I’ve been on HRT for years – is my sudden, dry and sore skin a sign my hormones have crashed?

BLOATING, burping and tummy pain can be symptoms of H. pylori, a common bacterium that infects the stomach.

Last week, a study suggested infection may be linked to as many as one in five bowel cancers, with exposure associated with around a 60 per cent higher risk of the disease.

However, this is an association and does not prove H. pylori causes bowel cancer.

Bowel cancer is the fourth most diagnosed cancer in the UK and the second highest cause of cancer death.

According to Guts UK, up to two in five people in the UK have H. pylori in their stomach, although most have no symptoms.

It can be diagnosed using tests such as a breath or stool test, usually arranged through your GP, and treated with antibiotics plus acid-suppressing medication.

Facial flare-ups getting me down

Q) I AM a 58-year-old woman and have been on Evorel Conti HRT patches since I was 51.

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Recently, my skin has been flaring up on my face.

Could this be due to an oestrogen drop and do I need something else? I was recently diagnosed with Crohn’s, too.

I’m becoming very self- conscious as it’s so sore and dry.

A) I’m sorry this is getting you down. A change in skin after menopause can be related to lower oestrogen.

The hormone helps support collagen, hydration and skin barrier function, so some women notice drier, thinner or more reactive skin after menopause.

However, as you are already on Evorel Conti, I would not assume a new facial flare means your oestrogen has dropped or that you need a higher HRT dose, as there are several other possibilities.

Facial redness, soreness and dryness may be due to rosacea, eczema, seborrhoeic dermatitis, contact dermatitis from skincare products or sun sensitivity.

Sometimes, people who look after their skin very carefully can still develop irritation from active ingredients such as retinoids, exfoliating acids, vitamin C, fragranced products or frequent product changes.

Inflammatory bowel disease, such as Crohn’s, can be associated with skin problems, and some Crohn’s treatments can affect the skin. There are also nutrient deficiencies, including iron, B12, folate, vitamin D or zinc, that affect the skin.

Take photos during flares and note triggers such as heat, alcohol, spicy food, stress, sun, skincare or medication.

Ask your GP, IBD team or dermatologist (if you have one) to review the rash, rather than just up the HRT. Stick to a simple skincare routine – a gentle, non-foaming cleanser, bland moisturiser and daily SPF.

Seek a review sooner if the skin is weeping, crusting, very painful, swelling around the eyes, or if you develop mouth ulcers, joint pain or worsening bowel symptoms.

WHY THE MOUTH PAIN?

Q) I’M a healthy 77-year-old. Last week, you said osteonecrosis can be a side-effect of bisphosphonates, which I have been taking for ten years for osteoporosis.

I have been on denosumab for four.

Earlier this year, I had severe right-sided mouth and tongue pain when swallowing, along with radiating face pain. I couldn’t eat anything for five days.

NHS dentists, GPs and a maxillofacial consultant couldn’t find the cause, and a biopsy was clear.

It resolved after six weeks, but recurred seven months later.

I spat out a hard piece of material, giving immediate relief. Could these symptoms be osteonecrosis?

A) Medication-related osteonecrosis of the jaw can very rarely occur in people taking bone-strengthening medicines such as bisphosphonates or denosumab.

These medicines are often very valuable for reducing fracture risk in osteoporosis.

So firstly, do not stop or delay your denosumab injections without medical advice, because doing so can increase fracture risk.

However, your medication history means this needs a proper dental or maxillofacial review, and I don’t think this should simply be ignored if the pain has gone.

Classically, osteonecrosis involves an area of jawbone becoming exposed or failing to heal, often after dental extraction or trauma – although it can occasionally appear without an obvious trigger. Symptoms can include pain, swelling, infection, loose teeth, numbness, exposed bone or a small piece of dead bone coming away.

What you describe – repeated pain in the same area, a hard object coming out, then rapid improvement – could fit with a small bony fragment, sometimes called a sequestrum. But dental root fragment, salivary stone, ulcer-related trauma or a sharp area of tooth or bone are other potential causes.

The fragment should ideally be examined, if you still have it. And I’d tell your dentist or maxillofacial team your medication history very clearly.

The fact this has recurred in the same area makes a follow-up even more important. You may need examination, dental X-rays or specialist imaging.

Seek urgent advice if you see exposed bone, develop swelling, pus, fever, loose teeth, numbness or difficulty swallowing.

Q) I’M 70 and recently split my knee in a fall. There was a lot of blood and I had 12 stitches. But a month later, the wound still hasn’t closed.

I am on blood thinners and my skin is thin due to age. I go to my surgery three times a week for dressing changes.

Could I be referred to a specialist or offered a skin graft?

The fact it is on the knee doesn’t help, as I constantly bend it.

I think there is some nerve damage, too, because it’s numb. Will it ever heal?

A) A deep wound over the knee can be very slow and frustrating to heal, especially when the skin is fragile and you are taking blood-thinning medication – and you are right that the position matters.

The knee bends constantly, so the skin is being put under tension every time you move.

That can make it harder for a stitched wound to stay closed.

Thin skin, bruising, swelling and bleeding or bruising related to blood thinners can also make healing more difficult.

If the wound is clean but still open, the plan may be for it to heal by secondary intention.

This means the wound is allowed to gradually fill in from the base and edges, rather than being closed together with stitches. It can be the safest option for some wounds, but it can take several weeks or longer and should come with a clear wound-care plan.

That said, if the wound is still gaping open, it would not be unreasonable to ask whether it has been reviewed by a tissue viability nurse or wound clinic.

This does not automatically mean you need a skin graft, but specialist wound teams can advise on dressings, whether the knee needs extra support or reduced bending and when referral to plastics or orthopaedics is needed.

Ask your GP surgery directly, “Is this healing by secondary intention and what is the plan if the wound does not start closing?”.

TIP OF THE WEEK

DO you wriggle around in bed every night, unable to find a comfy sleeping position?

If the answer is yes, try doing some simple stretches before you turn in at night, to ease tight hip flexors, muscle tension and your spine.

You may well find this helps you get to sleep more easily.

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