Ask the doctor - skin conditions: hair loss

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

Six weeks ago, my hair began coming out in clumps when I washed it and brushed it. Nothing has changed in my life. How can I make it stop?
Your hair grows about a centimetre a month and you lose about 50-100 hairs per day. Each one on your head has a life cycle of about three years. At any one time, one in 100 hairs is ready to fall out. This cycle may have been shortened because of stress or physical trauma. As a result, the hair stops growing and falls out sooner than it’s supposed to, and it’s most noticeable when you wash or brush it. Interestingly, it occurs about one to three months after the event. This type of hair loss causes thinning unlike alopecia, which leaves the sufferer with bald patches. The good news is that it rights itself in a couple of months. However, thyroid problems, lack of iron and crash dieting can cause excessive hair loss, too, so get a blood test.
Dr Pixie McKenna, Best (Jan 13)

At 45, my cheeks and jowls are drooping, making me look old and tired. Can exercising my facial muscles reverse the problem?
Like muscles in the body, you can tone and strengthen facial muscles with exercises, such as tilting your head back and opening and closing your mouth, while jutting your chin forwards. Exercising against resistance is most effective, however, and an American surgeon has invented an elasticated device, Facial Flex, that fits into the corners of the mouth to give around 30 muscles in the face and neck a really good workout (£46.99 from www.rosemaryconley.com). Another option is to stimulate these muscles electronically using Slendertone Face, which is designed to restore a youthful appearance by toning and lifting the muscles. The product is placed on the sides of the face to stimulate a nerve that tightens facial muscles. £250 from Boots, Argos and www.slendertone.com.
Dr Sarah Brewer, Prima (Jan 13)

A lump was removed from my back about eight months ago. It was nothing serious, but now I have a thick, ugly scar and the doctor says that he can’t remove it. I’m a bit annoyed as it’s even bigger than the original bump. What can I do?

This sounds like a keloid scar. These can occur after a trauma to the skin or an operation. They are firm, smooth growths, which can be skin- or flesh-coloured and crop up at the scar site. This type of scarring is more common in women, and on darker skin, and it often runs in families. It is generally found in the region of the shoulder, chest, back and earlobes. Your doctor is right that cutting this out would probably result in a larger scar and, most likely, a further keloid scar. However, they can be treated by injecting them with steroids, which tends to flatten them and make them less obvious, or covering them in steroid-coated tape. Using silicone gels or sheets, which have a similar effect, can also help. Laser treatments can reduce the appearance of these types of scars, too. If you are susceptible to this type of scarring, you should think very carefully about having minor blemishes and bumps removed as often the scar – as you say – is worse than the original issue.
Dr Pixie McKenna, Best

I have a rash on my groin. It’s red, scaly and very itchy. It came up a few weeks ago and seems to be getting worse. I also have athlete’s foot, but I don’t think it’s connected. What can I use?

This sounds like what the Americans call jock itch. It’s more common in men and young boys and is caused by a fungal infection in the skin of the groin. It tends to cause red, raised scaly patches and sometimes makes the skin look a bit darker or lighter. Everyone has microscopic amounts of fungus living on their skin, but in the right conditions of moistness and friction, they tend to thrive and multiply, giving rise to the rash. So it’s not surprising that it occurs more commonly in people who are sporty.

Your athlete’s foot is actually very likely to be connected, as the spores of the fungus can fall from the feet onto your underwear or sports clothes. When getting dressed, try to prevent this by putting your socks on before your undergarments. Talk to your chemist about treating it with over-the-counter creams, eg Clotrimazole (thrush cream), and keep the area dry and friction-free. Avoid scratching to avoid spreading it.
Dr Pixie McKenna, Best

I cut my leg on some glass and have been dressing it daily. Is it advisable to avoid using the Jacuzzi or steam room at my local gym?
The cleanliness of water in communal facilities cannot be guaranteed and, personally, I wouldn’t use these until a deep cut had fully healed. If signs of infection develop (redness, throbbing pain, swelling or visible pus) seek medical advice. It’s also important to make sure your tetanus injection is up to date.
Dr Sarah Brewer, Prima (Oct 12)

I had a fall a few weeks ago and have been left with a big swollen lump on my shin. It’s sore and purplish in colour. I thought it would soon disappear but after almost two weeks, it’s still there. Do you think I should I see my GP about it?

