A Question of Health

Will this treatment clear my spots? And is my binge-eating something to worry about?

Spotty problem

Spotty problem

Q. I have several white spots under one of my eyes. These are very hard and some of them are bigger and flatter than others. I've been told by some beauticians that these may be milia, and that they are the result of excessive moisturisation of the area. They suggest steam and extractions by very fine needles. Are they correct and should I go along with their suggestion or should I see a dermatologist instead?

A. Milia are tiny pearly white or yellowish skin cysts that contain a substance called keratin. The commonest place for them to occur is around the eyes. Milia are usually only 1-2mm across, so if yours are larger they may not be milia. Another similar skin problem around the eyes is caused by raised levels of cholesterol. These spots, called xanthelasma, tend to be yellower than milia, although they can look similar. Under the microscope, xanthelasma contain fatty deposits. Milia are caused by blocked skin and sweat pores. The normal secretions of the skin get trapped, causing a white deposit to develop. It is not necessary to treat milia, but they can be opened with a sharp sterile needle and the keratin can be removed. Unfortunately, they can form again if the pore is damaged.

Am I bulimic?

Q. I have recently grown quite concerned about my eating habits. Although I have sought help from my GP, I do not feel there has really been enough time during a consultation to discuss the issue. As a student, it would also be difficult for me to finance any private professional help, so I would be grateful if you could suggest what I ought to do. According to my doctor I have an average body mass index and weight for an 18-year-old, and I try to exercise on alternate days (cycling or brisk walking). Nevertheless, for the last few years there have been many occasions when I would binge-eat frequently, and recently this seems to have escalated. Last October I started to induce vomiting to prevent weight gain following large intakes of food. I am ashamed of this. I am not sure if it is a result of stress from university or the feelings of depression I often have, but I am sure that I have lost a sense of balance - I find it difficult to stop eating between meals, especially when I am alone and not hungry.

A. You are describing many of the symptoms of bulimia. Binge-eating followed by induced vomiting, shame and guilt, stress and depression are all aspects of bulimia, an eating disorder that is remarkably common. Unlike anorexia, which causes severe weight loss, people with bulimia are often of normal weight. Some studies have shown that as many as 35 per cent of young women have had some symptoms of bulimia. Bulimia seems to have become more common, perhaps because of the stresses of modern life. I think you are right to seek help because bulimia can become a pattern of behaviour that is difficult to change. If you are a student, it is likely that your student health service has experience in helping people with eating disorders. Ask if you can be referred to a counsellor or therapist who is experienced in helping people with eating disorders. Your GP might be able to refer you. The other aspect of your health to consider are your feelings of depression. If these can be helped, your urges to eat and vomit may be easier to control. Get in contact with the Eating Disorders Association. Its website (www.edauk.com) contains a comprehensive database of experienced professionals and helpline numbers.

Clarity please

Q. Nutritional information on food packets lists the amount of "sodium" per 100 grams. Does this mean "salt" (sodium chloride), or does it just mean "sodium"? Medical advice warns us against high salt intake, so such vagueness is not very helpful.

A. Ordinary table salt is made up of both sodium and chloride. One gram of salt (sodium chloride) contains 0.39 grams of sodium and 0.61 grams of chloride. When a label says that it contains a certain amount of sodium, it means exactly that. So, for example, if a tin of baked beans contains 0.39 grams of sodium, it will also contain 0.61 grams of chloride, making a total of one gram of salt. The recommended daily intake of salt is 6 grams, which is the equivalent of about 2.3 grams of sodium. As a rule of thumb, multiply the sodium content by 2.5, to get the approximate salt content.

Have your say: Readers write

MW comments on fingers that keep developing blisters:

I'm an anaesthetist, not a dermatologist, but it sounds like your reader may have pompholyx (or dishydrotic) eczema. I had this for many years before I realised the triggers for me were fabric and hair conditioners. My father and brother both have this so there may be a familial element to mine. Unfortunately it's not much use for your correspondent as the mainstay of treatment is as for all eczema - avoiding triggers, emollients, topical steroids, and antibiotics for secondary infection. I found potassium permanganate soaks helped to dry up the blisters and antihistamines were useful for the itch. Avoiding any chemical allergens may be difficult, but their occupational health department should help.

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