Dear doctor

Scar tissue

Q A few years ago I had a nasty cyst removed from my chest - just above where my cleavage would start, if I had one. The small operation to cut out the cyst went well but I was left with a horrible heaped up scar which my GP said is called keloid. I've been told that any treatment to remove it may result in worse scarring. Is there really nothing to be done?

A Keloid is an inherited tendency to overhealing of cuts. When wounds heal you produce too much fibrous tissue, causing raised scars that can itch or be uncomfortable. Treatments include injecting steroid into the scar, laser, pressure, or freezing with liquid nitrogen. None is guaranteed to work and nearly half of the scars will recur.

There are great hopes for a newer treatment using sheets of silicone gel (Cics-Care), which is like sticky-back plastic as featured on Blue Peter in the late 60s and can be bought over the counter. It probably works by sealing moisture into the scar, which makes it flatter and softer. Cut the self-adhesive sheet to fit the scar. Stick it on and leave for four hours a day, building up to 24 hours as soon as you can. Each piece can be left on for up to a month, though it should be cleaned twice a day. Continue treatment for two to four months.

For further advice contact the Scar Information Service (0845 120 0022).

Eczema distress

Q I've developed the most irritating dermatitis on my hands. They're so dry, red and itchy that I'm constantly clawing away at them and they have developed weeping blisters on their backs that my GP said was infection from all the scratching. That calmed down with antibiotics but my hands are still so painful sometimes that I can hardly hold a cup. I use a strong steroid cream (Betnovate) but it doesn't seem to help any more. Any ideas?

A Dermatitis (or eczema - two different words for the same thing) is dry, irritated, itchy skin. When confined to the hands, it's almost always because you're in contact with something that your skin is sensitive to.

Common culprits are water, chemicals and rubber. I had one patient who developed awful skin rashes on his hands when he switched jobs to work as a technician in a hospital medical unit. Allergy testing (injecting tiny amounts of substances just under his skin, then noting the reaction) showed he was allergic to a cleansing solution used for the medical instruments. Wearing rubber gloves didn't help - he was allergic to rubber too. PVC gloves helped a bit, but ultimately he moved to a different
department and his hands healed. Try avoiding water and corrosive chemicals, and wear PVC not rubber gloves. But if it persists, why not ask to be referred for allergy testing?

Does he need more iron?

Q My toddler's a poor eater and never eats meat. Does he need iron supplements?

A If your son has lots of energy, seems well and looks around the same size as other kids his age, he's probably getting enough iron. Only a blood test will confirm whether or not he lacks iron and it may be worth requesting if you're concerned about his growth or development.

Your health visitor can give specific advice about iron-rich foods - red meat's got lots but broccoli and dried apricots have some too and may be more acceptable to him. Avoid tea with meals as it binds to iron and prevents its absorption. Giving iron supplements to non-deficient children is potentially harmful and can slow their growth. Drops containing vitamins A, C and D for children aged one to five are a good idea while he's faddy with food. Vitamin C will help him absorb more iron from Hula Hoops and Ribena while you keep plugging the meat and two veg.

Will I get my hair back?

Q I had a bad nervous breakdown last year from which I've made a slow but steady recovery. Though I'm only 37, my hair went from thick dark brown with a few grey hairs, to sparse white hair like an old man. Will it ever return to its former colour and texture?

A It's great to hear that you've made such a good recovery. Any severe stress, physical or mental, can make your hair fall out. Coloured hairs, like your brown ones, are shed first whereas the white hairs are sturdier and less likely to fall out. So, seemingly overnight, your hair goes from looking predominantly brown, to white. The good news is that hair often grows again and with any luck it will be brown not white.

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