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. 

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

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

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

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]

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]

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]

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Tips to Find Low Priced Luxury Holiday Package Deals Fast

For most families, it has already been a common practice to spend the Holiday season in a foreign location. This is caused by the aviation market changes which have given a lot of benefits for people who travel a lot. Airfares going to different tourist destinations are becoming more inexpensive. What does this mean? If there is a perfect time to purchase luxury holiday package deals, now it the right time! Based on the market trend nowadays, you can save both money and time when you go for a luxury holiday. There are countless offers that combine travel and accommodation in one package which is a lot cheaper than getting separate deals. Aside from that, it is also risky to individually book the services that you need for the vacation. You might end up missing out on some important details of the trip. Unlike when you take advantage of luxury holiday package deals, you can be sure that everything is organized meticulously and according to what you really need. Nonetheless, you would still need to carefully select the package that would fit your needs. Review the following tips in getting packages that are reasonably priced. · Normally, luxury tour packages include accommodation, flight travel and transportation to individual tourist destinations. It would be best to choose the complete package so you won’t have to worry about other vacation elements. In addition to that, these are the packages that have the biggest discounts. · You can get big mark down prices, if you will purchase more packages. It is not a bad idea to share the wonderful moment with your loved ones. By doing so, you would not only enjoy, you will also save more money. You can even use your savings for other activities on your vacation. · It would be best to know how much you are willing to pay for the luxury tour packages. You can already work around your budget. You have to stick to your budget. If not, you might end up spending a lot and you will be left with less money for your vacation. · Prices may vary depending on the destination of the tour. You can do a research about places that are attractive yet inexpensive. There are thousands of destinations and you just have to choose wisely. · There are packages that include recreational activities. This means that you are paying for all the activities when you purchase these packages. The right thing to do is to make sure that the activities that are included would be the ones that you really enjoy. There is no sense in paying for activities that will not really make your vacation memorable. If you are going with friends, you should also consider their preferences so that you can be sure that everyone will enjoy the trip. There are other ways on how you can be sure that you are getting the best deal for your luxury holiday vacation. No matter how you choose to do it, you have to get adequate information about the packages. This will help you determine whether it is worth the price.

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