A Question of Health

I suspect my daughter is cutting herself; how should I respond? And what is the best way to tackle persistent blackheads?

Should I ignore it?

Should I ignore it?

Q. I recently noticed that my 14-year-old daughter had deliberately cut her wrist. In the brief moment I saw it, it looked like a portcullis. When I spoke to her about it, she looked sheepish and hurriedly covered it up, and refuses to discuss it. I gather this could be some sort of ritual that girls do, but I am still concerned. I don't want to over-react, or ignore something serious. Should I insist she see our GP, with a view to getting help, or is it better to ignore it?

A. The fact that your daughter has been cutting herself is a sign that she is distressed and troubled. This type of self-harming is unlikely to be "some sort of ritual" she and her friends are doing. The fact that you have shown concern and are not over-reacting is good, but I think you should at least try to point her in the direction of further help. Young people who harm themselves in this way are often suffering strong feelings of anxiety or depression. Sometimes, they are feeling emotionally "numb", and the cutting is a perverse way of making sure that at least they are feeling something. She is not trying to commit suicide, but she is expressing the pain she is feeling. Although she may refuse professional help, I think you should at least offer this to her. The best person to help her would be a psychiatrist or psychologist who has a special interest in adolescents and young people. Your GP may be able to put you in touch with someone, or you could suggest she look at the sites of the National Self-Harm Network ( www.nshn.co.uk) or Mind ( www.mind.org.uk). Mind publishes a useful guide, "Understanding Self-harm". Another organisation, the Self Harm Alliance, has a telephone helpline: 01242 578820.

Gap-year first aid

Q. I am going on a gap-year trip to South America, and I want to take a supply of medicines that might be useful. Can you recommend any antibiotics for things like cystitis and infected cuts and bruises?

A. If you're travelling in rural areas, without access to good medical care, it is sensible to take emergency medications. They are not a replacement for medical care, but they can solve some problems quickly without risking much harm. For cystitis and urine infections, antibiotics such as trimethoprim or ciprofloxacin are good; both will treat most cases of urine infection within a couple of days. It could be sensible to have both drugs; if one doesn't work, the other might. Ciprofloxacin might also help with a bad case of traveller's diarrhoea, although the most important treatment for this is plenty of fluid. For skin infections and infected cuts and bruises, I'd suggest flucloxacillin, a specialised form of penicillin that is highly effective against staphylococcal bacteria, which get into cuts and skin gashes. You will need a doctor's prescription for these antibiotics, although you may be able to buy them at a chemist when you are abroad. And don't forget to take your malaria tablets and to make sure that your travel immunisations are up to date.

Spots of bother

Q. I am 37 and since my early teens I have been persistently embarrassed by the appearance of the skin on my nose and forehead. I have never really suffered from acne, but the skin in these areas is covered in blackheads. They are nothing to do with a lack of personal hygiene, and they are stubbornly resistant to facial cleansers such as Clearasil and Oxy. Is there anything else that might help alleviate a painless but psychologically distressing problem?

A. Blackheads, also known as comedones, are small dark spots caused by plugs that block skin pores. Blackheads are a form of acne, and like other forms of acne they are commonest in the teenage years, tending to disappear with age. But acne can persist into the thirties and forties. One particularly effective treatment for comedone acne is called Retin-A (also known as tretinoin), available as a cream, gel and lotion. Retin-A is derived from vitamin A, and it has a powerful effect on the skin. It sometimes has unwanted side-effects: it is not uncommon to experience some redness and peeling of the skin, but this usually settles down after using the treatment for a few weeks. Retin-A comes in two strengths. It is probably sensible to start with the weaker strength. If this is not effective, move up to the stronger preparation. You will need a prescription to get Retin-A, and you should not use it if you are pregnant or trying to get pregnant.

Have your say: readers write

LG's 10-year-old has suffered problems with dizziness and car sickness:

My 13-year-old son has suffered from sickness, giddiness and headaches for about three years. The symptoms appear roughly every three months and often coincide with a growing phase. He has always been a bad traveller in any vehicle and cannot cope with any kind of roller coaster ride or playground equipment. We control it using "Sea Bands", the acupressure wrist bands which suppress the nausea of travel sickness. The doctor also suggested that he takes travel sickness pills when the worst of the symptoms arise. These seem to work.

Please 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 to health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions