Bad breath, body odour, smelly feet, spots, boils and ‘moobs’ are just some of the conditions which, although they won’t kill you, can still get you down and affect your quality of life.
In our unique series on the health problems no one likes to talk about, we help you find the right remedies...
Bad breath, oral malodour, or halitosis is estimated to affect up to 40 per cent of us at some point. Mervyn Druian, a dental surgeon at the London Centre for Cosmetic Dentistry, says he regularly sees patients who are totally socially withdrawn because they are so embarrassed about their breath.
‘The irony is that these sorts of problems are totally fixable, but people are too embarrassed to see anyone to ask for help,’ says Dr Druian, now a fellow of the College of General Dentistry.
Bad breath, oral malodour, or halitosis, is estimated to affect up to 40 per cent of us at some point
It’s totally normal to have ‘morning breath’ — bad breath caused by the mouth drying out overnight and a build-up of smelly bacteria, but this will clear when you’ve had a drink and brushed your teeth.
Other causes of temporary bad breath are certain foods such as onions or garlic — which contain natural sulphur compounds — drinking alcohol or smoking.
Most cases of persistent halitosis are caused by a build-up of bacteria: there are around 100million bacteria living in the mouth, and there are 15 types thought to be linked to bad breath.
‘Almost all instances of halitosis are down to oral hygiene problems,’ says Stephen Porter, professor of oral medicine and director of the UCL Eastman Dental Institute at University College London.
‘If you don’t remove food left in your mouth, the bacteria will break down the debris, producing volatile sulphur compounds, which are sometimes called sulphides or VSCs.’
However, sometimes bad breath can be a symptom of an underlying medical disorder, including infections of the sinus passages and also tonsillitis, where the tonsils become inflamed, as well as acid reflux.
‘Sometimes a foreign body trapped in the nose can cause obstruction, and this can manifest itself as bad breath because bacteria will grow around the obstruction,’ says Professor Porter.
‘If children have a piece of a toy stuck up their nose and this has gone unnoticed, their bad breath can be the first sign that something is wrong.’
Other causes include a condition known as dry mouth, which reduces saliva so debris sticks to the teeth — this can be a result of age or as a side-effect of drug treatments, most commonly antidepressants, explains Professor Porter.
‘Less common causes of halitosis include gastritis, which is caused by the bacteria infection helicobacter pylori, chest infections, cancer of the lung, and undiagnosed diabetes, or the rare instances of liver or kidney failure.’
Some people are convinced they have bad breath when they actually don’t have it, a condition called pseudo halitosis.
‘It’s quite difficult to persuade them they don’t have it,’ says Professor Porter, and indeed this can be a notably disabling disorder as the person perceives that everyone around them thinks they have bad breath.
‘As a result, they can have significant problems maintaining relationships, and may even change their jobs. It is very difficult to shift.’
Dental surgeon Mervyn Druian says halitosis treatment should focus on good oral hygiene.
‘The cells in the lining of the mouth normally break down every two to four days and the saliva you produce carries them away,’ he explains.
‘But in some people, the cells renew more quickly and they break down every six to eight hours, giving off sulphides, which build up, causing bad breath.’
Simple things you can do to prevent this happening include not skipping meals (eating stimulates saliva flow), drinking more water, chewing sugar-free gum or mints and snacking on fruit between meals because it has a high water content and will prevent your mouth from drying out.
As well as brushing your teeth, gums and tongue and removing food with floss, Dr Druian recommends using a mouthwash containing the chemical chlorhexidine, which neutralises sulphides, and/or a toothpaste containing a dilute form of chlorine dioxide — this breaks down sulphur compounds in the mouth rather than just masking the smell.
‘These will all help with halitosis caused by oral health problems and are available from pharmacies and dental surgeries,’ he says.
Other antibacterial ingredients to look out for in mouthwashes and toothpastes include cetylpyridinium chloride, hydrogen peroxide, and zinc.
The National Institute for Health and Care Excellence (NICE) recommends cleaning the tongue with a tongue scraper, particularly the rear upper part of the tongue, where bacteria builds up.
We produce two types of sweat — the watery sweat that cools us down, and an oily liquid that may be linked to sexual attraction.
Cooling sweat is produced by the eccrine glands, found on the soles of the feet, palms of the hands, forehead, cheeks and armpit. If the body becomes too hot, sweat glands in the skin produce more sweat.
The sweat itself doesn’t smell — odour occurs when sweat stays on the skin for too long and bacteria break down proteins in it, creating an odour in the process.
The sweat itself doesn’t smell — odour occurs when sweat stays on the skin for too long and bacteria break down proteins in it, creating an odour in the process
The second type of sweat is produced by the apocrine glands in the armpits, genitals and nipples.
They produce an oily liquid that is full of fat and protein — it’s thought to contribute towards sexual attraction.
