Friday 13 December 2019

Understanding rashes and reducing risk of breast cancer

If Urticaria is made worse by exposure to the cold then try to wrap up well before heading outside.
If Urticaria is made worse by exposure to the cold then try to wrap up well before heading outside.

Nina Byrnes

Advice from our GP on hives and on concerns over breast cancer risk.

Question: I have a rash at the moment - itchy red patches of varying sizes on my body that come and go. I haven't eaten or used anything new. Do you know what causes this?

Dr Nina replies: It sounds like you have urticaria or what is more commonly known as hives. This can come on suddenly and causes red, slightly raised, skin blotches. These can be intensely itchy. They may come and go in different areas of skin and turn white when you press on them. These patches are called wheals.

Urticaria occurs in about 20pc of people at some stage in their lives. Well-known triggers include insect bites and stings, reaction to various plants, food-related urticaria (nuts and shellfish are some of the most common triggers), drug reactions and reaction to pets.

Other less well-known triggers include viral and bacterial infections, exposure to outside stimuli such as heat, cold, pressure, the physical response to exercise, and occasionally other materials such as nickel or latex.

Urticaria refers to the rash that appears. This in itself is not dangerous. In a more severe reaction angioedema may also occur. This causes swelling of the face, eyes, hands and airway. This may result in a potentially fatal anaphylactic reaction.

It isn't necessary to go searching for causes in the case of simple urticaria. Taking an over-the-counter antihistamine tablet may settle the rash and it may never return again. If there is an obvious link with a particular food or stimulus it is sensible to avoid this in the future.

If urticaria persists or is frequent, or is associated with any symptoms of angioedema, then chasing a cause may be worthwhile. Your doctor can examine you and rule out any concurrent infection.

If food or a certain allergen is suspected, a skin prick test may help identify this. If urticaria is made worse by exposure to the cold, try to wrap up warm when going out. Wear gloves and a scarf. Those with cold-induced urticaria also need to be very careful if going swimming. Plunging into a cold pool can bring on a severe reaction. Body heat produced by sweating, exercise, hot showers and even stress can bring on cholinergic urticaria.

Those who suffer chronic or recurrent bouts of urticaria will likely benefit from taking regular antihistamine tablets. If there is a risk of anaphylaxis an Anapen should also be available.Occasionally short courses of steroids may help calm the skin.

Question: I am concerned about my risk of breast cancer. My aunt had it in her 60s. She was the only member of my family diagnosed. Is there anything I can do to reduce my risk of developing this disease? What should I do?

Dr Nina replies: People always worry about their genetic cancer risk but the truth is that 85pc of breast cancers occur in those who didn't have a family member with a history of the disease.

Having very dense breasts slightly increases the risk. It can also make mammograms more difficult to assess. Those who had their first menstrual period before the age of 12 or those who have a late menopause are at an increased risk. This is thought to be due to the longer periods of exposure to hormone cycles.

This also increases the risk in those who have no children or have their first child after the age of 30. Being on the oral contraceptive pill or taking combined HRT in menopause will increase the chance.

Many are not aware of the lifestyle issues that increase the risk of breast cancer.

Being obese, especially after menopause, is associated with an increased risk. Recent studies suggest that those who smoke heavily for many years and even second-hand smoke may increase the likelihood of developing breast cancer.

There is a strong link between alcohol intake and the risk of breast cancer. One unit a day can increase your risk by 9pc whereas regularly drinking more than two units daily increases the risk by 41pc. Potential risks include working night shift and exposure to certain chemicals. Antiperspirant does not increase the risk.

Exercising as little as one to two hours weekly can reduce your risk by 18pc. Breastfeeding also reduces the risk. The most important thing to do is to modify the risks you can, do regular self exams and attend age appropriate screening.

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