Saga expert Dr David Roche: health Q&As

Dr David Roche / 29 December 2011

Dr David Roche answers questions on a heat rash and open angle glaucoma



Q: While on holiday abroad I have suffered from what a pharmacist told me was heat rash on hot, sultry days. Hydrocortisone cream seemed to cure it after a few days. Do you agree the cause is heat or could it be some kind of pollution?

A: All skin rashes are reliant on an experienced eye to recognise the pattern, position and context of the rash. It is very likely that a local pharmacist’s opinion will be accurate; heat rash is easily recognised. Pollution on the other hand would be an unusual cause unless there was direct contact between the area affected and the pollutant. If the pollutant was airborne it is much more likely that your eyes, nose and chest would react, rather than skin.

Heat rash goes by several different names including miliaria and prickly heat and is caused when sweat glands in the skin are obstructed by a combination of skin debris and bacteria. Hot and humid weather, when sweating rates are increased, is the commonest trigger. The rash appears as small raised, itchy lumps associated with a prickling sensation. Keeping the skin surface cool and do what you can to avoid getting sweaty will help a lot. It is important to avoid oily, greasy creams which can plug the sweat glands further. Calamine or cooled water based moisturisers can be soothing, as can low dose steroid creams, such as hydrocortisone.

Q: I have been using eye drops for primary open angle glaucoma but now my doctor has suggested an operation. I'm concerned about possible complications. What's your opinion?

A: The reasons for considering surgery in your form of glaucoma are fairly straightforward. Primary open angle glaucoma is caused by excess pressure within the fluids in the eyeball; if this is sustained for some time vision can be permanently damaged and no repair is possible. Initial treatment is with eye drops and many people find this controls the condition so they don’t need any further therapy. Surgery is usually considered when drops don’t bring down the pressure effectively.

Surgery aims to improve the flow through the natural drainage channels for the fluid in the eyeball so as to reduce pressure. Laser treatment (laser trabeculoplasty) is a more limited and less invasive procedure than full surgery . If this is not successful then an operation called trabeculectomy is performed, creating an additional drainage channel out to the surface of the eye, under the top eyelid. Complication rates are low but make sure these are explained to you before going ahead as many can be avoided with good aftercare. Seventy per cent of people achieve a good pressure reduction afterwards and usually surgery is more effective than eye drops.


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