DR ELLIE: What are these unusual brown patches showing on my legs?

I’ve been taking a blood pressure drug called ramipril for about a decade. Since the dose was increased in 2019, I’ve developed some large, flat freckles on my shins which look like stains. Could this be due to the drug?

Dr Ellie Cannon replies: New skin lesions should always be checked out by your GP.

We look for worrying moles – those which have changed colour, shape or size – as this can be a sign of skin cancer.

But other types of skin changes can be a sign of a medical problem, too.

Many GP surgeries allow patients to send in pictures of skin lesions, which can then be passed on to a dermatology specialist for review.

New skin lesions should always be checked out by your GP, writes Dr Ellie Cannon

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

Hemosiderin deposition is often seen in patients with high blood pressure, so it’s not surprising that someone taking ramipril would get it, and it’s unlikely to be triggered by the drug itself.

It is a commonly used high blood pressure medication.

One side effect is a skin reaction, but usually as rashes or spots – not freckling.

Instead, it might be a sign that the Ramipril is not doing enough to bring down the blood pressure.

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

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

Anyone concerned that the staining on their legs is getting worse should consider moving around more, as well as elevating the legs when possible.

It would be worth speaking to a doctor or pharmacist to see if a light compression sock would be safe to try, as this can improve the blood flow.

A skin reaction might be a sign that the Ramipril is not doing enough to bring down the blood pressure, Dr Ellie writes

I was recently told I have recurrent bronchitis and will need to take antibiotics for a year. I’ve heard that antibiotics can lead to muscle-weakness, so should I be worried about the long-term side effects?

Dr Elie replies: Taking antibiotics for an extended period can have side effects, but it is almost always in the best interest of the patient to do so.

Bronchitis is a medical term for a chest infection. When a patient has recurrent bronchitis, this means that they are battling repeated infections which the body is struggling to clear.

A long course of antibiotics can help remove bacterial chest infections as well as prevent further ones setting in.

Recurrent bronchitis is not to be confused with chronic bronchitis – which is when the lungs remain inflamed even when there is no infection.

One of the most commonly used antibiotics for bronchitis is called 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 may cause gut problems such as a reduction in appetite, pain and nausea. This is because the gut is full of ‘friendly’ bacteria which can be disrupted by the use of an antibiotic.

However, when azithromycin is prescribed for recurrent bronchitis, it is usually given as a low dose compared to when people take it to fight a severe infection, so the risk of these side effects is much lower.

I’m 79 and had my prostate removed about six years ago due to cancer. I’ve been slightly incontinent ever since, but I’ve heard about a procedure called Bulkamid which might help. Might it help me?

Dr Ellie replies: Bulkamid is a procedure which involves partially blocking the urethra – the pipe through which the urine leaves the bladder. 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 fewer leaks, meaning it is a great alternative to more invasive forms of incontinence treatment such as surgery or implant mesh.

But studies suggest it does not work as well for men. The success rate is about 30 per cent and, for this reason, it is only offered to women on the NHS, though it can be done privately for men.

However, there are other options for incontinence. Some medications can combat the issue, 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 exit to the bladder.

It’s worth speaking to a GP about what would be the best way to reduce leakages.