I’ve developed crusty, white patches on my tongue. Should I be worried? And what can I do to get rid of them?
Dr Ellie replies: New patches or lesions on the tongue should always be reviewed by a GP or dentist.
The most common cause would be mouth ulcers – small, painful sores. These can be triggered by a number of things, including scratching the tongue, stress, hormonal changes, nutritional deficiencies, viral infections, and acidic and spicy food.
Ulcers usually last for less than two weeks. Anyone who regularly gets them should speak to their GP, who can help work out the cause.
Lesions that persist for longer than two weeks need to be checked by a doctor because, in rare cases, it can be a sign of mouth cancer. Tumours often look like ulcers and can also be crusty, red or white. Mouth cancer is more common in people who smoke, chew tobacco or regularly drink heavily.
Crusty patches can also be caused by thrush or a yeast infection. These usually look white or yellowish. They are most common in people with poor oral hygiene or on medicines that suppress the immune system.
Infections can be easily treated with anti-fungal drops or gel, which a pharmacist can provide over the counter.
There is also a condition called geographic tongue, where the central part goes red and the outer edges turn white and yellow, making it look like a map. It is more common in people with eczema and psoriasis.
Geographic tongue, where the central part goes red and the outer edges turn white and yellow, making it look like a map, is more common in people with eczema and psoriasis
Similarly, crusty patches can be triggered by lichen planus, which is an inflammation that affects the lining of the mouth.
There is no cure, but geographic tongue and lichen planus can be managed by improving oral hygiene, avoiding spicy and acidic food, alcohol and smoking, and by using irritant-free toothpaste – called SLS-free on the packaging – that a pharmacist should be able to help you find.
I want to start taking oestrogen vaginal cream but can’t seem to find any. I’ve tried a few chemists, but the only one that stocked it would only sell it to me for £25, which I can’t afford. What should I do?
Dr Ellie replies: The cream combats some of the more uncomfortable menopause symptoms – and can be bought without a prescription.
It replaces the female sex hormone oestrogen that is lost during the menopause. It is particularly good at combating vulval and vaginal dryness, as well as other symptoms such as itching and incontinence.
Users usually apply it every day for two weeks, then two to three times a week after that. Each tube should contain around a month’s supply. It can be taken long-term, and is very safe, which is why it can be handed out over the counter.
It’s different to other forms of hormone replacement therapy (HRT), such as patches or pills, in that the hormones are only delivered to the vulva and vagina.
Patients struggling to find the cream should try their nearest large high street pharmacy, such as Boots or Superdrug. It can also be purchased online and delivered to their home.
However, if patients are struggling with the cost, it might be worth getting a prescription. While it can be purchased without one, it would almost certainly lower the price, as NHS prescriptions are usually capped at £9.90. Patients who pay for HRT prescriptions three or more times in a year may also benefit from an HRT prescription prepayment certificate, which can be bought from the NHS website for £19.80, and allows an unlimited number of certain HRT medicines for 12 months.
Those over 60 are exempt from prescription charges.
My blood pressure is normal during the day but in the morning it is very high. I take the blood pressure medicine Ramipril. Should I be worried?
Dr Ellie replies: It is normal for blood pressure – an important marker of health because it measures how effectively the heart is pumping blood around the body – to go up and down during the day.
High blood pressure is linked to heart disease, stroke, kidney disease and vascular dementia.
In the past, most patients had it checked at their GP surgery, but we now encourage readings to be taken at home using a portable monitor. This is because blood pressure often goes up while in a healthcare setting due to nerves. But even at home, readings can vary. Many people notice their score goes up in the morning, before settling down later in the day. This does not necessarily point to any risks.
However, anyone concerned about their blood pressure score – or unsure about the accuracy of readings – should talk to their GP about trying out a wearable monitor. These, fitted around the arm, can be worn for 24 hours.
The GP will then work out the average reading. Research has shown that this it is the most accurate measure.
Patients taking blood pressure tablets but who still have unhealthy readings may need a larger dose. Equally, it is important to consider lifestyle changes, such as reducing salt intake, losing weight and increasing exercise.
Did you put on weight to get free fat jabs on NHS?
Some patients who pay for their weight-loss jab prescriptions through private clinics or pharmacies are being advised to come off them and put weight back on just so that they can qualify for the drugs on the NHS (picture posed by model)
I’m concerned at the lengths patients are having to go to get weight-loss jabs on the NHS.
The NHS prescribes Mounjaro, but very few patients can get it. Only those who are extremely obese and have at least four obesity-related conditions – such as diabetes – are being offered it.
Now I’ve heard that some patients who pay for their weight-loss jab prescriptions through private clinics or pharmacies are being advised to come off them and put weight back on just so that they can qualify for the drugs on the NHS.
I expect even more people to start doing this soon as, from September, the price of Mounjaro is going up by as much as £2,700 a year.
This is worrying, but I understand why people would do this. After all, these jabs are already unaffordable to many. So have you come off the jabs in order to regain weight and get them on the NHS? Please get in touch using the email address below.
HRT… with fewer downsides
There was good news for menopausal women last week after a new HRT tablet was launched on the NHS.
The drug, called Nalvee, produces progesterone, a female sex hormone that is used in combination with oestrogen to provide relief from menopause symptoms. But compared with many menopause medications, Nalvee is less likely to trigger irregular vaginal bleeding – a fairly common symptom of other treatments.
While this kind of bleeding is not dangerous in itself, patients who experience it must be examined in case the bleeding has been triggered by womb cancer.
So women taking Nalvee are more likely to avoid intrusive tests and unnecessary worries about cancer.
If you think that you might benefit from this tablet, speak to your GP. I know that I will be offering it to patients.
Do you have a question for Dr Ellie Cannon? Email DrEllie@mailonsunday.co.uk. Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context.
