Why do my red spots keep coming back? DR MARTIN SCURR answers your health questions

I constantly get red spots on my nose, which are very tender. No sooner do they calm down than they return in the same area. My doctor prescribed Rozex gel but it hardly makes any difference. I’m 75 and otherwise healthy.

Patricia Harris, via email.

This is most likely to be a form of rosacea, a disorder that commonly affects those aged 30 or over.

It is the result of changes in the immune response in the skin, which reacts to microorganisms that can live there, such as Bacillus olenorium and a microscopic mite called Demodex folliculorum. This triggers inflammation and spots.

Your doctor prescribed Rozex gel, a medication containing the antibacterial agent metronidazole. 

This can treat the inflamed spots or ‘papules’ — as can the naturally occurring azelaic acid, which has antibacterial properties.

If these don’t work, antibiotics can help suppress the Bacillus olenorium, though they won’t deal with the Demodex mite. 

They could also tackle another potential cause, the bacterium Helicobacter pylori, which tends to be found in the stomach lining. 

When patients are treated with antibiotics for a Helicobacter pylori infection, rosacea has been found to improve, although there is conflicting evidence about the benefits of antibiotics in this case.

This is the result of changes in the immune response in the skin, which reacts to microorganisms that can live there, such as Bacillus olenorium and a microscopic mite called Demodex folliculorum (pictured above)

Other organisms that may play a role include Staphylococcus epidermidis, commonly found on the skin, and Chlamydia pneumoniae, a type of bacteria you can catch.

Typically tetracycline antibiotic tablets are prescribed. These can be rapidly effective, but have to be continued long term. 

The benefits must be weighed against potential adverse effects on your gut microbiome (a colony of bacteria that is important for health) and the possible development of antibiotic-resistant bacteria.

As an alternative to antibiotics, it may be worth considering ivermectin cream, which is anti-inflammatory and also kills the Demodex mite. 

There are high-quality trials confirming its effectiveness, and I would suggest discussing it with your doctor.

I am diabetic and have a problem with an overactive bladder, sometimes going four times a night. Could my medicines be causing it? I am 80.

Colin Tidbury, Reading.

This is an extremely common, and often upsetting, symptom in older men. Waking once in the night to empty your bladder is considered normal, but waking twice or more is not.

Known as nocturia, the increasing frequency you describe suggests it’s most likely to be due to benign prostatic hyperplasia (BPH). This is where the prostate grows in size with age.

It can cause symptoms such as increased urinary frequency and urgency — and, in many cases, nocturia — due to the extra tissue obstructing the flow of urine and distorting the bladder’s shape.

Most men develop BPH as they get older — it affects 60 per cent of those aged 60 and 80 per cent at 80. I must stress that it’s not a risk factor for prostate cancer; it occurs in the central zone of the gland, while cancer primarily originates in the peripheral part of the prostate.

In addition to BPH, there are two other causes of nocturia linked to ageing. The first is a drop in the production of vasopressin, a hormone that controls the output of urine from the kidneys. 

Normally vasopressin levels rise in the evening, reducing urine output. But with age, we lose that evening boost. Secondly, as we age our kidneys respond less well to the vasopressin that we do produce.

I suggest you discuss BPH with your GP, who may prescribe an alpha-1 adrenergic receptor antagonist (e.g. tamsulosin or alfuzosin) to take long term. If this is unsuccessful, a drug such as finasteride can reduce nocturia by shrinking the prostate gland.

These treatments can all have side-effects, but most urinary symptoms improve with these options. Unfortunately nocturia seems to benefit the least, but do consult your GP to discuss the possibilities. 

Write to Dr Scurr

Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email: drmartin@dailymail.co.uk — include contact details.

Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context.

Consult your own GP with any health worries.

In my view… Remember to take vitamin D with fat to absorb it better

A subject rarely out of the news has been the debate about whether taking a vitamin D supplement boosts immunity against Covid, and makes it less likely you’ll get symptoms.

What is missing is hard data from a randomised controlled trial (where one group receives the treatment, the other a placebo). 

One such trial is under way, but all research so far has been observational — including two new studies, which failed to confirm that taking vitamin D helps against the virus.

Before the pandemic we knew people with respiratory infections tend to have low vitamin D levels, but whether this is a cause or an effect of the infections remains uncertain.

Until we have the trial results, we should ensure we have a diet rich in natural sources of vitamin D, such as eggs and oily fish, and get some sunshine.

But why not also take a supplement? The NHS advises 10mcg (400 IU) a day, while I favour a once-weekly regimen of 3,000 IU for convenience — taken with fat so it’s properly absorbed. I hope and believe that, when it comes, the data will be on my side.

A subject rarely out of the news has been the debate about whether taking a vitamin D supplement boosts immunity against Covid, and makes it less likely you’ll get symptoms [File photo]