I have a rash on both hands for which my doctor has prescribed steroid cream and Cetraben, but six months on it’s no better. Can you suggest anything?
James Edwards, Caernarfon Gwynedd.
A scaly, itchy, widespread rash on the hands is often due to eczema, also referred to as dermatitis.
Eczema tends to occur in those with allergies and can be provoked by triggers such as detergents or even stress.
It leaves the skin dry, red, itchy and may crack and feel sore.
While I don’t think it’s advisable to diagnose a skin complaint without seeing you in person, I suspect this is the diagnosis you’ve been given because the doctor has prescribed the standard treatment for eczema: a steroid cream to reduce inflammation and itching, along with Cetraben which hydrates and protects the skin.
Unless your skin is exposed to something that keeps provoking the rash — such as a sensitivity to washing-up liquid or cleaning detergents, for example — this treatment should clear the symptoms.
Eczema tends to occur in those with allergies and can be provoked by triggers such as detergents or even stress. It leaves the skin dry, red, itchy and may crack and feel sore
The fact that your symptoms are not improving with this treatment makes me wonder if it might be psoriasis instead. This is an autoimmune condition that causes the over-production of skin cells, resulting in patches of scaly itchy skin.
It’s caused by a combination of genetic and environmental factors.
Psoriasis can be almost indistinguishable from eczema, but it usually requires more potent steroids such as Clobetasol.
However, these stronger steroids have significant side-effects, such as burning or stinging of the skin, and should be used sparingly and for the minimum possible time.
If this doesn’t help, then calcipotriene, a synthetic form of vitamin D that comes as an ointment, may be effective. It halts the over-production of skin cells, although exactly how is unclear.
This, too, can cause side-effects such as burning skin and sensitivity in the sun.
My advice is to discuss your symptoms with your GP once more; a referral to a dermatologist may be necessary.
I have had high levels of ferritin in my blood since 2002 (currently my level is 569). Should my doctor be considering bloodletting to reduce this level?
Steve Poole, Bournemouth.
Firstly, for the benefit of other readers, a quick explanation of the science.
Ferritin is the protein that holds onto iron in the blood. Iron is a vital component of many systems in the body but it’s particularly important in haemoglobin, the pigment in red blood cells that carries oxygen around the body.
Ferritin levels are measured by a simple blood test.
Iron comes from the food that we eat, but some people absorb excessive amounts due to factors such as obesity (inflammation triggered by obesity disturbs the balance of the hormone hepcidin, that regulates iron).
High levels of iron can be harmful as the excess can react with other chemicals in the body, causing widespread tissue damage and inflammation. This can lead to damage of the liver, heart and pancreas and in turn, type 2 diabetes (which you say in your longer letter you were diagnosed with in 2014).
However, I think it is unlikely your diabetes diagnosis is linked to high iron levels, as widespread tissue damage only begins when ferritin levels are 600 to 900ng/ml.
As your ferritin levels have been raised for so long (anything above 300ng/ml is considered abnormal), it suggests you may have the genetic condition haemochromatosis, where iron slowly builds up in the body over many years.
Ferritin levels are measured by a simple blood test. Iron comes from the food that we eat, but some people absorb excessive amounts due to factors such as obesity (inflammation triggered by obesity disturbs the balance of the hormone hepcidin, that regulates iron)
The treatment for raised ferritin levels is venesection — taking a unit of blood (500ml) periodically to deplete the body of excess iron.
This is offered to patients when their ferritin levels reach 500ng/ml.
Venesection may stop further damage to the pancreas and other organs though it is unlikely to remedy the damage that has already been done.
I assume that your ferritin levels have been below this threshold in the past, otherwise you would have been offered regular venesection.
However, now your ferritin levels are at the stage when venesection will be considered.
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Replies should be taken in a general context and always consult your own GP with any health worries.
In my view… A 20-minute brisk daily walk could boost longevity
As regular readers will know, I am a great enthusiast for the UK Biobank study — and now its latest findings offer even more insight into what really supports prolonged good health.
The Biobank study, to remind you, is monitoring more than 500,000 people (one of them being my wife) in order to understand many aspects of our health, contributing not only to longevity but also to cost savings in healthcare.
New data from the study, published in the British Journal of Sports Medicine, confirms that people who participate in high levels of exercise and have better diets had the lowest risk of death during the 11 years of the study.
OK, so that’s not the most surprising finding, but it’s another warning to those who like to trot out stories about acquaintances who exceeded their life expectancy despite avoiding all fruit and veg and walking no further than to their car on the drive, as a way of suggesting that this can lead to a healthy old age.
This new finding underlines the fact that in most cases it will not.
In fact, it should be a warning to us all to cast an eye on our diets and take some daily exercise — preferably something that raises the heart rate, even if only for 20 minutes daily.
Nobody in any age group, medical problems notwithstanding, can fail to find a suitable activity. I’ve just taken up a fast ‘daily mile’ come rain or shine. My advice? Just do it.
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