A Question Of Health

Why is my scalp dry and itchy? And what can I do to stop my ankles swelling up?

ANTISOCIAL ITCH

Q. I suffer from a very dry, itchy scalp. I am constantly scratching it at work, which must irritate my colleagues, though they are good enough not to comment on it. I produce a lot of dandruff, too. I am a 26-year-old male, with otherwise healthy (albeit receding) hair. On my hairdresser's advice, I switched from Head & Shoulders to a Body Shop organic shampoo, thinking it would contain fewer chemicals, and I now wash my hair every other day rather than daily. But it's as itchy as ever and is becoming an antisocial obsession (I even do it in my sleep), so I would be grateful for any advice.

A. Dry, itchy scalps are often the result of a chronic fungal infection, and I suspect that this may be the underlying cause of your problem. The culprit organism is known as Malassezia ( Pityrosporum ovale), a yeast that normally lives happily on the skin. However, when it begins to overgrow, it causes dandruff, scalp itchiness, and a skin condition called seborrhoeic dermatitis. Dandruff is sometimes said to be the mildest manifestation of seborrhoeic dermatitis, which also causes redness and scaliness of the skin around the face, eyebrows and ears. The most effective treatment is designed to slow down the growth of the yeast. Two brands are available over the counter - Nizoral and Dandrazol. They both contain an antifungal called ketoconazole. If you want to avoid drug-based treatments, try a shampoo called Selsun, which contains selenium sulphide and also effective, although probably not as good as ketoconazole. I doubt very much that your itchiness is in any way related to the fact that your hair is thinning. Very severe fungal infections of the scalp can permanently damage the hair roots, but dandruff does not make the hair fall out.

JUST SWELL

Q. I am a 56-year-old woman with a water-retention problem. I have suffered from swollen feet and ankles for years but, until recently, only in hot weather. My feet return to normal size overnight but, by the end of the next day, are swollen again. And I now have the problem all the time. Is there any way I can prevent this from happening, rather than just taking diuretics to solve it?

A. Feet and ankles swell up when fluid leaks out of the blood vessels and into the tissues of the lower leg. Gravity and walkingput pressure on veins and capillaries in the legs, forcing fluid out into the tissues. The fact that you have had this problem for years probably means there is a genetic leakiness in your blood vessels. The swelling recedes at night because, when you lie down, the fluid redistributes itself. A low-salt diet helps the body to retain less water, so try to reduce salt and sodium intake. Exercise that uses the calf muscles - walking, running or simply wiggling feet around - will pump some excess fluid out of your legs. You could try wearing support stockings, which apply gentle pressure and force fluid upwards. There are other, more serious causes of swollen ankles and feet, such as heart and kidney problems, so, if things have got worse, have them checked out.

Have your say: Readers write

AD managed to solve her bladder problems simply by changing her diet:

I suffered from urine leakage problems for a couple of years and attributed the situation to the fact that I was getting older.

However, the problem then cleared up, which I put down to my decision to give up eating citrus fruits and drinking fruit juice. I suggest removing acid foods from the diet, and possibly even drinking bicarbonate solutions, as recommended for cystitis. It might take some time to be effective, but it seems to be worth a try.

Send your questions and suggestions to: A Question of Health, 'The Independent', 191 Marsh Wall, London E14 9RS; fax 020- 7005 2182; or e-mail health@independent.co.uk Dr Kavalier regrets that he is unable to respond personally to questions