DR ELLIE CANNON: I've been on HRT for 21 years, so why am I still having hot flushes?

After developing menopausal symptoms aged 49, I was put on HRT patches and stayed on them until I turned 65. My hot flushes continued while on them and these have worsened to the point where, now aged 70, the slightest effort leaves sweat dripping down my face and my hair soaked. What could be causing it?

Dr Ellie replies: It is very possible that sweating may still be due to menopause and a lack of oestrogen.

However, the fact that it first appeared while you were on HRT would indicate something else was going on.

It is worth knowing that there are no longer arbitrary limits on how long somebody can use HRT.

If HRT does control sweating and flushing caused by the menopause, it can be continued afterwards at the lowest possible dose, usually as patches.

Flushing and facial sweating may be related to a skin condition called rosacea

In someone who doesn’t want to use hormones but suffers bad flushing, an alternative hormone-free medication can be tried.

Clonidine is a drug for high blood pressure but licensed for use in the menopause. It is worth discussing with your GP whether or not this could help and is safe.

However, flushing and facial sweating may be related to a skin condition called rosacea. It’s prevalent in post-menopausal women, and causes redness and flushing of the face.

This comes with an intense feeling of heat. There are topical medications available on prescription, such as brimonidine cream or metronidazole gel, that may calm any rosacea or redness and, in turn, reduce the sweating. It is worth asking your GP for a prescription to try one of these.

Facial sweating may also have no underlying cause and this is called primary hyperhidrosis.

There are specialised treatments – such as botox – to reduce sweating and this may be an option once you have been referred to a dermatologist.

Every morning my eyes are sticky and puffy. I am 77 and take ibuprofen and co-codamol for arthritis. Could my problems be a side-effect of this treatment?

Dr Ellie replies: This would not be a typical side- effect for ibuprofen or co-codamol. Sticky wet eyes are commonly a condition called blepharitis. This can be uncomfortable and irritating.

The eyelids are usually crusted with discharge and this tends to be worse in the morning. They can also look inflamed and feel gritty. You might see fluid pouches because the tiny glands on the eyelids can get blocked.

The treatment for blepharitis is a daily routine called eyelid hygiene, which unblocks any glands. First, warm the skin of the eyelids to allow fluid to drain. You can do this with a flannel soaked in very warm water for up to ten minutes, or you can buy heat bags online.

Secondly, massage the eyelids to get fluid out of the glands. Finally, clean the eyelids. You can get a blepharitis cleaning fluid or wipes on the high street. A safe alternative is diluted baby shampoo.

Regular sticky eyes may also be caused by an allergic conjunctivitis, perhaps related to hay fever or infection. If this is the case, the eyelid hygiene method would not help and advice from the pharmacist would be needed.

I'm 90 and for several months I’ve had a spotty, infected rash on my chest. A blood test suggested I was low in sodium and I was put on tablets for three months but they didn’t help. Neither did steroid creams. What should I do?

Dr Ellie replies: Rashes can be difficult to diagnose and may take a few trials of treatment, or visits to the GP, to get a definitive answer. Even then, a miracle cure is not always possible.

Low sodium would not tend to cause this type of rash but whatever is causing the low sodium might.

For example, we know that certain medications such as antidepressants and blood pressure tablets can reduce and also cause a drug- induced rash. Your GP or pharmacist would be able to review the medication.

Steroid ointments are commonly used for skin issues and tend to work if something is inflamed, such as eczema or other types of dermatitis. If it’s not working, there are two possibilities. Firstly, a strong enough steroid may not have been tried. Secondly, a steroid may not work at all if the problem was due to infection.

Skin infections are not uncommon, and one causing a spotty rash would be folliculitis. This causes little pustules and red spots and may be caused by a bacteria or a yeast infection.

A yeast type of folliculitis is more likely in someone with dandruff. A GP could take a swab from one of the spots to test what bug is present. For a yeast folliculitis an anti-fungal shampoo is used as a body wash.

For bacteria it would be an antibiotic and this would need a prescription.

Trying an anti-fungal ketoconazole shampoo, available over the counter, as a body wash is a low-risk option.

If the wait for a dermatology appointment is too long, you can ask about teledermatology, where photos are sent to a dermatologist instead.

Burden of botched holiday ops

Medical tourism – the vast numbers of people flocking to Turkey and other destinations for cheap cosmetic surgery – is putting massive pressure on the NHS, the British Medical Association warned last week.

Along with just about every other doctor, I’ve seen it often myself. Someone goes abroad for a nip and tuck, or a hair transplant, and when they get home it all starts to unravel.

No one thinks it’ll happen to them, but complications are common, particularly if you’re immediately jumping on a plane and the after-care instructions are in another language.

Six Brits died last year after procedures in Turkey and many more end up with infections or problems that required an NHS admission. Botched ops or unpleasant-looking results won’t be fixed, however.

I’m keen to hear if you’re a medical tourist who has been delighted with the results – or did you have a bad experience?