Marks on face

Q . I have a brown mark on the side of my face, close to my eye. I know this as a liver spot and it's been with me for a few years. It seems to be getting bigger and more and more unsightly. I have also noticed the beginnings of some more spots under my left eye and on my lower cheek. Is this something I will just have to live with, or is there something that can be done about it?

A. Any changes in pigmented areas of the body, especially on the bits regularly exposed to sunlight should be checked by your doctor. Melanoma can arise on any part of the body but does so more commonly in pigmented areas like moles.

Lesions caused by moulds

Q . I have been sick with various skin lesions and throat swelling. I just found out that I have been staying in a house infested with the following moulds (aureobasidium, penicillium, and aspergillus). The skin lesions are on my upper back and neck, inside of my nose and face. What could I use to treat these?

A. The good news is that there are very few moulds or yeasts which will infect humans other than those which live on them in the first place. Our homes are covered with all kinds of moulds and they don't cause any harm. Some may even be of benefit such as penicillium. You need to show these lesions to a dermatologist especially if you suffer from any immune deficiency such as by taking steroids, diabetes or HIV.

Fordyce spots?

Q . Hello,

I am an uncircumsized 19 year old male, and I have many tiny white spots all over my foreskin, they seem to be underneath the surface of the skin. They don't cause any pain or discomfort to me, nor do they discharge in any way. I've read some of the articles here, and I think I have "Fordyce spots." When I have an erection, the skin stretches and these spots stand out and give my foreskin a very rough feel. My questions are: Would the friction of these hard spots cause discomfort to a female during intercourse? Will each spot grow hair (some seem to be doing so)? And because I have many, will they go away or is there a way to get them treated?

Thank you.

A. Now this is just the kind of question I really love to answer. Not only do you not have a problem, your partner is on the receiving end of an advantage. The bumps you refer to are nothing more than hair/sweat follicles which sit inside the thin skin of the penile shaft. As the penis becomes erect these follicles stand out more prominently. I suspect this is part of the cunning plot of nature as the vagina will be more stimulated by these bumps. If you need confirmation take a look at the dildos on sale in sex shops. For goodness sake, if only for the sake of your partner at least, do not even consider getting rid of these perfectly normal sexy bumps you lucky, lucky man.

Eczema on nose

Q . Several years ago I was diagnoseed with sebhorreic eczema on the bridge of my nose and the creases either side. Since then I have always had red patches in these places, despite the skin being otherwise fairly healthy. I am concerned that the steriod treatment may have caused thinning of the skin in these areas as treatment took some time. I recently went to my GP who prescribed oxytetracycline for one month which has helped with the appearance but has now left me with small blotches of red as opposed to totally red. While I will be grateful for any insights, my chief question is that should I return to my GP for a further course and would this be likely to help further?

A. It sounds as though your skin condition has not been helped too much by the medication prescribed. I am interested as to why you were diagnosed as having sebhorreic eczema and prescribed steroids. Yes, it can occur in these places but is more common in the scalp or hairy bits of the face. Constant steroid treatment can cause thinning of the skin and this is seen particularly with oral medication. The oxytetracycline will help for any infection of the skin, particularly for acne types of follicle infection (acne). I'm afraid you do need more advice and yes, it would be wise to talk to your GP, but at the same time discuss the side effects of treatments.

Wheelchair user with skin problem

Q . I am a 54 year old male and I have had MS for 25 years, 18 of which in a wheelchair. Sitting at the moment is very painful and at the base of my spine a large area of my skin has gone dark brown. At the top of the crease between the cheeks of my bottom. The skin is very lumpy and sore. I have tried changing my wheelchair cushion and my wife has tried rubbing in a cream that has a local anaesthetic in it. But it doesn't seem to be working. I would be grateful for some advice.

A. Constant use of local anaesthesia gels is not a good idea although you might get some relief at first. There is a danger of developing a pressure sore without realising it when sitting down for prolonged periods, especially if there is little movement. The dark area may be simple bruising and pigmentation from blood. You have tried one obvious way of easing the discomfort with your cushion. You might find it better to fill the tube with water rather than air. One danger of these tubes is from any obstruction of blood flow in the area and especially down to and up from the legs. As much as you find possible you need to move your legs or have them massaged. Again, if possible, rising from the sitting position as often as you can will also help take the pressure off the area and blood vessels. I recommend you talk to your GP for a physiotherapy session to help you reduce the pain and improve circulation.

Lumps connected with colitis?

Q . I have lots of lumps all over my body especially the tops of my legs.Ive had a few removed by surgery, and was told they were lipomas which are harmless. They look awful and if I have them removed im covered with scars. is there any other way of removng them? I am 33 male, and have colitis could this have anything to do with the lumps?

Thank you

A. Lipomas are relatively harmless lumps of fatty tissue which grow just beneath the skin. They can grow to alarming proportions often reaching the size of golf balls or even larger. Surgery is simple and usually solves the problem but can cause some scaring. With modern surgical techniques this can be reduced to a minimum with only a tiny scar being visible. If your skin is black these scars can be more noticeable but even so they should be very small. Injections of steroids were once used to reduce the lipomas but this often had more damaging effect than the surgery. There are autoimmune conditions linked to the occurrence of lipomas. I suggest you talk to your GP about having them all removed under a general anaesthetic.

