DR. ELLIE: Unusual reasons for intimate itching… and how to get rid of it

I have suffered from genital itching for years. I’m taking prescription medication that lists itching as a side effect, but I don’t understand it why it should be limited to down there. My doctor says there is no rash. What can I do?

Dr. Ellie answers: Itching is a side effect of many common medications, including antibiotics, statins and antidepressants.

Anyone taking prescription drugs and experiencing new symptoms should consider stopping treatment briefly to see if the problem goes away. This must be done under the supervision of a doctor.

However, it is unusual for a symptom such as itching to be confined to only one place.

Another cause may be a skin problem known as dermatitis, but this is usually accompanied by a visible rash. Other less common causes include lichen sclerosus or lichen simplex – both chronic itchy skin conditions caused by changes in the tissue. They are harder to spot, but can be treated with prescription creams.

Nerve problems are known to cause itching, and this can occur in the genitals

Infections can also cause itching, especially thrush. But again, this would usually cause a rash or discharge.

It is possible that menopause is the cause. During menopause, the body produces less estrogen, which causes the vulva to itch and dry out. A simple emollient can help, not only to moisturize the area, but also as a soap substitute, as regular soap can irritate sensitive skin.

A topical estrogen cream can help relieve these symptoms and can be used for a trial period to see if there is any improvement.

Nerve problems are known to cause itching, and this can occur in the genitals. Our nerves control all sensations, including touch, and any damage to them can lead to chronic itching. It is not uncommon for a nerve problem due to back problems or a herniated disc to cause itching elsewhere.

Some hospitals have a vulva specialist in the gynecology or dermatology department who can investigate whether the GP has missed an underlying cause of the itching. Even if no cause is found, anti-itch treatments such as hydroxyzine can help. GPs can also prescribe the antidepressant amitriptyline if the itching affects sleep and quality of life.

After I bought a smartwatch I noticed my heart rate jumping from as high as 160 to as low as 65. Sometimes in the morning I notice my head spinning and feeling out of breath when climbing stairs. Should I be concerned?

Dr. Ellie answers: It is normal for the rate at which the heart pumps to change during the day.

When you exercise it increases and during sleep it decreases. The normal range when not exercising is between 60 and 100 beats per minute (BPM). For some, this may drop even lower during sleep.

However, anyone who regularly has a heart rate above 165 beats per minute while not exercising should consult a doctor. This can be a sign of a number of serious heart conditions, including atrial fibrillation, which causes an irregular heartbeat.

A GP can perform a heart test, called an electrocardiogram (ECG), which can detect problems. Patients may also need to wear a monitor for 48 hours that looks at how the heart is functioning over an extended period of time.

It’s also important to remember that while smartwatches can be useful, they are not medical devices and can be inaccurate.

Anyone concerned about their heart health should contact a GP who can offer a number of tests, including for cholesterol and blood pressure, which are more important indicators of disease than heart rate.

My mother has pink-rimmed eyes. She has been prescribed an ointment called chloramphenicol, but it does not completely solve the problem. Is there a treatment that would be better for her?

Dr. Ellie answers: Chloramphenicol is an antibiotic used to treat bacterial eye infections, also called conjunctivitis. It comes in the form of eye drops that are available without a prescription, or in the form of a stronger ointment, which must be prescribed.

Pink-rimmed eyes on both sides are not a typical infection symptom. Instead, it’s more likely to be an eyelid disease called blepharitis, where the tissue around the eyelash becomes inflamed. It is usually caused by a buildup of the oil produced by the eyelashes.

People suffering from blepharitis often suffer from pink and watery eyes, which can become painful, itchy and crusty, especially in the morning.

Chloramphenicol can help calm symptoms, but it cannot cure them. A better option is regular and thorough cleaning of the eyelids, also called eyelid hygiene. This involves massaging the eyelids with baby shampoo diluted in warm water to remove crusts and allow the oils to drain properly. It may be easier to use special cleaning wipes for blepharitis, which you can buy at a pharmacy.

Anyone who has been prescribed chloramphenicol should ask their doctor why exactly they are taking it. If it is not an infection, it should be stopped eventually as it is not intended for long-term use.

Rise in rickets a national scandal

You may have read about the rise of ‘Victorian’ diseases such as scurvy and rickets among British children – a national shame.

These are caused by poor nutrition. Scurvy is caused by a deficiency of vitamin C, which is found in many fruits and vegetables. It can lead to swollen, bleeding gums, fatigue, muscle pain, and skin that bruises easily.

Rickets is due to a deficiency of vitamin D, obtained from sunlight, oily fish and foods fortified with the vitamin, such as breakfast cereals and milk. It can soften children’s bones and cause disabilities.

We have almost eradicated these diseases, but they are on the rise again, the Royal College of General Practitioners has found.

This is because parents do not know what healthy food is. It’s tragic because there is so much information out there.

The government must do more to educate new parents about child nutrition.

Has the risk of stroke made you give up HRT?

I was interested to read the new NHS guidance on hormone replacement therapy (HRT) for menopause.

GPs have been told to inform patients about the dangers, including a small increase in the risk of cancer, dementia and stroke. The longer you take HRT, the greater the risk of a life-threatening stroke, where a clot blocks blood flow to the brain. The risk is even greater in patients with underlying cardiovascular problems such as high blood pressure and an unusual heart rhythm.

In the UK there is no upper limit on how long women can use HRT and many experts believe doctors should be stricter in telling patients to stop taking HRT.

I’d like to know what you think. Have you been using HRT for more than ten years? Have you been informed of the risks, but do you still decide to proceed? Write and let me know.