Dear doctor

Lesions in the sun

Q: Every summer, when I am exposed to hot sun, I suffer from a fierce, red, raised, itchy rash on my neck and upper chest. The affected area appears to be spreading as I get older and is making my holidays a misery. Last year in Greece, I wore factor 60 suntan lotion, but I still got the rash. I am going to Greece again this year. Is there anything I can do to prevent this problem?

A: You've probably got what they call a photosensitive rash - it comes out in the sunshine. Most people who get this have no underlying cause and so, apart from avoiding the sun, there's little you can do. This has the fancy name of polymorphous light eruption. Covering up with a cotton T-shirt is better than using sun-blocking creams. Taking antihistamines a few days before you go on holiday (such as Zirtek - it won't make you sleepy) can help avoid a major allergic reaction and lessens the itchiness. It's best taken daily until you're back home. Sometimes the rash is not sensitive to sunlight on its own, but is triggered when you use a particular cream on the skin or take certain drugs by mouth. The oral contraceptive pill can trigger photosensitive rashes and it may be worth considering another form of contraception if you've only had this problem since going on the pill. If you can identify and avoid the trigger, then you'll be able to go out in sunlight without erupting.

Unsustainable growth

Q: My daughter has a wart on her finger that has been there for a few months. As well as being unsightly, it tends to rub against her pen. What should she do about it? She's 12 and a self- confessed coward.

A Warts are part of growing up. Up to 20% of the population in the UK have a wart of some sort at any given time. Reassuringly for your daughter, over 90% of 12-year-olds with warts will be free of them by the age of 16. Almost all warts clear themselves within two years but your daughter may not be happy to have the wart for that long. Cowards should probably opt for either no treatment or to use liquids that are painted on to the skin that contain salicylic acid (eg Salactol, Salatac). For best results, soften the skin first with warm water, pare down thickened skin with an emery board or pumice stone and paint on the liquid once a day for up to three months. Cover with a plaster to keep the paint on her finger and not on her pen. That does the trick in nearly 70% of cases. Failing that, the best-proven technique is to freeze the wart with liquid nitrogen, which is done in some GP surgeries or hospital clinics. One treatment is usually enough. It may hurt momentarily when applied and feel uncomfortable for a few hours afterwards.

Fat and fit?

Q: I was asked by a keen new "fitness manager" at my local gym if I would like to have a free fitness test which is on offer during May. I accepted out of curiosity, and have just returned from it in a state of panic and confusion. I was aware that I am overweight although I consider myself to be reasonably fit. I was not, however, expecting the barrage of "nutritional instructions" that I received. I was told that my ideal body weight is about four and a half stone less than I weigh now, meaning about six and a half stone! (I am 29 and 5ft 4in.) Presumably he made a mistake converting kilograms into stones. What I am more bothered about are the unsolicited and forceful instructions to alter my diet so that it includes no starch at all as I have so much fat to lose. I was told - it was not phrased as a suggestion - to eat only protein and vegetables in small quantities, four or five times a day. Is this good advice? I might as well admit that I have absolutely no intention of following it as the thought of living on eggs and celery makes me feel ill. Am I wrong about this? It was apparent to him that I was unhappy and he pressed me - quite intrusively, I thought - to say why but I didn't have the guts to argue with him. By the way, apparently my blood pressure, lung capacity and heart are all excellent so my instinct that I was fat but fit is not far off. What do you think I should do about his advice, or rather, instructions?

A: Follow your gut instincts; ignore his twaddle, eat a bit less of everything, especially fats, and establish a sustainable exercise programme to lose some excess weight if you want to, and maintain your excellent fitness. If you're 5ft 4in and weigh 10 and a half stone, you're not really overweight at all, and your emphasis would be on not gaining more weight as the years go by rather than embracing this faddy new low carbohydrate (Atkins) diet that is trendy but daft. Some feedback about his unsolicited, unproven and dispiriting advice would be useful, if only to stop him inflicting it on others.

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