Itchy rash on back of legs

Q . I have over the last 3 or 4 years been developing a skin rash on my legs. It is infrequent but is very itchy and scabs over in a few days. Although it does not cause me any suffering it is itchy and a nuisance. It usually develops on the lower back part of my legs (either one). Any advice would be grateful. Thanks

A. Without seeing the rash it is very difficult to give you a definitive answer. You may have eczema or psoriasis. Eczema is very common and can be caused by contact with irritants. Some men find their socks, either from the material or the washing powder used, can cause localised rash. Psoriasis tends to affect the flexures of the body joints. It can flare for no apparent reason but stress and exposure to cold weather are classic triggers. It would be useful to know your age as there are some rashes which form from poor blood circulation. Either way I suggest you see your own doctor.

Red, itchy bites on back

Q . About a week ago I developed a ring of what look like bites on my back. They are red and are very itchy, but limited to one particular area. I think they may have increased in number but can't be sure. The itchiness has not died down.

Can you help or suggest anything?

A. Generally speaking, things which look like bites turn out to be bites especially if they are in one particular area such as round the ankles, the belt line or around the scalp. Even so, the big mimic is the rash caused by the combination of Herpes and Roster viruses, cold sores and chicken pox, to produce the classic erupting rash of shingles. It generally affects only one side of the body and is intensely itchy and painful. Early diagnosis is important as you can take an anti-Herpes drug which stops it in its tracks. Otherwise you will need to wait for the three weeks or so for it to take its leave. Ask your doctor to check.

Change in pigmentation around penis and scrotum

Q . When I started puberty i began to notice a change in the colour of my skin around my penis and scrotum. After a few years, the browness covered a larger area of skin surface. I'm 18 and have not had sex. I went to see the doctor who gave me some cream, just in case it was a fungal infection, but she said it is most likely to be pigmentation and i could do nothing about it. I have been too embarrassed to return. Could it be a pigmentation problem and is it true nothing can be done about it? It is making me feel low, and I'm afraid of getting into a relationship in case it leads to sex!

A. I am taking this very seriously but I do wish I had a penny for every time someone asked me this question. It simply goes to show that there is insufficient education for boys about their own bodies and we grow up with all kinds of worries, too scared to ask anyone for fear of being made to look a fool. Your doctor was right. Without even seeing it myself I can reassure you that it is only pigment. I always thought this was strange as generally we don't walk around with our tackle open to the sun, yet it turns brown. During an erection, however, the skin is stretched and the penis appears much lighter in colour. Perhaps evolution was trying to avoid us men getting sunburnt in those places lagers always reach. Relax and enjoy being a man.

Warty lumps

Q . For about a couple of months now I have been concerned about what can be descibed as warty type lumps underneath the top part of my foreskin. It started off with a lot of iching around this area, then the appearence of these warts. They also seemed change, opening up into what I can only describe as having lots of little heads on. This effect seems to come and go, also mild itching around the base of the penis where I appear to actually have a wart type looking thing.

I seemed to have always hade a wart on and around my hands ever since a child.

I am on various medication from a ten year old kidney transplant, Azathioprine 150mg once a day and Neoral 125mg twice a day. Please can you give me some guidance.

A. What you describe is probably what you suspect - genital warts. They are very, very common and fortunately don't cause much trouble to the infected man other than mild irritation and occasional bleeding. A totally different story for your female partner should she become infected as genital warts are linked to cervical cancer. Being on immunosuppressants might just make them spread faster but the treatment remains the same. Do not attempt to remove them yourself with wart remover. Nip down to your local GUM clinic. Mention your drug treatment.

Is this thrush or something else?

Q . I am a healthy 25 year old and I have been suffering recently with an outbreak of 'smelly penis' which I have read from previous questions on this website can be as a result of thrush. Unlike some of the questioners though, I have not had any 'red mottled' effect on my head, nor any itching, nor any discharge. In addition to this pungent smell (and I wonder if this is linked) I have had a smelly belly button with small amount of discharge and a very itchy anus (this mainly occurs late at night and first thing in the morning and drives me mad!).

I appreciate parts of this question has similarities with others, but I am concerned about this combination of symptoms (especially the anus problem). Is it a Canestan 'job', and do I just cover everything in the stuff?

Many thanks in anticipation...

A. Good question. Thrush is a yeast infection and makes its presence felt in different ways. There is not always a mottled helmet but the fish smell is very common especially in men who are uncircumcised.

It is perfectly possible to have thrush elsewhere on the body especially the anus and even the belly button. If you are badly run down, taking long courses of steroids or antibiotics or have diabetes, it is more likely to be thrush. Chlamydia infection will also produce the smell without the rash. It has a minimal effect on men but can cause ectopic pregnancy, infertility and even death in women. Obviously without seeing you it is impossible to make a clear diagnosis but I would strongly recommend you see your own doctor to have it checked. Your local GUM clinic will see you completely anonymously with no records kept and your GP will never know.

