I could finally clear up my skin but fear I will then get Covid

QI’ve had psoriasis for years, with large scaly patches on my arms, legs and scalp. It feels dry and uncomfortable, but the main problem is it looks awful.

I hate exposing my skin in warm weather. When my scalp is bad my hair and shoulders look like I’ve got mega dandruff. The numerous creams and lotions my GP prescribed didn’t make much difference, so I’m now under the hospital dermatology clinic.

My specialist has recommended Bimzelx and said it can be successful. But she also warned me it can affect my immune system, so how dangerous is this with so much Covid around? I’d be the first to admit that psoriasis has affected my confidence, but should I put my health at risk just for the sake of my appearance?

In psoriasis, red areas covered in silvery scales appear on the skin, most commonly on the elbows, knees, lower back and scalp, although they can appear anywhere. They tend to come and go, and although some people have only small patches that are short lived, others, like you, have more persistent, large areas that can look unsightly.

It’s caused by overproduction of skin cells, which is thought to be an auto-immune problem where the body’s own immune system attacks skin cells. It is commonly treated with creams containing chemicals similar to vitamin D, along with moisturisers. Others can be tried, including dithranol and shampoos containing coal tar for the scalp. Light therapy can also be effective.

However, if these don’t help, more powerful treatments that suppress the immune system are available, such as methotrexate and what are known as “biologicals”, which include Bimekizumab (Bimzelx).

These are specifically designed to mimic chemicals that are naturally found in the human body and are now increasingly used to treat many auto-immune conditions – and they all tend to have names that are very difficult to pronounce.

There is a range of them available to treat psoriasis, which work in slightly different ways, but there is evidence that Bimzelx may be more effective than other biologicals.

All of them reduce the immune response not only in the skin, but also to infections. This does mean you are more at risk of getting not only sore throats and thrush, but also Covid – and if you do catch Covid, you may get more severe symptoms.

For this reason, most people on biologic treatments are classified as being immunosuppressed and should

Ahave three doses of the Covid vaccine as their primary course as well as a booster, so four doses in total. Immunosuppressed people should be on a register where they can obtain priority PCR tests and if you test positive you should automatically be sent a course of antiviral treatment.

Together with vaccination, this really does reduce the risk of severe Covid, and especially the risk of needing hospital treatment.

It does sound that, like many people with severe psoriasis, it is hugely affecting your quality of life and the new treatment could make a huge difference to your skin and your confidence. I suggest you talk through with your GP the pros and cons of this treatment, which will help you decide what you want to do. Q

I’ve been tired recently and a blood test showed I’m a bit low on iron. My GP said this was likely to be because I don’t eat much red meat, but I’m wondering if my periods might

be another reason. I’m 45 and they have become a lot heavier in the last few years. But I don’t know if they were just light before and now they are normal. No one discusses how many sanitary towels they use, so what exactly counts as a heavy period?

AThe average amount of blood lost during a period is 35ml (three tablespoons) and bleeding is considered to be abnormally heavy if you lose more than 80ml.

But unless you are in the habit of weighing your sanitary towels (I have yet to meet a single woman who has done this other than for a research trial) it can be rather difficult to know exactly how much you are bleeding each month.

However, tell-tale signs that your bleeding is above average is suddenly bleeding so much it soaks through to your clothes, having to change a large pad or tampon more than every two hours on a regular basis, or having to wear a pad as well as a tampon.

Passing a few small clots, about the size of a pea, can happen in a normal period, especially on the first or second days, but passing larger clots than this can also be a sign that your period is heavier than normal.

Women of reproductive age need 14.8mg of iron each day (compared to 8.7mg for men and older women) to compensate for the blood that is lost each month.

Red meat is a particularly good source of iron, with 3.6mg per 100g. It is in a form, known as haem iron, that is easy to absorb.

Other animal proteins such as fish and poultry are also good sources.

The iron found in plant-based foods is non-haem, which can be harder to absorb, but this can be boosted by eating these foods with vitamin C.

A cup of cooked lentils provides 6.6mg of iron, while green vegetables such as spinach contain around 1.6mg per 100g.

Many foods are also fortified with iron and every little bit can add up.

I suggest you do some quick calculations and if you are eating enough iron, then it may well be that your periods are heavier than normal. This is a common problem in women in their 40s and there are treatments available from your GP that can help to reduce monthly flow.

If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.