Ask the Doctor

Q. I am a 30-year-old professional male. Recently, I developed a patch of ring worm on my hand. I was prescribed a special anti-fungal cream and this improved it for a while. However, it has since returned and I now have it on my chest. Apart from applying the cream twice a day, is there anything else I can do to get rid of it faster? And why does it keep coming back?

A. Ring worm is a fungal infection (it is not due to a worm as you may expect from the name!). It can be picked up directly from someone who has it or indirectly (eg by sharing towels with them). It can also be picked up from pets (cats and dogs) or less commonly farm animals. Again it can be from direct contact or indirect (eg. touching a gate that infected animals have passed through can infect the skin). An infection may seem to occur out of the blue. This may happen because you have come into contact with objects contaminated with the fungus. The cream is a good way to treat it.

Your best bet is to try to prevent picking it up again in the future. The following tips should reduce your chances of this: Always dry yourself completely after a bath or shower as fungi multiply in moist areas; Try to avoid sharing clothing, sports equipment or towels with other people; If you go to the gym or local pool always wear flip flops; If any of your family or household contacts have a rash make sure they are treated; Also if your pet has patches of missing hair take them to the vet. Sometimes a second assessment by your doctor is a good idea to ensure the diagnosis is correct. Also I would recommend getting bloods checked. This is to ensure that you don’t have Diabetes or problems with your immune system that could predispose you to recurrent fungal infections.

Q. I am a 26-year-old female and I've suffered from really heavy periods ever since I begun menstruating at age 14. The blood flow from my periods has become so heavy lately that it's curtailing my work and social life. My periods last for a total of eight days. There's a history of blood clots in my family so I'm too nervous to take the pill. What could be the reason behind the heavy blood flow and what would you recommend I do to improve my situation?

A. Sorry to hear you're having heavy periods, periods are a pain at the best of times but its very frustrating if they're heavy! It is a common complaint with 33% of women describing their periods as heavy. There may be an underlying cause such as fibroids or endometriosis or an underactive thyroid etc. However in many cases the cause is not found. It may be due to high levels of a chemical called Prostaglandins in the lining of the womb. It is a good idea to attend your GP to outrule an underlying cause. Your nervousness in starting on the Combined Oestrogen and Progesterone pill is justified. The next option would be Non Steroidal Anti Inflammatory Drugs such as Ibuprofen (eg Nurofen brand) or Mefanamic Acid (eg Ponstan brand). These medications may reduce the blood flow by approx 20-50%.

Other options to consider would be Progesterone methods of contraception to lighten the blood flow. These forms don’t have a risk of clots associated. These include the Progesterone injection every three months or the Implanon bar inserted into the arm and lasting for up to three years. Also the Mirena Coil (a Progesterone containing coil) inserted into the womb is effective. This is more suitable for someone who has had children. There are pros and cons with all these options. If the above have failed you could consider surgical treatment. However this may not be an option if you want to have pregnancies in the future.