Red patch between buttocks

Q . I have only just started being concerned about the redness of the skin between my bottom cheeks, although it has been like it for years. It used to itch a lot, but it seems to have stopped now. Between the cheeks, it looks extremely sore and red. It does not hurt to touch or wash etc, but I am quite worried, as it has never gone away. I am not sure when I developed this.

It would be great if you could give any suggestions on how to relieve this problem.

Thanks

A. The very first thing I have to tell you is to stop worrying. This is as common as toilet paper which is just possibly what is not helping the problem. Obviously I cannot give you a totally accurate diagnosis without seeing the redness but I suspect you have just noticed what those of us with less mobile backs, long necks or access to a small mirror have never seen before. The area around the anus is naturally red/brown from pigmentation. If it is only the colouration you have nothing to be concerned about.

Excessive rubbing with toilet paper is one of the main causes of redness and itchiness. Anything which makes you go more often is a culprit so look out for drinking too much alcohol, too much fruit juice or straining when at the loo. Thrush can cause itchiness just like it does on the penis. In most cases you will never know what is causing it but a short course of mild steroid creams can help enormously so long as you don't keep using them all the time. Rarely a prolapse of the anus showing the inner lining of the rectum can occur as can a fissure in the anal ring which can be particularly itchy and sore. Diabetes can also sometimes shows itself this way so it might be a good idea to see your doctor.

Lump between testicles and anus

Q . My boyfriend has a lump the shape of a bean that's the size of a thumb in between his testicles and anus. He even pinched it once and a white fluid came out. He says it hurts when he touches it like a bruise. Have you any idea what it could be or what it couldn't be for sure? Please email me as soon as you know or don't know. Thank you

A. First relax. This is nothing the X Files would be interested in. It could be a number of things and it would need personal examination to confirm my thoughts. Sebaceous cysts are very common in this area and they can grow to quite large sizes. Sometimes they remain closed over and can be painful. It may also be a small amount of duct or testicular material which found itself in the wrong place during development. Another possibility is a small hernia of the ductal material from the scrotum itself.

None of these things are serious but if it is annoying him he should see his doctor and have it painlessly removed.

Skin coloured spots on penis

Q . I read your questions and noticed a guy with a similar condition as mine but didn't get a conclusive answer. I have noticed clusters of small skin coloured spots developing around my foreskin as well as bigger spots on my foreskin. I haven't had sex before so I don't understand what is wrong. I'm sure you appreciate this is a big cause of concern. Thanks

A. I have a horrible feeling you are not going to get a conclusive answer either for the simple reason that until we get video pictures along with the written description it will be impossible to give a definitive diagnosis. I would need to know your age and previous medical history to go much further. I can, however, reassure you that it is very unlikely to be anything serious or abnormal. Skin pigmentation is intense on the penis especially over the foreskin. This thins out on erection but makes the pigment spots appear pale and much larger. (try writing in felt tip on a balloon then inflating it). If this is really driving you crazy you should see your own doctor who will have the advantage of seeing the 'problem' before giving you the same reassurance.

Spots on penis and testicles

Q . I am 15 years old and have noticed some spots over my genital area. The first is a smallish white lump on the base/middle-lower part of my penis it is more noticable when I have an erection. I also notice a few if I stretch the skin on my balls (excuse informal language). These cannot really be felt and are unnoticable if I don't pull or stretch the skin on my balls.

Are these dangerous? What shall I do? I am too embarassed to see a doctor.

A. Relax. You have absolutely nothing wrong with your tackle. The bumps you feel during an erection are hair follicles or sweat glands which sit nice and comfortable when the penis is flaccid. As the skin gets thinner they are forced outwards and some doctors think that they act as a source of stimulation for your female partner during intercourse.

Good news for you and even better news for someone else too.

Small white bumps on penis and testicles

Q . I have small white bumps on my penis and testicles. At first I thought they were acne because they look similar but after popping one I found they were not. They are filled with a white/yellow cream but just come back bigger after. I am confident they are not caused by a STD. Please tell me what they are and how I can get rid of them. Thanks.

A. What you are developing are pilar cysts - these are cysts that develop in relation to the hair root. You can get pilar cysts anywhere on the body and they are common on the back and face. The penis and scrotum are common sites and in some men, the scrotum can become covered with them. In most men, the shaft of the penis is devoid of hair and the scrotum can be very sparsely covered. In these sites, pilar cysts can still develop due to the ectopic presence of part of the hair root at these sites. They usually start small and painless and gradually grow bigger, up to 1 cm across.

Occasionally, they can become infected, increase in size upto a golf ball size and burst onto the surface to leave a crater like scar. Normally they are filled with solidifed oil which is the white stuff you squeezed out. Squeezing is not a good idea, as this can encourage infection.

These are not dangerous but are more a cosmetic problem and can be very embarrassing with a new sexual partner. The only way of getting rid of them is by surgery - your GP will need to refer you to a dermatologist or surgeon.

Lump in pelvis near base of penis

Q . Recently I noticed a small lump at the base of my penis (the side facing me). It's not actually on my penis but slightly under my pelvis under the skin. I tried to pop it but it doesn`t have a head on it. I think it swelled a bit after that and got a bit more painful, yet it is only really painful to touch or squeeze.

