What are these strange brown spots appearing on my legs – and should I be worried? DR ELLIE has the answer

I have been taking a blood pressure medication called ramipril for about 10 years. Since increasing the dosage in 2019, I have developed large, flat freckles on my shins that look like spots. Could this be due to the medication?

Dr. Ellie Cannon responds: New skin lesions should always be examined by your GP.

We look for worrying moles – moles that have changed in color, shape, or size – because these could be a sign of skin cancer.

But other skin changes can also be a sign of a medical problem.

Many GP practices allow patients to send in photographs of skin lesions, which can then be passed on to a dermatologist for evaluation.

Brown spots on the legs are often called hemosiderin deposition. This is something we see on the ankles and legs of patients whose blood vessels are not working as well as they should. This causes blood cells to leak out of the veins and into the skin – hence the brown spots.

Hemosiderin deposition is often seen in patients with high blood pressure. It is therefore not surprising that someone taking ramipril will develop this. It is also unlikely that this is caused by the drug itself.

It is a commonly used drug for high blood pressure.

A side effect is a skin reaction, but usually in the form of a rash or spots, not freckles.

It may also be a sign that Ramipril is not working well enough to lower blood pressure.

This is worrying because high blood pressure increases the risk of heart disease.

Other ways to manage high blood pressure include exercising, eating a healthy, low-salt diet, and not smoking or drinking alcohol.

If you are concerned that the spots on your legs are getting worse, you may want to consider exercising more and elevating your legs if possible.

It’s worth talking to a doctor or pharmacist to see if a light compression stocking is safe to try, as this can improve blood flow.

A skin reaction may be a sign that Ramipril is not doing enough to lower blood pressure, writes Dr. Ellie

I was recently told that I have recurring bronchitis and will need to take antibiotics for a year. I have heard that antibiotics can cause muscle weakness, so should I be concerned about long term side effects?

Dr. Elie replies: Long-term use of antibiotics can have side effects, but it is almost always in the patient’s best interest to do so.

Bronchitis is a medical term for a chest infection. When a patient has recurring bronchitis, it means that he or she is fighting repeated infections that the body is trying to clear.

A long-term course of antibiotics can help clear bacterial chest infections and prevent new infections from developing.

Recurrent bronchitis should not be confused with chronic bronchitis, in which the lungs remain inflamed even in the absence of infection.

One of the most commonly used antibiotics for bronchitis is azithromycin. Muscle weakness is not listed as a possible side effect, although joint pain has been reported in about one in ten users.

Taking antibiotics for a year can cause intestinal problems, such as loss of appetite, pain and nausea. This is because the intestines are full of ‘friendly’ bacteria that can be disrupted by the use of an antibiotic.

However, when azithromycin is prescribed for recurrent bronchitis, it is usually done at a lower dose than when people are taking it to treat a serious infection. The risk of these side effects is therefore much lower.

I am 79 and had my prostate removed for cancer about six years ago. I have been mildly incontinent ever since, but I have heard of a procedure called Bulkamid that may help. Could it help me?

Dr. Ellie responds: Bulkamid is a procedure in which the urethra, the tube through which urine leaves the bladder, is partially blocked. This is done using three to four – often uncomfortable – injections of gel into the wall of the urethra.

Many women who have undergone Bulkamid report reduced urine leakage, meaning it is a great alternative to more invasive forms of incontinence treatment such as surgery or mesh implants.

But studies suggest it doesn’t work as well for men. The success rate is around 30 per cent and for that reason it is only offered to women on the NHS, although it can be done privately for men.

There are other options for incontinence, however. Some medications can help with the problem, including oxybutynin, solifenacin, and mirabegron, which are most helpful if the bladder is overactive.

The NHS also offers bladder physiotherapy, which involves exercises to strengthen the muscles that control the outlet to the bladder.

It is worth talking to a GP about the best way to reduce leaks.