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Ask Dr Mark Porter

Dr Mark Porter

4 May 2021

Our health columnist, Dr Mark Porter, is one of the country’s best-known GPs.

Our expert on itchy skin, hot tub bugs and the link between sleeping pills and dementia.

Q.  For the past year or so I have been plagued with itchy legs, below the knee. Oddly, it only happens at night in bed, when it often wakes me up. The skin on my shins does look scalier and drier than it used to but otherwise there is nothing abnormal to see – no spots, no rash.

A.  I would need to examine you to be sure, but from what you describe this may be simple age-related drying of the skin (xerosis).

There are lots of reasons why people itch – from obvious causes such as eczema to less obvious ones like kidney and liver disease and drug side effects (for example codeine-type painkillers) – but if localised to the lower legs, xerosis would be top of my list.

Two simple measures can help. Try to reduce your exposure to soap. If you want to have a bath or shower every day, never wash your legs with soap, make sure you rinse any shampoo off your legs in the shower, and avoid bubble bath.

Moisturise your legs at least once a day, preferably after you have showered or bathed – just pat your legs dry and rub the lotion in while your skin is still damp. If you have sensitive skin, ask your pharmacist to recommend the best product.

If I am right, you should notice a benefit within a couple of weeks. If it works, then please keep up the regime from now on as the older you get, the drier your skin tends to become.

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Q.  What are your views on the link between sleeping tablets and dementia? I have been taking zopiclone for years as I have always struggled with insomnia. My GP is constantly telling me to try to wean myself off them, but every time I go without one, I am awake most of the night. However, at 65, the last thing I want to do is increase my odds of developing dementia.

A.  When Z-drugs, such as zopiclone and zolpidem, were first launched in the 1990s they were hailed as safer alternatives to the Valium-like family of sleeping drugs, such as temazepam and nitrazepam. However, they work in the same way as their predecessors, so it was no real surprise when it was subsequently discovered that they carry the same risks.

Longer term use – even for more than a few weeks – can lead to tolerance (you need to take more to get the same effect) and addiction. Plus, you risk hangover effects and falls (they make people wobbly). And, just to compound matters, when you try to stop them you can get withdrawal effects like the rebound insomnia you describe, meaning people are often understandably keen to restart them. And so, a vicious cycle develops.

There is an association between sleeping tablet use and dementia. NICE estimates that older people (over 65) taking drugs like zopiclone are around 60% more likely to develop dementia than their peers who don’t – although it’s not a clear-cut relationship and the exact nature of the link remains the subject of debate.

My advice? I would listen to your GP and try to come off the tablets. You are likely to feel better if you do. However, it should be a slow process and supported by something else to help your insomnia. In older people who often don’t get outside as much as they would like – particularly during recent lockdowns – a three-month course of night-time melatonin could help reset your body clock (which depends on exposure to daylight).

Better still, have you considered cognitive behavioural therapy? It is very effective for insomnia, even in people who have been taking sleeping tablets for years, and if you use the internet can often be accessed online for free under the NHS (provision varies across the UK). Visit Sleepstation as an example.

Q.  Can you catch infections from hot tubs? We are due to share one on a glamping holiday we have booked in the summer (regulations permitting), but I don’t like the idea. It feels too much like sitting in other people’s bathwater.

A.  My wife and I have booked a holiday too, albeit in autumn, so we’re keeping our fingers crossed that it goes ahead. As for hot tubs, I share your reluctance. Proper cleaning and water treatment should minimise the likelihood of cross infection, but it’s always a risk. I don’t have any data on coronavirus as most public hot tubs have been shut during much of the pandemic. However, a review by the US Centers for Disease Control and Prevention (hot tubs are very popular in the States) identified at least two other pathogens that can lurk in them.

Cryptosporidium – a hardy parasite that causes diarrhoea and vomiting – thrives in warm water, and is very resistant to chlorine and other disinfectants. The second, pseudomonas, is a bacterium that is also more resistant than most to commonly used water treatments.

Pseudomonas can cause a range of infections, but the two most common are hot tub rash – an infection of the hair follicles that looks like a cross between acne and chickenpox – and swimmer’s ear (painful swelling of the ear canal).

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Q.  Now that the worst of the pandemic seems behind us, do we need to keep taking daily vitamin D supplements? My wife and I have been vaccinated, and we are spending more time outside in the sun.

A.  From now until the end of September most adults over 50 will get all the vitamin D they need from being outdoors in the sun and can stop supplements. However, there are some exceptions. People with dark skin, the housebound, and people who cover up when outside or wear high-factor sunscreens on exposed skin will probably not get enough sunlight exposure to maintain good levels. These groups should continue supplementation throughout the year (go for D3 and a minimum of 10mcg/400 units a day).

If in doubt keep taking the supplements, but for general health rather than for added protection against coronavirus – for which the evidence has never been that convincing.

Email or write to Dr Mark Porter at Saga Magazine, Enbrook Park, Folkestone, Kent CT20 3SE. He can’t reply individually but will respond to queries in Saga Magazine. Always talk to your own GP.

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Article first published in Saga Magazine May 2021.

The opinions expressed are those of the author and are not held by Saga unless specifically stated. The material is for general information only and does not constitute investment, tax, legal, medical or other form of advice. You should not rely on this information to make (or refrain from making) any decisions. Always obtain independent, professional advice for your own particular situation.

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