I`m not sure if it is fluid or not. I don't think it's hard, but it is definitely a lump. I once had a spot at the base of my penis before, but that was different as it had a white head on it. I do also have white spots on the underside of my penis, but these are only cysts or something, nothing to worry about I have read, but I`m not sure about this lump.

A. You are quite correct about spots and lumps on the penis and scrotum. They are invariably normal. Without an examination it is impossible to give any sort of definitive advice. It is worth remembering that a number of ligaments which tether the penis to the pelvis lie just beneath the surface of the skin and can feel like lumps especially when the penis is flaccid and the ligaments are slack.

Some lymph nodes lie in this area although they are generally more to the side of the groin. Inflammation can cause swelling and tenderness. Swelling of the epididymis (cysts) can feel like lumps but are usually soft and not tender. They are normally on the underside of the penis within the scrotum.

As I cannot give you reassurance or definitive advice I recommend you see your GP for examination.

How do lasers work for skin conditions?

Q . I suffer from redness in the face from years of acne and the harsh products used to treat it, I may even have a touch of rosacea. I hear that lasers and laser peeling can clear this up and give me a clearer complexion. Could you please explain what they can do?

A. If you have rosacea with your acne your skin will be red but you will also be getting flushing attacks, which are the hallmark of rosacea. It is not uncommon to get acne and rosacea together.

If this is the case the redness could respond to drugs such as clonidine which you could get from your GP. The type of laser that could help is one that preferentially attacks the red spectrum and will thus target the small blood vessels in the skin. This leads to a marked reduction in the red colour of the skin. The type of laser is a tuneable dye laser. Lasers have improved over the last few years and this type of laser is now very effective with few side effects. If your skin is scarred you need a different form of laser which vapourises the upper layer of the skin, removing some of the scarring with it.This is a CO2 laser and the proceedure is called laser resurfacing. If you need resurfacing it is probably best to have this done first and then to go for the tuneable dye laser treatment. It is important to get advice from a qualified practitioner - this should be a dermatological surgeon or a plastic surgeon. It is best to avoid the clinics that advertise in the newspapers.

White bumps on foreskin and in mouth

Q . Hi. About a year ago I noticed a cluster of small white bumps (about 1mm) on my foreskin, and on the lips in my mouth. One of the lumps has started growing to about three times that size. From looking around on the internet, it appears the obvious answer would be genital warts. But since I haven't had sex, it's probably quite unlikely. Also, the larger lump is on the glands, a few milimetres away from the urethra. I expect you get thousands of letters like this, but it is quite embarrasing. Thanks.

A. It is difficult to be precise about a diagnosis without seeing the spots, but from your description, it is unlikely that they are warts. Genital warts are usually skin coloured rather than white and on the head of the penis they often become filiform (meaning that they grow into small lumps that look like they are made up of tiny filaments.

Warts can of course transfer to other sites of the body, but usually by direct contact and when they occur on the lips, they usually occur on the outer part of the lip or around the mouth. It is more common for genital warts to transfer to the area round the anus, causing sore lumps to appear. From your description, it is more likely that you have developed Fordyce spots - small glands on the shaft of the penis and on the head and inside the mouth, around the lips. These are glands that are usually associated with hair structure, but in these sites occur by themselves. They are 'under the skin' and are often pale or white. They are nothing to worry about and a lot of men develop them.

Bunions

Q . I am 65 years old and in excellent health. I've inherited bunions - it's worse on my right toe. I am a jogger, and I can jog alright, but when it comes to walking (for exercise, or long distances) it becomes somewhat painful. I've spoken to a couple of people who have had surgery for their bunions and it was very painful and they've said they wouldn't go through it again, although they are fine now. Is this surgery worthwhile for someone my age who is active but nevertheless can get along as is??? Thanks and best regards.

A. Bunions are due to a change in the joint at the base of the big toe which angles outwards. This causes rubbing of the skin against the shoe and soreness develops often with a callous developing. Big toe straighteners can be obtained from large chemists and podiatrists which may help to correct bunions at their early stages. Homeopathic treatment also seems to have an impact. Surgical treatment involves remodeling the joint so that the toe is straightened, and although not pleasant, is an effective way of correcting the bunion.

Spots on back and shoulders

Q . I don't have too much of a problem with acne/spots as a general rule but the exception to this is my back, especially round my shoulders. Sweat seems to be a bit provacative and I am pretty sure that alcohol consumtion doesn't help either. However, it is quite a painful condition and there doesn't seem to be much I can do to cure the problem. I have had them as a significant problem for about 18 months now, although am yet to see my doctor. This will be my next step as I always assumed that the problem would eventually go away or that I could sort it myself. Not so.

Looking around your site it seems as though there is little that can be recommended for skin conditions such as this and I am not too keen to start a course of antibiotics. Therefore, assuming there is nothing you can add to what is already on the site then I guess my question really is why I should be having a particular problem with my back rather than anywhere else?

Thanks.

A. People develop acne at certain sites because of the activity of the sebaceous glands (oil producing galns) at those sites. Some people have most active glands on the face and only get spots on the face. Others have highest activity on the back or chest or upper arms and get spots there. You can get spots anywhere from the head to the ankles if your glands are active enough. With age the distribution of acne changes with the activity of the glands, often shifting from the face to the neck and then onto the back and chest.

