What can banish rough skin from my scalp?

MY SCALP is dotted with blemishes that do not cause any trouble, but I can see them in the mirror and they are a source of embarrassment. I am bald for the most part and the blemishes are only under the hair that I have left, which is thinning. Can you recommend a treatment?

James Atkinson, Farnborough, Hants.

Skin complaints are one of those conditions that really do need to be seen face to face, as it were. As i have said often, dermatology — which is devoted to the treatment of skin complaints — is a spectator activity and i might be wrong in making an educated guess without having seen you.

But with that caveat in mind, what i suspect you might have are seborrhoeic keratoses. These are the most common form of blemish we see on the scalp under the hair (as distinct from bald areas).

Seborrhoeic keratoses are raised, often warty plaques — they can be smooth or dry, rough and cracked, and are usually greyish or dark brown, though they can be black.

The plaques can vary from the size of an apple pip up to the size of a thumbnail. They are harmless and are very common — most people develop at least one at some time. However, you can have any number of them, and once they appear, they are with you for life.

Sometimes they are referred to as warts, but they are not caused by the human papillomavirus, as warts are. What does cause them is unknown.

ANOTHER possibility is that the blemishes are actinic keratosis. These are scaly, white, crumbly lesions that often develop on skin that’s exposed to sunlight, such as the back of the hands, the forehead or the front of the scalp where the hair has been thinning through middle age.

These are different from seborrhoeic keratoses and are the result of UV damage from the sun. Though pre-malignant, only a small proportion of them will go on to become cancerous.

But as the blemishes you describe are in the hair, i suspect they are harmless seborrhoeic keratoses. You should see your GP for an exact diagnosis. Seborrhoeic keratoses tend to have such a typical appearance that a biopsy — taking a sample of tissue for assessment in a laboratory — is rarely necessary.

Unwanted tissue such as this can be treated with cryotherapy — f reezing i t to a very l ow temperature to destroy it.

Most doctors in general practice have the equipment for this treatment: we use the same technique for warts and verrucas.

one or two cryotherapy applications will cause the keratosis to form a scab and drop away in a few days, followed by complete healing with no scar.

i have had much success over many years with these sort of lesions and there is every reason to hope your doctor will achieve the same for you — once the exact diagnosis is confirmed. FOR more than 20 years I have been taking proton pump inhibitors (PPI) to help with reflux. I usually take a 15mg tablet of omeprazole once or twice a day.

If I miss a tablet, I soon know about it. In the past I have also taken 30mg of lansoprazole each day.

Five weeks ago I fell and broke my leg in two places. Is there any evidence PPIs will cause bone thinning or osteoporosis?

After 20 years of taking these tablets, is there a possibility of having another broken bone?

Is it alarmist to ask for a bone density scan? Howard England, Shipley, W. Yorks. PROTON pump inhibitors reduce the amount of acid secreted by the stomach and so are prescribed for those with acid reflux.

They are excellent for this but, as you suggest, there is some evidence that long-term use does increase the risk of fractures — according to some studies by as much as 10 to 20 per cent. This could be related to how they affect the absorption of calcium and perhaps vitamin D, both of which are vital for the maintenance of bone strength.

i must stress PPis are safe and effective, and some can even be bought over the counter without a prescription.

The problems can come, though not inevitably, with long-term use of more than a year.

i should add we don’t know for sure that PPis are the culprit with fractures — the difficulty with the research into this subject is that there are so many other factors that can influence bone strength and osteoporosis.

THeSe include the amount of exercise taken throughout life, alcohol use, other medicine such as corticosteroids (which can reduce bone strength), vitamin and mineral supplement use, and diet and lifestyle.

Another risk factor is smoking — this can also trigger excess acid and acid reflux, reasons for taking a PPi in the first place.

So, as you can see, there can be many confusing factors.

Having said that, i do think your decision to request a referral for a bone density scan is correct.

This will measure your bone density at the hip and lower spine and provides an accurate guide about your risk of future fractures, and whether or not treatment is necessary.

normally, repeat scans will then be done every three to four years.

Meanwhile, it would make sense for you to take a regular dose of calcium and vitamin D.

However, check with your doctor once the scan results are available, as i t may be that stronger medicine to strengthen your bones is needed.

WRITE TO DR SCURR

TO CONTACT Dr Scurr with a health query, write to him at Scottish Daily Mail, Good Health, 20 Waterloo Street, Glasgow G2 6DB or email drmartin@dailymail.co.uk — including contact details. Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.