Dear doctor

Eczema fears for baby
Q: My first child had severe eczema as a baby though thankfully her skin is now smooth and lovely. I'm pregnant again now and desperately want to do everything I can to prevent my next baby having the same problem. What do you advise?

A: As you discovered, most babies do grow out of their eczema in time. But you are right to be concerned because there is an inherited tendency and your next baby is more likely, though not certain, to have the same problem.

There is some evidence to show that if you breastfeed the baby for five months without introducing any formula or solids, the chance of eczema is reduced. Keeping house dust mites at bay in your home may also help: special bed covers over the mattresses and stripping out the carpets where you can are the most practical measures. Some women cut out eggs and cows' milk from their diet while pregnant but there's no evidence that it makes any difference.

Should I restart the pill?
Q: I am a 35-year-old woman with no children. Up to five years ago I took the pill regularly but stopped due to migraines. I now find I am getting period pains for a few days before each period. I would not describe them as severe but they do wake me up at night. My periods used to last two to four days and they still last the same but they are heavier with lots of clots on the first day or two. Should I try the pill again?

AI can see why you might want to restart the pill - it will make your periods regular, lighter and less painful. Most migraine sufferers can actually safely take the combined pill, though doctors often give conflicting advice. The women who must avoid the combined pill are those who get migraine with an aura. This fairly rare phenomenon causes visual disturbances just before the headache starts, such as loss of half of the visual field or zig-zag shapes that move across your visual field and seem to grow. The worry is that women who get migraine with an aura may be more at risk of strokes and taking the pill will increase that risk.

The other groups of women who are at increased risk of having a stroke while on the combined pill, are heavy smokers, obese women and those with a family history of strokes and heart attacks under the age of 45. You may feel that even without an increased risk of stroke, you'd rather try a different method of contraception. Your options would include the mini-pill (progestogen only) which may alleviate the period pains or a cap or coil if you want a non-hormonal alternative, though they won't help period pains and the coil may make them worse. Migraine Action Association: 01932 352 468.

Itchy bottom torment
Q: I have had an itch around my backside for a number of years. My GP (and numerous locums) has prescribed pills and creams but the itch returns once I stop using them. The GP did a test and found bacteria but another GP said this was not significant as these would normally be present. I am not keen on using creams as I believe they can damage the skin; at one point I was bleeding heavily (not from inside). I know it sounds a minor problem but it affects my sleep which, after a number of years, becomes depressing.

A: You'd be amazed how many people are tormented by an itchy bottom. Young kids and their carers have usually picked up threadworm - small white devils that come out at night. The traditional method of detecting was to stick a piece of sellotape over your anus while sleeping and peel off in the morning to reveal the trapped culprits. More practical advice is to take a dose of anti-threadworm medication (eg Vermox) and dose the whole family. The second major cause is piles: varicose veins of the back passage that itch, bleed on wiping your bottom and sometimes protrude from the back passage so you can feel them.

Anusol cream and Xyloproct suppositories or similar preparations help, but you need to get them checked before assuming that bleeding is due to piles. Thrush is a third cause of itchy bottoms. The fungus thrives in hot wet places like our groins and bottoms.

Keeping the area dry, wearing loose cotton underwear to let air circulate and using Canesten cream will all help. General measures to reduce the itching are to avoid washing more than once a day, use extra soft toilet paper and try some hydrocortisone cream with zinc cream on top to allow the skin to heal.

• These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.

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