Sweating can aggravate acne, particularly if it is retained against the skin in tight fitting clothes. If you look at how acne develops, the first change is the development of a partial blockage in the skin pore (the pore allows oil to drain onto the surface of the skin). This blockage is cause by a change of growth of skin cells. With time the microscopic blockage develops into blackheads and whiteheads and when the blockage seals the pore, oil cannot escape and pools under the skin where it becomes inflammed and infected leading to pusy spots. If you sweat and particularly if sweat is retained against the skin, water from the sweat can get into the pore and swells the blockage up, causing acute complete blockage of the pore and allows the pusy spots to develop. On the back, spots are often deep in the skin, which is why they are so painful and why they often leave scarring.

You are doing all the wrong things! Acne is a disease, just like arthritis or hypertension, that needs to be properly treated. If it is not treated it will persist - my oldest male patient with acne is 76. Your acne is obviously too severe to respond to over the counter medicines and you really need to see your doctor for some proper treatment. This should include a gel containing vitamin A to unblock the pores and an antibiotic to suppress the infection and inflammation.

Small bumps

Q . I have recently (last 2-3 months) developed a number of small bumps on my lower abdomen and also one (the largest at a couple of mm and also the first to appear) at the base of my penis. At first I thought they were spots but they have persisted. They do not itch, are not inflamed but are preventing me from pursuing sexual relationships due to potential embarassment. I am concerned as to what these are (pimples/warts/???) and am desperate to rid myself of them. Please help!

A. Without actually seeing them it is very difficult to be sure, but I can reassure you that they are almost certainly nothing horrible. The first thing that comes to mind is a wart although they are fairly obvious with their rough head. They can be removed with wart remover from your pharmacist.

If they are on your penis you should attend a GUM. It could also be a case of molluscum contagiosum which is a harmless growth looking rather like a volcano. They will disappear on their own but can be encouraged to do so by your GP. Perhaps you would like to give a better description so I can give you a better idea of what you might have.

Blisters under armpit

Q . In the last few weeks, I have been plagued by small blisters under one of my armpits. I initially thought it was a reaction to deodorant or bodywash I was using. At first they appeared under both armpits now is only one. I have discontinued use of deoderants and other washes for the last 3 weeks but the blisters are still appearing under one armpit. Any ideas what could be causing it?

A. It is difficult to be precise about the diagnosis. It is certainly not your deodorant, as irritant reaction will settle within a few days and even allergic reactions will clear within a week of avoiding the substance. You did not say whether the blisters were itchy or not, nor how old you are. If the blisters are itchy, it is probably a form of eczema and this could be due to an allergic reaction to clothing or something in the clothing such as detergent. The armpit is a common site for such reactions, as the dye or detergent needs to be leached out of the clothing, ie by sweat, before the skin can react to it.

If it is not itching, there a a number of skin conditions that can look like blisters, but are not. Molluscum contagiosum - a form of wart - is one such disease that is often descibed by the sufferer as blistering, but in fact the spots are solid. In older people, ie over 60 years of age, a number of conditions can cause blistering on different parts of the body. Bullous pemphigoid is one such disease which can be localised and may or may not be itchy.

Bright red mark on baby's skin

Q . My baby aged 2 months has developed a bright red mark on his skin. This has got bigger over the last four weeks. What should be done about it?

A. This is a haemangioma and is sometimes called a strawberry naevus. It consists of a mass of small blood vessels and the reason why these birth marks (haemangioma) occur is not known. They often grow over the first 4-6 months of life and then they gradually recede usually over the next two or three years. When they are disappearing they often become white in the centre. Usually they go of their own accord and it is not wise to attempt to remove strawberry naevi by operation as this may result in unsightly scarring and may technically be very difficult because of all the blood vessels present. Very occasionally they can become ulcerated and infected.

Antibiotics and dressings may be needed in this situation. Rarely they occur on the eyelid and interfere with sight. In these rare instances treatment is needed, which would probably now be by laser.

The most appropriate management is to observe the strawberry naevus over a period of time to see that it is disappearing. This nearly always happens. If there is bleeding from a knock to the strawberry naevus then gentle pressure with a damp flannel should be applied for ten minutes and the bleeding nearly always stops.

Spot on end of nose

Q . I have had a small red spot on the end of my nose around 1mm radius for the last six months. It does not grow or lose any fluid, but it will not go away. Should I be concerned at all?

A. You are correct to want to know what it is, but you should not be desperately concerned. It is unlikely to be a 'spot' as it has lasted too long. Depending on your age and your occupation it could be a very slow growing tumour called a rodent ulcer. These growths are seen most on areas of the face and head which are exposed most to the sun. The nose, forehead and ear tips.

Thankfully, they can be removed without disfiguration. At six months the growth will be very small and can be removed with very little scarring. You most certainly will not lose the end of your nose, a common unfounded fear. See your GP for referral to the dermatologist. They will take it away as an outpatient with the minimum of pain or discomfort. Check the rest of your head for any more and remain vigilant although not obsessed, as they can appear again elsewhere.

