Friday 30 September 2016

Embarrassing and distressing complaints

Nina Byrnes

Published 12/04/2016 | 02:30

Dr Nina Byrnes
Dr Nina Byrnes

Advice from our GP on what to do about dark circles under your eyes and how to treat candida.

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Dark circles under the eyes are a very common complaint occurring in both men and women. They are more common in those with darker skin. While not causing any major illness they can be distressing and frustrating as they often make the person appear tired, stressed or older than they are. It can occur at any age but is more common as we get older.

This condition can run in families so a genetic link is likely. Both eyes are usually affected but one may be worse than the other. Dark circles appear due to the presence of blood vessels superficially in thin skin under the eyes. Ageing plays a role. Our skin becomes naturally thinner, losing collagen with age, making these blood vessels more visible and circles more obvious.

Allergic shiners are dark circles that occur in those with rhinitis or hay fever. These can be seen in children and adults with chronic blocked nasal passages or irritated itchy eyes. Treating the allergies and congestion may improve symptoms.

Smoking and excess alcohol make dark circles more likely. Smoking is known to affect collagen production resulting in thinner skin. Smoke also irritates the skin and eyes, further increasing the risk. Alcohol dehydrates you, dries the skin and increases the risk of superficial small blood vessels making dark circles more likely. Dehydration in general also increases the risk as, in those who are dry, fluid is drawn from the skin to internal organs making sunken eyes and dark shadows more obvious.

A lack of sleep can lead to dark circles. This should however be transient and resolve once sleep improves. Nutritional deficiencies such as a lack of iron may also make dark circles worse. This rarely occurs alone. Other symptoms such as fatigue, dizziness or malaise will be present too.

UV exposure increases pigmentation in the skin and can predispose to dark under eye circles. Wearing a good sunblock and choosing appropriate sunglasses can help here.

Improved diet and lifestyle, adequate sleep and hydration and good UV protection should be the first line of treatment for dark circles. Cover-up may help reduce the appearance of dark circles. There are many good camouflage creams available. Opt for those with a light reflecting yellow or gold base and apply these in the shadows.

If your eyes tend to be puffy and dark, sleeping with extra pillows may help. Applying cooled cucumber, tea bags or raw potato compresses may actually help by reducing puffiness.

If none of these are helping and the circles are causing you significant distress talk to your doctor.

There are a number of cosmetic procedures including laser, peels and fillers that may help. A referral will be required to access these. Unfortunately most of these procedures are considered cosmetic so it is unlikely that they can be accessed in the public system or that private insurance will cover them.

Standards and cost of cosmetic procedures vary so research before you commit.

My eyes constantly have dark circles underneath them. People keep asking me am I tired or feeling unwell. Is there anything I can do to get rid of them?

Question: I keep getting an itchy whitish discharge from my vagina. It is worse around my monthly period. I have to keep using creams and pessaries. What causes this? Why is it occurring so frequently and what can I do to prevent this?

Dr Nina replies: Candida is normally found in the vaginal area and makes up part of the normal bacterial flora. Symptoms and discomfort occur when an alteration of the normal bacterial environment leads to an overgrowth of this yeast.

In women menstrual flow, the use of tampons and pads, sexual intercourse, pregnancy and the use some contraceptive pills can increase the risk of thrush developing. Antibiotics can disrupt the normal bacterial balance and increase the risk.

A diet high in refined sugars can increase the risk in some people. Diabetes should be ruled out if you have recurrent symptoms. Yeast thrives in a warm, moist environment so wearing tight or synthetic clothing may also increase the chance of attacks of thrush. Emotional stress and anxiety may also trigger attacks.

Thrush causes genital discomfort, itch and irritation. A whitish cottage cheese like discharge may appear and cracking of the skin at the corners of the mouth may also indicate the presence of thrush.

Creams or oral gel purchased in a pharmacy may provide relief. For vaginal symptoms pessaries are also available. If these haven't helped, prescription anti-fungal medicine may be required. Thrush can transfer between sexual partners so treating your partner is advised. If symptoms are frequent or reoccurring it may be necessary to have swabs to rule out other vaginal infection or have bloods to rule out other medical conditions.

Avoid wearing tight or synthetic clothes and avoid using perfumed washes. Change pads and tampons frequently when menstruating and consider probiotics.

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