Monday, 30 November -0001

YOUR HEALTH Dr James Le Fanu: 31 August

Considering chlorine as a cause of eczema, whether to repair a perforated ear and how some wines can make you sneeze

Written by Dr James Le Fanu
Dermatology is a most satisfying speciality as people are more than usually grateful to have their unsightly skin conditions sorted out. It does, apparently, have one major drawback. Dermatologists find it very difficult to be 'off duty' as they are driven instinctively to scrutinise the skin of everyone they come across. 'While one part of my brain is conducting a conversation, another is assessing the presence of acne scars, seborrhoic dermatitis or inappropriate facial hair,' writes Dr Tony Burns of Leicester's Royal Infirmary.

There is no respite either during a night at the cinema, for while the rest of the audience at Titanic were appreciating the special effects, Dr Burns was closely observing Leonardo DiCaprio's chicken-pox scars and wondering whether there might be something amiss with Kate Winslet's nipples.

But while the appearance of skin complaints are instantly recognisable to an experienced eye, it can be much more difficult to identify possible remediable causes. Thus a reader from Hertfordshire has for many years kept fit by visiting her local swimming baths four or five times a week. Over the past few years the areas behind her knees, the crook of the elbows and around each shoulder became very itchy. Her family doctor – and later a dermatologist – confirmed this was due to eczema – and she was treated accordingly.

However, when her local swimming pool closed for refurbishment, forcing her to go to another pool for six weeks: 'I became aware that my rash and itchiness had disappeared. I returned to my local pool when it reopened and within four days it was back again.'

This experience encouraged her to make some enquiries about the concentration of chemicals in both pools. These turned out to be within the recommended limits – but the level of chlorine was five times greater in her local pool. How many other regular swimmers, she wonders, might similarly be sensitive to chlorine, but quite unaware it is responsible for their eczema.

This week's medical problem comes courtesy of a lady from Kent, who, following an infection a couple of months ago, has developed a perforated eardrum that has adversely affected her hearing. She has been advised that a repair may improve her deafness, but wonders if this is advisable.

The main purpose of repairing a perforated eardrum is to prevent recurrent infections of the inner ear. 'It may result in improved hearing,' according to ENTUK, the professional association of ENT surgeons, before adding, more pessimistically, that 'it seldom leads to great improvements'. Indeed, it can have adverse effects, causing rarely facial paralysis and dizziness. This would certainly suggest the need for caution before consenting to the procedure.





The several possible causes of bouts of sneezing include sensitivity to alcohol – as the following account from a reader in Surrey confirms. 'My husband used to make wine from an assortment of packs. Latterly he has been buying cases of supermarket plonk, which he reckons is nearly as cheap as making it himself without all the hassle. Gradually I came to realise my spasmodic compulsive projectile sneezing, originally caused by my husband's home brew, can now also be due to some (but not all) types of wine he buys. When we entertain we serve good-quality wine, and it is only rarely that I embarrass our guests by having one of my horrific explosive sneezing attacks.'

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