Athletes foot and toenail fungus

Q . For many years I have suffered from athletes foot. During the last 4 years I have also suffered from fungi under the toenails. My nails are so thick and unsightly to look at, I dare not go on the beach when we go away due to the look of my feet. I have tried several paints that you paint on the nail, but after 12 months these are not working, because the problem is under the nail not above hence the paint can't get to it.

I have been told there is a tablet you can take to help with this. I've been to my GP and he told me this wasn't a problem that would threaten my life and told me to go away, which I was disgusted with. So please can you help?

A. What you have is a specific fungal infection of the skin and nails caused by a dermatophytic fungus, probably Trichophyton rubrum. Nail paints can help but they rarely irradicate the problem.

The best treatment is with an antifungal tablet called terbinafine or Lamasil. The antifungal agent kills the fungus but it is still retained in the nail and the nail will still look abnormal for up to 2 years - i.e. until the old nail totally grows out. The tablet is only available on prescription, so it does mean going back to your GP and requesting the tablet. You will need to take it for 3 months in total to kill all the fungus. It is generally well tolerated, but occasional patients do complian of nausea when they take it.

Innocent cyst?

Q . I have a small hard lump on my shin. It's been there for a couple of years now. I wasn't worried about it, thinking it was just a cyst, but a colleague has been winding me up telling me about someone he knew dying from cancer from something that started out just as inoccuous.

Is it anything to worry about?

A. Nice to have understanding friends isn't it? Most lumps on shins come from trauma earlier in life. If it is soft and round it could be a lipoma, a collection of fat which is quite harmless and easily removed. It is unlikely to be an infection of the bone although some types of infection can remain for very long periods of time. They are often tender and painful. If it is hard, and you can't get your fingers between it and the shin bone, it could be a benign tumour which is very common and not lethal. It grows very slowly and the shin is a common site. The good news is that it is often relatively easy to surgically remove. You do need to have it checked out by your, GP so maybe you do owe your mate a pint, or at least a half anyway.

Acne - treatment recommendations please

Q . I am 23 years old and have suffered for the last 6 years from acne, which varies on an almost daily basis from being mild (i.e. just red, dry skin on my face) to severe (whiteheads and cysts on my face and neck). I have tried nearly all over-the-counter products, including benzyl peroxide and salycic acid, and have now been on oral antibiotics for over 1 year. I am worried about the effects of this medication on my liver, and also feel emotionally inhibited by this disfiguring condition. Can you recommend any other treatments, including natural products, and give me some advice about safety of long-term antibiotic use?

A. Acne is a common condition affecting up to 90% of adolescents but persisting into adult life in about 30% of men. The incidence of acne falls with age but at 40 years of age, 2% of men still have significant acne. When you develop acne, three major changes occur in the skin: oil production is increased, blockages form in the skin pores, due to a change of growth of skin cells, which restricts oil flow onto the surface and with pooling of oil deep in the skin, the oil becomes inflammed and infected. The blockages develop into blackheads and whiteheads while the inflammation leads to red and then pussy spots.

To treat acne effectively, you need to unblock the pores, using a cream or gel containing a vitamin A like drug, and treat the inflammation with antibiotics. People's response to antibiotics also varies and if you have not achieved about 50% improvement in the first 2 month of treatment the treatment needs to be modifed and upgraded. There are a lot of antibiotics that you can try including tetracycline, erythromycin, minocycline, doxycycline, lymecycline and trimethoprim. Some people respond to one better than others. It is important to follow the instructions on how to take the antibiotics carefully.

There does seem to be some concern about the safety of antibiotics taken long term, most of which is unfounded. Some antibiotics, in some people can affect the liver, but this is very obvious to the person as they feel unwell and become intolerant to fat and alcohol. This is rare and in the many thousand patients I have treated over the years, I have not seen a patient who developed liver problems. Obviously, if you feel unwell when taking the antibiotics you should see your GP.

Remember, you need to unblock the pores while on the antibiotics and should be using Differin gel, Isotrex gel, Isotrexin gel or Retin A cream or gel.

Apologies to the person who asked this question, but you didn't receive a personal reply as your email address was incorrect.

Excessive itchiness

Q . I have been experiencing excessive itchiness around my chest and upper back, sometimes it is hard to locate the source for where to scratch. There are also a few blotchy spots (never had these b4) appearing which are very painful if I squeeze them.

I have been pushing myself at the gym a little more recently - is this the cause?

A. You describe common spots or boils which are very common in this area of the body. They can be related to hormone changes as in teenagers and acne. They have little to do with 'the right soap' - indeed too vigorous cleaning will encourage them as you remove the body's natural bacterial defence. They can be treated topically with over-the-counter preparations, but avoid cleaning agents containing alcohol. Your GP can prescribe antibiotics which will also clear them up. Stress and overwork can be a link as can undiagnosed diabetes. It is easy to test for both by reducing your stress level and testing your blood sugars at the GP surgery. If you are tempted to use anabolic steroids - beware - as they can also cause spots and boils but also - worse, much worse, not least - liver failure.

Growths under armpits

Q . Under my armpits I have little growths of skin. They're the same colour as the rest of my skin and they don't hurt at all but I seem to be getting more and more of them. I've had one or two for years (since I was a teen) but now there's quite a few more.

