Bizarre blood marks to agonising back pain – Dr Zoe Williams answers your health queries

MUSCULOSKELETAL pain is one of the most frequent topics I get asked about by readers, whether it be in the chest, legs, back or elsewhere.

When there’s been no injury, patients can be unsure why pain has begun.

There are many different causes, from a muscle or tendon tear, arthritis, nerve damage, an old injury, poor posture or even something you never thought might be related, such as carrying a handbag on the same shoulder for years or wearing ill-fitting bras.

These issues often resolve on their own, but you should see your GP if you have been experiencing pain for more than 12 weeks.

But generally, I tell patients not to worry because there are physio services available through the NHS and referrals may also be made for X-rays or scans.

However, there can be long wait times, so GPs may advise you to take painkillers and, often, to stay active as much as possible.

In rarer cases, pain may be more serious than originally thought, and a symptom of disease including cancer.

Here are my responses to readers this week . . . 

Q: FROM time to time I get extremely itchy skin.

It can last weeks, sometimes even months.

I can’t find a trigger and have tried various shower gels, lotions and washing products, creams and antihistamines but nothing helps.

The itching is intense, it feels like red ants are biting me.

I am 75 and in pretty good health.

A: IT sounds as though you have already taken ­sensible steps in trying to keep a diary to see if there are any triggers.

Pruritus is the medical term for itchiness, and some people who have it say they would rather have pain than severe pruritus.

Dry skin is a very common cause, but it can also be linked to an underlying medical ­condition, an allergy, contact with an irritant or a reaction to a medication.

Pruritus can also be triggered by stress, excessive heat or excessive cold.

One of the first things to try is washing less often and avoiding soap, so bathing only two to three times a week to help your skin preserve its natural oils.

Use an emollient as a soap substitute.

You can also use the emollient to moisturise the skin, aiming for four times a day, which can help settle it down.

Sedating antihistamines, such as chlorphenamine, can give nighttime relief.

If this doesn’t help then it’s important to be assessed by your GP in case there is an underlying condition.

Your description of red ants also made me question if the symptoms could be caused by damage to some of the nerves that supply the skin.

As your symptoms are intermittent it’s worth taking pictures and video when it’s at its worst.

Then you can show this to your doctor if the appointment doesn’t coincide with a flare of symptoms.

Your GP may choose to do a “pruritus screen”, which is a set of blood tests.

Q: I AM a 65-year-old woman and I keep getting these blood marks on my arms.

I have attached a picture showing my forearm with a red mark.

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A reader is suffering from strange blood marks on their arm[/caption]

They don’t hurt or itch.

A: Thank you so much for sending in the picture of the outside of your forearm, which shows some well- defined red/purple patches – which have the typical appearance of ­purpura.

Your skin is also visibly quite thin.

Purpura is caused by blood leaking out of damaged blood vessels in the skin.

There are a number of causes, of which the most common in people of your age is something called senile purpura.

This affects more than ten per cent of those aged over 50 and is equally common in both men and women.

The location of the marks on the outer-lower arm is also highly typical in cases of senile purpura.

It becomes even more likely in people who are taking steroids or blood-thinning medication, and in those who have had lots of exposure to the sun.

Usually, there has been some very mild trauma, but this could even be caused by leaning on a hard surface because the skin and blood vessels are ­fragile and tear easily.

This condition is benign but it’s important to take good care of the skin, protect it from the sun with SPF and be careful not to injure the skin.

Unfortunately, it does tend to recur, and you’re likely to keep getting new patches – which usually last one to three weeks and can leave a brown discolouration to the skin long term.

There are some other causes of purpura.

These include issues with clotting of the blood, the blood vessels or low platelets.

But if you’ve been checked over by your GP and had normal blood tests then there’s no need for concern.

Q: I AM 78 and have suffered from back pain for several years.

After my dog passed away six years ago I did not get another because walking caused me pain.

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The spine is complex and sometimes, unfortunately, there is little that can be done[/caption]

Now, however, I really suffer even when just standing.

It almost feels like my discs are under pressure and can’t take the weight of my upper body when I am standing.

I am fine sitting down and lying down.

Do you think I would benefit from some sort of back support?

Over the years I have had numerous doctors appointments, physio, acupuncture and X-rays.

The only thing found, years ago, was a ­calcified lump but I don’t know where.

A: MY initial thoughts with this one are around whether or not your dog was actually helping keep this issue at bay.

Maybe that daily walk helped to keep you stronger and more active.

I certainly think that you would benefit from an in-depth assessment by a physiotherapist.

There are different conditions that could explain why you have pain standing but not sitting down.

You may benefit from revisiting some tests, such as X-rays or even an MRI to get a better understanding of what is going on in your spine.

At the age you are, there are likely potential degenerative changes in your spine and the course of action will depend on what is found.

The spine is complex and sometimes there is not too much that can be done.

But focusing on strengthening an area around where there’s weakness can go a long way in compensating for issues in a specific area.

Depending on where you live, it might be that your GP will need to refer you to a physiotherapist, or it might be that you can self-refer.

Once a physio has said it is safe to do so, I’d advise you to get moving again as much as you can, starting slowly and building up gradually.

This approach to regaining strength and muscle is a better long-term solution than opting straight away for a back brace – which may help the symptoms but not deal with the underlying cause.

I’m hoping that with the right support, you may be able to exercise and strengthen your way out of this.

You will need to be patient though, because you could be looking at three to six months of exercises three or four times a week to help you.

If you’re up to it and want to start walking again, you definitely should give it a go.

Start with short distances slowly and increase from there.

Maybe the end of the road and back and then go a few houses further every walk.

Do keep in touch and let me know how you get on.