DR ELLIE: Unusual reasons for an intimate itch

I’ve had a genital itch for years. I take prescription drugs which have itchiness listed as a side effect, but I can’t understand why it would be confined to just down there. My GP says there’s no rash. What can I do?

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

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

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

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

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

There is the possibility that the menopause could be to blame. During the menopause, the body produces less oestrogen which can leave the vulva itchy and dry. A simple emollient may help, not only to moisturise the area but as a soap substitute, as normal soap can irritate sensitive skin.

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

Nerves 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 stemming from back problems or a slipped disc to trigger itching elsewhere.

Some hospitals have a vulva specialist in their gynaecology or dermatology departments who can carry out an examination to see if a GP has missed an underlying cause of any itching. Even if a cause is not found, anti-itching treatments such as hydroxyzine may 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 jumps from as high as 160 to as low as 65. Sometimes in the morning I find my head spinning and I get out of breathe climbing stairs. Should I be worried?

Dr Ellie replies: It's normal for the speed at which the heart pumps to change throughout the day.

When you are exercising it will increase and during sleep it will decrease. The normal range while not exercising is between 60 and 100 beats per minute (BPM). For some, this can fall even lower during sleep.

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

A GP can carry out a heart test called an electrocardiogram (ECG) which can spot issues. Patients may also need to wear a monitor for 48 hours which looks at how the heart functions over an extended period.

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

Anyone worried about their heart health should speak to 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’s been prescribed an ointment called chloramphenicol but it doesn’t clear the problem completely. Is there a treatment that would be better for her?  

Dr Ellie replies: Chloramphenicol is an antibiotic used to treat bacterial eye infection, also known as conjunctivitis. It comes as eyedrops which can be bought over-the-counter or stronger ointment, which must be prescribed.

Pink-rimmed eyes on both sides is 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’s usually caused by a build-up of the oil produced by eyelashes.

People suffering with blepharitis often experience pink and weepy eyes, which can get sore, itchy and crusty, especially in the mornings.

Chloramphenicol may help calm the symptoms, but it can’t cure it. A better option is regular and thorough cleaning of the eyelids – known as lid hygiene. This involves massaging the eyelids with baby shampoo diluted in warm water to remove crusting and allow the oils to drain away properly. It may be easier to use blepharitis-specific cleaning wipes which can be bought from a pharmacy.

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

Rise in rickets a national scandal  

You may have read about the rise of ‘Victorian’ illnesses such as scurvy and rickets among UK children – a national disgrace.

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

Rickets is due to a lack of Vitamin D, gained through sunlight, oily fish and foods fortified with the vitamin, such as breakfast cereal and milk. It can make children’s bones soften, and cause disabilities.

We’ve nearly eradicated these illnesses but they are on the rise again, the Royal College of General Practioners has found.

This is because parents do not know what a healthy diet is. It’s tragic because there is so much information available.

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

 Has the risk of stroke made you ditch HRT?

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

GPs have been told to inform patients of the dangers, which include a slim rise in the risk of cancer, dementia and stroke. For the longer on HRT, the higher the risk of a life-threatening stroke, where a clot blocks blood supply to the brain. The chances are even greater in patients with underlying cardiovascular problems such as high blood pressure and unusual heart rhythm.

In the UK there is no upper-limit on the length of time women can take HRT and many experts believe doctors should be stricter about telling patients to come off HRT.

I’d like to know what you think. Have you been taking HRT for more than a decade? Have you been informed of the risks but decided to carry on? Write and let me know.

Write to Dr Ellie

Do you have a question for Dr Ellie Cannon? Email DrEllie@mailonsunday.co.uk. Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context.