This sounds like a haematoma where blood collects in the tissues after an injury or trauma, such as your fall. It’s more common in older people or those who take drugs such as aspirin, which thin the blood. It is usually harmless in that the body simply reabsorbs the blood back into the system. In some cases haematomas are large and require drainage by a surgeon. The other issue is that they can sometimes become infected as both the injury and the pooling of blood provide the perfect environment for bacteria. It’s worth showing it to your doctor if it doesn’t seem to be budging so they can assess it and see if it needs treatment or will simply resolve itself on its own. Do try to keep the leg elevated at the end of the day and wear a compressions bandage to keep the haematoma contained. Icing it can also help, but this is usually in the initial period after the injury. Your pharmacist can advise you on various rub-on treatments to help speed up the breakdown of the collection of blood.
Dr Pixie McKenna, Best

My teenage son has bad acne and has been to see a dermatologist. They advised he go on a drug called Roaccutane. I’ve read bad things about it making people feel depressed. Is it worth the risk?

Acne affects about 80% of us at some point in our lives. Roaccutane is a potent drug that works by putting the brakes on the grease glands in the skin – less oil being produced means less acne. It’s prescribed by specialists where other drugs have been tried and failed. Roaccutane should never be given without prior counselling as it has potentially serious side effects. With regards to the depression issue, this drug should never be prescribed to someone who suffers from depression or has suicidal thoughts, as there is some evidence to suggest it may make symptoms worse. When used under supervision, Roaccutane can have life-changing effects by ridding people of their acne in a matter of months. The drug has been around for decades and is prescribed on a very regular basis. Your son should discuss concerns with his GP as, generally speaking, he would need to be on the treatment for three to four months for it to work.
Dr Pixie McKenna, Best

I keep getting hives on my stomach and legs. I went to the doctor and he did a blood test, but couldn’t find anything. I’ve cut out dairy and nuts. What else can I do?

It’s unlikely, although not impossible, that dairy or nuts are the culprits. Some people – women in particular – can suffer from chronic urticaria, where hives, as we know them, crop up periodically out of the blue. You tend to develop red raised areas, which may be itchy. Histamine is the culprit in terms of the internal chemical that kicks the reaction off, but often we can’t pin down the cause. Ask your GP to put you on an antihistamine and take it every day for three months. This may break the cycle. Also, try to avoid stress, extreme temperature changes, alcohol, aspirin, red wine and food containing tartrazine. Tomatoes, strawberries and strong cheese can also aggravate the condition. Hives tend to disappear over the period of a few months, but if you ever suffer an attack and have difficulty breathing, call 999, as it could be an anaphylactic reaction.
Dr Pixie McKenna, Best

I’ve developed red, spotty skin in my late 30s, which I find very upsetting. My GP says I have rosacea and has given me antibiotic cream, but is there anything else I can do?

Rosacea, or acne rosacea, affects as many as one in 10 people, and often starts in your 30s or 40s. It usually appears on the central parts of your face (cheeks, forehead, nose and chin) and causes redness, acne-like spots and sometimes sore, stinging eyes. Frequent flushing is often the first symptom, and may be all you notice for months or even years. Some of my patients mistake it for the hot flushes of the menopause. Because it’s so visible, rosacea can be extremely distressing, although it rarely causes serious problems. The only exception is inflammation of the front of your eye – if you do get an acutely painful red eye, seek medical help urgently. While there’s no cure, antibiotic creams (or sometimes tablets) can reduce the spots. While everyone needs some sunshine to avoid vitamin D deficiency, with rosacea, keeping your face out of the sun can help enormously. If you do go in the sun, use a high sun protection factor (30 or more) unscented, non-greasy cream. Your skin is likely to be sensitive, so you should also steer clear of cleansers containing alcohol or acetone. Don’t exfoliate and always use hypo-allergenic, non-waterproof make-up. Many people find certain food triggers increase redness, so experiment with cutting out spicy foods to start with, and keep alcohol to a minimum. Others, however, find their flushing is triggered by hot drinks or stressful situations. And do be aware that excess heat and strenuous exercise also make flushing worse – so cool down regularly.
Dr Sarah Jarvis, Good Housekeeping (Aug 12)

I get an occasional painful swelling in my left armpit. It ares up, then goes away. Is this a boil? I recently had a mammogram, which was normal, but this swelling worries me.
Your armpit contains hair follicles and oil glands, which can become infected and swell to form a boil. It is important that your doctor sees the lump to make the correct diagnosis, but if it is an infected sebaceous cyst and keeps recurring, it may need to be surgically removed, which is relatively simple and straightforward. Your doctor will probably want to check your glucose, too, as a raised level can be associated with recurring boils.
Dr Sarah Brewer, Prima (Jun 12)

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)