If I had to describe what they look like, they kind of look like a deflated mole. I would think if they were something urgent I would feel pain or there would be some discoloration but other than their actually being there they seem normal.

Any guesses?

A. What you have are skin tags, medically termed squamous papillomas. They are commonest in the armpits, around the neck and in the groins, although they may occur anywhere on the body. They represent bits of redundant skin and thus are completely harmless. They tend to run in families and are more common as you get older. You can get them from early teens, but most people get them from mid-thirties onwards. They are easily delt with by using a local anaesthetic and then burning them off with a hot needle.

Spots/warts on testes

Q . Please can you help. I have spots/warts on my testes and underneath my penis. There are many very small little white spots - they do not hurt but cause me great concern with relationships with girls etc. Can you suggest what they are and a possible solution to my problem? I have had them for several years but like I say do not cause any pain.

A. These could be one of two things:

1. Fordyce spots which occur on the shaft of the penis, around the edge of the crown of the penis and on the scrotum. These represent ectopic glands in the skin which are usually associated with hairs. On the shaft of the

penis and the crown of the penis, you do not have any hairs, but occasionally the glands persist looking like small millet grains under the skin. On the scrotum, most men have some hair but there may be more glands than hairs. These seem to come up out of the blue but once you have noticed them they do not increase in number. They are very common and most men have some so girls will not be at all phased by them.

2. Plain warts - these are due to a virus called human papilloma virus and thus spread and can cover the scrotum, penis and the upper thighs. They are usually flat and soft and can increase up to 1 cm in diameter.

On balance, I think you have Fordyce spots, but the only way to be sure is to see your doctor. If these are what you have there is no treatment for them. If they are warts, these need to be treated as you can pass them on to sexual partners - treatment is either with special paints that are applied to the warts or freezing treatment.

Spots and boils

Q . I have spots/boils that appear on my neck and face, these are similar to teenage spots. I have always had them. They seem to get worse evry three or four weeks and then clear up. My skin is not unduly greasy and is kept clean. The spots seem to comoe from deep within rather than from clogged pores. Any suggestions?

A. If I had a penny for every spot that afflicts men I would be able to bale out the Dome - again. There is such mystery and myth surrounding spots it can be difficult to tell the truth. Teenage spots (acne vulgaris) are just one end of a spotty spectrum enhanced by hormonal changes. In fact, spots appear and disappear on a regular basis but most of the time they don't cause too much annoyance. What you describe is classical for these spots and may be related to the shaving area. Men with beards complain less about spots but then they are hidden underneath all that fungus.

Chocolate, masturbation and bad thoughts about the girl next door do not cause spots. Just as well or there would be standing room only for them on most men's chins. They are simply infected blocked skin pores or follicles. Once the natural sebum stops normal function the follicle quickly becomes infected causing the swelling and redness. Avoid strong soaps. Never use a spot squeezer (they can scar). The over-the-counter lotions do help but avoid the alcohol-based cleansing pads and solutions. If the spots are very bad, your GP can prescribe a course of tetracycline which will help. You describe a cyclical nature to your spots. It would be worth keeping a diary of food, activity and sleep to see if there is any connection and therefore things possibly to avoid which may be acting as a trigger. For most people there is no such link and it is a matter of waiting. If the spots are very nasty with a lot of pus you should check with your practice nurse to make sure you are not diabetic.

Fungal toe nail

Q . I think I have a fungal toe nail infection. What should I do? Are there any over the counter products I can use or should a visit to the doctor be in order?

A. Fungal infections of the toe nails are both common and destructive. The nail becomes discoloured with a yellow waxy appearance and can elongate like a horn. Alternatively it can lift away from the nail bed causing great pain. It is caused by a fungus similar to that which causes ringworm and is infectious, although poor foot care can make it worse.

People with diabetes should be very careful about these infections as they can damage the toes very badly.

Thankfully there are treatments, although they take some time to act. The older preparations could take up to six months to clear the infection but newer drugs - such as terbinafine - half the time. There is little point in using topical preparations as they are of greater benefit for skin not nail infections. See your GP or ask your pharmacist for advice.

Itchy bottom

Q . I have been suffering for a few months with terrible itching between the cheeks of my bottom & around the anus.

It seems to be worse at night & it often wakes me up.I'm sure its not worms as there are no signs of worms after I have been to the toilet. In addition to the itching , the skin between the cheeks is very sore , especially upon washing & also on wiping after having been to the toilet.

I have tried creams such as savlon, sudocrem, eurax & lanacane to no avail.

Is it possible it could be eczema?

I would be grateful for any suggestions to help. Thank you

A. Proctitis really is a pain in the bum and can be caused by a large number of things. First, remember that very serious conditions of the bowel don't show themselves as an itchy anus, so relax. Yes, you checked for worms, but are you aware they are very small (1mm) and usually brown rather than white until they hit the water? If the itch is much worse at night it might be worth checking again.

Diabetes can cause proctitis through fungal infections or yeast infection such as Candida. Get your blood sugars checked if you are thirsty all the time, losing weight, (or are very overweight) have diabetes in the family, or are tired all the time.

