miconazole) that kills the fungus, and an inflammatory agent (hydrocortisone) that treats the eczema and the redness caused by the infection. You can buy it from pharmacies (around £5.99 for 15g) and it is also available on prescription if your doctor thinks it's suitable.
Dr Sarah Brewer, Prima (Jul 10)

I have constantly red cheeks and, embarrassingly, I've started getting acne again even though I'm in my 30s. What could it be?
It sounds as if you have a condition called rosacea, which affects up to 1 in 20 people. It affects only the face, and causes redness that can look like sunburn. But it can also cause acne-like spots, which seems very unfair when you think you've put teenage skin problems behind you. It can also leave you with sore, stinging eyes. The spots can be treated with antibiotics given over several months, often in the form of a gel or lotion. Although the redness doesn't disappear, keeping cool and avoiding spicy food (and, as far as possible, stress) will reduce its severity significantly. Keeping out of the sun is also important. Your skin may well be sensitive, so stick to hypo-allergenic products. If the redness is a major problem and camouflage make-up isn't enough, talk to your GP about a referral to a dermatologist for possible laser treatment.
Dr Sarah Brewer, Prima (May 10)

I'm in my thirties and have started to lose a lot of hair. I'm really worried - what could be causing it?
As many as 50 per cent of women will experience a form of hair loss at some stage in their lives. One of the most common to affect women is telogen effluvium - when hairs are shed all over the scalp and on other parts of the body too. It is often a reaction to a period of intense stress, or can be a reaction to some type of medication. It's difficult to pinpoint the cause because your hair often doesn't start to fall out until some months after the stressful event. But it usually clears up on its own within six months. Another common type of hair loss is androgenetic alopecia, which is triggered by hormonal changes in your body. Up to half of women over 40 will be affected by it. It often runs in families and is the main cause of male pattern baldness.
However, the pattern of hair loss in women is different, with more general hair loss from the top and sides of the head. There's no quick fix, so don't be tempted to try a ‘miracle cure' from the internet. The drug minoxidil has been found to help around 20 per cent of women, but you have to take it indefinitely or your hair will start to fall out again. As a last resort there is hair transplantation, but the results can be disappointing. In the meantime, you should have a blood test to check your iron levels and thyroid function, as either of these may be causing the problem.
Dr Louise Selby, SHE (Apr 10)