I’m a man in my 50s and my crotch is always itchy. What could be the problem?
Dr Ellie replies: A persistent groin itch could be due to a yeast infection.
This is a very common problem but many men and women are often too embarrassed to tell their GP about it.
The skin in this region is particularly warm and moist, making it prone to irritation and infection. The most likely cause is simple skin irritation, which is not triggered by any sort of bug.
Instead, tight or close-fitting underwear and trousers can cause persistent chafing. Shower gels, soaps and laundry detergents are also frequent triggers.
Switching to loose-fitting underwear and using a soothing hydrocortisone cream, available at most pharmacists, are sensible first steps.
The groin is also a prime site for thrush – a yeast infection that thrives in warm, moist conditions. This produces a chronic itch and the skin may appear red, though not always. An over-the-counter antifungal cream such as clotrimazole, used consistently for two to four weeks, will usually clear it.
Those who suffer from eczema or dermatitis elsewhere on the body may find the same condition affects this area, too. The same emollient and treatment creams used on other parts of the body can safely be applied here.
The skin in the groin region is particularly warm and moist, writes Dr Ellie, making it prone to irritation and infection
For patients who have not had eczema or dermatitis before, look for red, scaly patches of skin.
Less commonly, itching in this area can result from lice acquired through close physical contact. These tiny insects attach to coarse body hair and grow eggs. Patients may notice small brown or grey specks moving in the hair, or tiny white eggs – known as nits – clinging to individual hairs close to the skin.
Treatment creams are available from pharmacies and sexual health clinics.
It is worth noting that recurring thrush can sometimes be an early sign of undiagnosed diabetes, so persistent symptoms deserve a GP assessment.
If the problem has not resolved within a month, a GP should examine the area to rule out any underlying cause.
I’m 86 and I take amitriptyline for my neck arthritis. However, I’ve been told this drug could raise my risk of dementia. Should I consider coming off it?
Dr Ellie replies: The benefits of amitriptyline to an 86-year-old arthritis patient outweigh the risks.
Every medical treatment involves weighing up pros and cons, and that applies here.
Amitriptyline is particularly effective for the type of deep, persistent neck pain that does not respond well to standard painkillers such as paracetamol. It also helps with sleep, which is crucial for cognitive health.
The concern about dementia is understandable. Amitriptyline belongs to a class of drugs called anticholinergics, which have been linked to a modest increase in dementia risk through their impact on memory. This is worth taking seriously. But the risk remains relatively low. Moreover, disrupted sleep is almost certainly more dangerous as it can lead to daytime drowsiness, significantly raising the risk of falls.
Unmanaged pain carries its own physical and mental health consequences. Patients should always discuss stopping or changing medication with their GP. This is particularly important for a drug such as amitriptyline, which can trigger unpleasant withdrawal symptoms – including nausea, headaches and poor sleep.
I have peripheral neuropathy in my feet. Now it is creeping up my legs. What can I do to halt its progression?
Dr Ellie replies: The most important step in managing peripheral neuropathy is finding what is causing it, because treating the underlying reason is the best chance of slowing progression.
Peripheral neuropathy – damage to the nerves outside the brain and spinal cord – leads to tingling sensations underfoot and pain that spreads up the legs.
It can be a debilitating condition, but there are steps that can be taken.
The most common causes are diabetes and vitamin B12 deficiency – a crucial nutrient for nerve health found in the likes of meat and dairy. Both are diagnosable and treatable. B12 injections, for example, can make a significant difference if deficiency is the cause.
Meanwhile, diabetes – where rampant high blood sugar damages the body – can be managed by diet changes, regular exercise and prescription medicines.
Other known causes include certain medications – chemotherapy and some antibiotics among them – as well as chronic kidney disease, autoimmune conditions such as lupus and excessive drinking.
Each of these requires its own management.
For the pain itself, tablets such as gabapentin and pregabalin are commonly used.
Physiotherapy is worth pursuing to build muscle strength around affected areas.
Daily walking is also genuinely helpful. The NHS website offers further guidance on possible exercise routines to help.
Why summer drinking is not all fun in the sun
I’ve been enjoying the heatwave, but I can’t help but worry about the damage that we as a nation of drinkers do to our livers whenever the sun is out.
Many do not realise that even a short stretch of binge drinking can lead to serious damage – sometimes even potentially fatal liver disease.
If anyone is concerned about their summer drinking, they should request a liver function test from their GP
I advise my patients to pace themselves when drinking in the sun. Enjoy it by all means, but maybe alternate between alcoholic and non-alcoholic drinks, for example.
If anyone is concerned about their summer drinking, they should request a liver function test from their GP.
Have you struggled with summer binge drinking? Did you get your liver checked? Please write in on the email address above to let me know.
Name change that means a lot
I was very pleased to see the name of the common female hormone condition PCOS has been changed.
The health issue is known to trigger irregular periods, excess hair and fluid-filled sacs in the ovaries, called cysts.
It was previously known as polycystic ovary syndrome, or PCOS, but experts argued that this gave the impression it was primarily linked to cysts when, in fact, many women never develop them.
Instead, it has been renamed polyendocrine metabolic ovarian syndrome, or PMOS, because it is more strongly linked to blood sugar levels – metabolic refers to how the body processes energy, such as blood sugar.
It’s certainly a mouthful, but by focusing on treating blood sugar issues, women may now experience some pronounced improvements to their treatment – especially as it will address their actual needs.