Too much alcohol will also cause it as will eating a chilli on a regular basis, but then so will haemorrhoids. They don't have to appear outside of the anus to cause irritation so check it out with your GP.

Small cracks or tears in the anal ring also cause intense itching and sometimes pain. Increasing fibre in your diet can help but, as it is not easy to see your own backside, nip down to your GP.

After all this the commonest cause is using too many creams and soaps. Lay off them for a while and see what happens. Avoid local anaesthetics like the plague. They are OK for short term use but only make the whole thing worse if used too often. Judicious use of suppositories or creams like Protosedyl can help but should not be used long term.

Finally check out your undies. Use natural fibre rather than nylon.

Scaly scalp

Q . For many months now I have suffered with an itchy scalp, which is scaly in parts causing dust fall out on my shoulders.

I have seen my GP who has prescribed Noverix Shampoo,which I have used without avail. I have also been to see my GP on about 4 times with a skin irriation on my face. He has prescribed Cortisone Creams of different types again unsucessfully.

I would like some help if possible

A. A great deal depends on what is causing the itch. If you have circular red patches on your scalp, which is possibly losing hair, you may have a form of ringworm. This is not as it sounds actually a worm, but rather a fungus and it will respond well to an antifungal shampoo from your pharmacist.

It may be a form of eczema and your scratching is producing a secondary infection which makes the itch even worse. Before using any of the powerful shampoos just try rubbing your scalp with olive oil. Leave overnight then wash off in the morning. You can do this for a few days. If this doesn't work then by all means try the shampoos available from your pharmacist.

Nits are very common and are often overlooked as a cause of itchiness. Buy a fine steel comb and check. There is an epidemic of them at present. You can get rid of them by repeatedly using a hair conditioner followed by fine combing while wet. There are chemicals but they are losing their potency and need to be used repeatedly which may be harmful in the long term.

The marks on your face are impossible to comment on without seeing them. The overuse of steroid creams can cause skin thinning so it would be best to get a definitive diagnosis from a dermatologist. Your GP can refer you. It is unlikely to be psoriasis as it usually spares the face, but if you have any silvery scale plaques on your elbows or knees, you may have a mild form of the condition which would explain your scalp condition.

Two rashes

Q . Approximatelty 6 weeks ago I developed two rashes. The first appeared on the inside at the top of my thighs. This looked fungal and I was prescribed an anti fungal cream. This initially died down but after 2 weeks the rash came back and I was then prescribed Diflucan. Although the rash appears to have died down I still suffer from extreme itchyness.

The second rash appeared on my upper arms and is extremely itchy. This does not look fungally, instead it is very raised, pimperly and red. A hydroquartezone cream was prescribed but this has not made any difference whatsoever. I am very hesitent when using creams as I scared my inner arms using dermavate when I was a teenager. I have a tendancy to exzema and hayfever. I have not changed my diet or washing powder in the last 6 months. Where can I go from here?

A. The rash in your groins could be a bacterial infection called erythrasma or could be your eczema - the anti-fungal creams tend to have an anti-inflammatory effect and can reduce the inflammation caused by skin problems other than fungal infections, but this would only last a short period of time before the inflammation flared up again.

The rash on your arms sounds like keratosis pilaris, which is a condition often linked with hayfever and atopic eczema. Atopic eczema is the type of eczema that is associated with asthma and hayfever and although commonest in infants and children, can persist to adult life or can re-activate after it has resolved in childhood. Keratosis pilaris often occurs on the upper arms with the skin feeling very rough and covered with little bumps associated with the hair follicles of the skin. This will occasionally become inflammed and red and the bumps may develop into pussy spots. To treat this you need lots of moisturisers - a particularly good one in this condition is called Aquadrate as it containes urea which reduces the bumps. If the skin is inflammed and you have been scratching it, you need a steroid cream with an antibiotic with it. The moderate steroid creams are very safe for short term use even if you have damaged your skin in the past with potent steroid creams. A cream such as Eumovate with the addition of Fucidin cream would be the correct sort of level.

Dry skin on scrotum

Q . I continually suffer with very dry skin on my scrotum. It is on the lower area towards the rectum.

It is fairly uncomfortable and at times itchy. I tend to scratch when unaware especially when asleep. This results in small cuts and scabs.

I've tried using germolene and similar creams to no avail.

Any suggestions on a treatment. I'm a bit too shy to go to my doctor with this problem.

A. The scrotum is a very sensitive area of the body and often acts as the focus for a number of skin conditions. This area may become affected without other areas of skin showing the same problem. From your description, you could have eczema or psoriasis. It is unlikely to be any sort of infection although this area often becomes secondarily contaminated with bacteria or yeasts. The skin of the scrotum is also very sensitive and if you scratch it for any length of time, it often thickens or becomes more sensitive and even more itchy, so you scratch more. This leads to a vicious cycle of itch and scratch which you need to break.

As the area is dry, avoid soap when you are washing the area and instead use aqueous cream, which cleans but does not dry the skin. If you do not want to visit you doctor for a prescription, you could try buying canestanHC cream from the chemist and using this twice daily. If this does not work, you probably need something stronger and you can only get this on prescription, so it means seeing your doctor.