Dear doctor

Acne angst

Q I developed acne for the first time in my early thirties having never suffered as an adolescent. I've now got spots on my forehead and particularly nasty, pus-filled spots on my back. I've tried anti-acne creams from the chemist and antibiotic lotion from the GP, neither of which have helped. What will?

A Healthy eating's always a great idea, but probably won't make any impact on your acne, which is usually unrelated to diet. Try not to pick or touch the spots, let the sun get to them, get rid of any dandruff and keep hair off your forehead. Wash your face twice a day and avoid heavy, greasy cosmetics if possible. Your best bet will probably be antibiotics by mouth such as oxytetracycline or erythromycin, but you will need to take them for at least three months. You will see the maximum improvement after six months and may need to keep taking them for up to two years.

Under pressure

Q I have been feeling lightheaded at odd times recently. The last time it happened I was out jogging. Does this mean I have low blood pressure?

A Lightheadedness may mean your blood sugar's a bit low and you need to eat a couple of hours before you jog. Similarly, being mildly dehydrated can make you lightheaded, so make sure you drink a couple of glasses of water before heading off for your run, avoid running outdoors in the heat of the day and remember to drink plenty when you return.

Low blood pressure is generally a good thing - a sign that you're healthy - but it's true that it can lead to lightheadedness when you stand up suddenly, get out of a hot bath, jacuzzi or sauna or spend a lot of time on your feet, especially in the heat. If it sounds like low blood pressure may be your problem, you can only redouble your efforts to drink plenty and avoid overheating as there's no specific treatment in this country. If you're lightheaded a lot of the time, breathless and tired, you may be anaemic - so get a blood test from your GP. It might be a good opportunity for a health MOT - your GP should be able to offer you a full health check.

Dealing with styes

Q I've got a painful and highly unattractive stye on one of my eyelids. It's the first I've ever had. What's the best way to deal with it?

A These unpleasant little abscesses are caused by bacteria from the skin getting into the space around the root of an eyelash. Usually they're a one-off, but they may recur if you're run down or if your immune system is below par. However you treat it, the stye will come to a head that will point outwards. It will then burst and release its pus. Antibiotic eye ointment such as chloramphenicol, available on prescription, may speed up the process. Don't bother with Brolene and other eye drops, which are available over the counter, because they won't help.

If you speak to your GP on the phone, he or she may be happy to leave you a prescription for collection so you don't have to wait to see them. My advice, however, would be not to bother treating it all. Just wipe the pus away when it comes out and be careful not to spread the stye to the other eye. Just for the record, you can't spread styes to other people.

Cancer checks

Q I've got freckles and moles all over me. I frequently check them to make sure I'm not developing skin cancer, but I'm not entirely sure what I'm checking for. What exactly are the warning signs?

A Freckles are small and only come out when the sun does, fading away as winter looms. As long as they stay less than 6mm across, you don't need to worry about them at all. Moles appear in childhood or adolescence and can be flat or slightly raised with a hair sticking out of it. We all worry about moles becoming cancerous, but melanomas, or skin cancers, although on the increase, are still rare with 3,500 cases a year in the UK.

However, it's worth being vigilant because the more promptly they're treated, the better the outlook. Some families are genetically predisposed to melanomas and have an unusual kind of mole called dysplastic naevi. If you have moles of this type, you should be under the care of a dermatologist who can photograph and record all your moles so any changes can be detected. Dysplastic naevi are bigger than most moles, more numerous than usual with more than 40 at any time on your body, are found on parts of your body that ordinary moles don't reach - like your scalp - and have an irregular outline so they seem to fade into your surrounding skin. Melanomas are most common on the lower leg of fair-skinned women over 30, but anyone can get one anywhere at any time. Here's a checklist you can use for any pigmented (ie brown/black) spot on your skin but if in doubt, ask a GP anyway. These are the warning signs to look out for:
• Asymmetrical spot (ie not round/oval)
• Border irregular
• Colour not uniform
• Diameter greater than 0.5cm.

What is this lump?

Q I was feeling inside my vagina to check I hadn't left a tampon in, when I felt a little round lump on my cervix. I'm petrified it's cancer.

A It's far more likely to be a harmless, fluid-filled cyst or polyp than cancer. Nabothian cysts are little lumps filled with mucus that the cervix makes to help the sperm on its way. They come and go, never cause any problems and don't need treatment. Or you might have a polyp that is a harmless growth on a stalk that comes from the cells that line the inside of the cervix. Polyps may bleed after sex or produce a lot of mucus which you would notice as a clear discharge. They can be twisted or burnt off by a gynaecologist. To be on the safe side, ask your GP to have a look at your cervix to check and have a smear test if it's due.

Coming off Prozac

Q I've been on Prozac for six months now and must say that it's really helped me through a nasty bout of depression that was triggered by being made redundant. I'm a lot better now, in a new job and on an even keel. Can I just stop the Prozac?

A Some people do just stop taking it suddenly but it's not a good idea because you can get withdrawal effects. These include dizziness, lethargy, pins and needles and nausea and, although they're usually mild and pass after a few days, they can be avoided by coming off your antidepressant slowly. The longer you've been on it, the more gradually you need to taper off - either by cutting a pill in half, or taking the same dose but on alternate days. If you've been on Prozac for six months or more, you will be advised to reduce the dose by a quarter every four weeks.

• If you have a question for Dr Robinson, you can email her at or write to her c/o The Health Editor, The Guardian, 119, Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into any personal correspondence.

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