Though it’s odourless when released, once this sweat is on the skin it reacts with bacteria such as Staphylococcus hominis, producing malodorous by-products.
Around 4 per cent of people suffer from excessive sweating or hyperhidrosis, says Dr Adil Sheraz, a consultant dermatologist at the Royal Free Hospital in London.
‘There are two types: primary hyperhidrosis, which has no underlying cause, and secondary hyperhidrosis, which is associated with thyroid gland problems and side-effects of medication,’ he says.
These include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and opioid painkillers.
Poorly controlled diabetes can also cause hyperhidrosis because low sugar triggers a fight-or-flight response that stimulates hormone production and sweat secretion.
Hyperhidrosis most commonly affects the hands, feet, underarms, face and head — as these areas have a higher concentration of sweat glands. People sweat excessively regardless of the temperature around them.
Over-the-counter treatments include antiperspirant sprays containing aluminium which block the sweat glands and antibacterial agents to kill bacteria. Some products combine both.
‘For hyperhidrosis, botulinium (botox) injections are available in some places on the NHS,’ says Dr Sheraz.
‘They work by blocking signals from the brain to the sweat glands, and are particularly effective for the underarm area.
‘Around 20 to 30 injections are made in each armpit, which is anaesthetised beforehand with a local anaesthetic.
‘The effects last from four to six months. They are not so practical for the hands and feet because more injections are needed and it’s more painful.’
Other treatments include anticholinergic drugs, which suppress secretions in the body, but these can cause dry eyes and mouth.
‘Another good drug is glyco- pyrronium bromide, but it’s expensive and your GP needs to apply to the local health authority for funding,’ says Dr Sheraz.
A permanent treatment for underarm sweating available privately is miraDry Plus, which uses microwave energy to destroy up to 82 per cent of the sweat glands in the affected area.
Dr Sach Mohan, a cosmetic physician and chief executive of the Revere Clinic in Harley Street, says this treatment was previously available only to hyderhidrosis sufferers, but is now licensed for use in people who are just worried about sweating.
‘We treat a lot of dancers from Strictly Come Dancing, for instance,’ he explains.
Treatment is one 45-minute session under a local anaesthetic. It costs £1,200, compared with £500 for botox injections every four to six months.
Potential side-effects include temporary underarm swelling and tenderness lasting several days.
HOW TO GIVE SMELLY FEET THE BOOT
Whiffy trainers, smelly socks, sandals and shoes and foul-smelling feet are all the result of bacteria breeding on sweat and building up in the foot area.
Consultant podiatrist Matthew Fitzpatrick, spokesman for the College of Podiatry, says no one has inherently smelly feet and that it’s all down to poor hygiene.
‘It’s not the sweat that smells but the bacteria that breaks down sweat on the foot, and if it’s not washed away and is allowed to build up in socks and shoes that aren’t changed regularly, then your feet become smelly,’ he says.
Whiffy trainers, smelly socks, sandals and shoes and foul-smelling feet are all the result of bacteria breeding on sweat and building up in the foot area
‘Because feet are covered up most of the time, this gives bacteria the ideal environment in which to thrive.
‘Your feet sweat into your shoes, so they get damp, and that is when bacteria start to grow.’
Here’s our expert guide for fresher feet…
HATE YOUR MAN BOOBS?
Excess breast tissue — known medically as gynaecomastia — is thought to be a common condition, but experts say it’s difficult to estimate exactly how many men are affected
Excess breast tissue — known medically as gynaecomastia — is thought to be a common condition with one study suggesting it affects up to a third of men, most commonly teenagers and the elderly.
It’s a cosmetic problem, ie, it’s not painful or harmful, but can cause psychological distress.
In fact some of those affected won’t have true gynaecomastia – rather, it will be an accumulation of chest fat called pseudo-gynaecomastia: this looks like breast tissue, but is essentially excess fat.
With gynaecomastia proper, there is a rubbery, firm mound of tissue directly behind the areola and nipple, and this may be surrounded by fat accumulation, explains Dr Sach Mohan, a cosmetic physician at the Revere Clinic in Harley Street.
It is caused by underlying hormone imbalances — primarily a rise in oestrogen levels. This can be the result of excess body fat, as fatty tissues produce this hormone.
It can also be down to liver problems (if oestrogen is not broken down in the liver, it builds up in the body).
Other causes of true gynaecomastia include falling levels of testosterone as a result of ageing. Rarer causes include lumps in the testicles.
Excess breast tissue can also occur as a result of drug treatments, including nitrates for heart disease, medication for stomach ulcers, and drugs and hormone treatments such as those for prostate cancer. Bodybuilders who use anabolic steroids may also develop moobs.
If your GP suspects gynaecomastia, you may be offered a hormone blood test. Treatment of gynaecomastia will depend on the underlying cause. In most cases it is caused either by obesity or liver problems that have raised oestrogen levels, according to Professor Ian Banks, an expert in men’s health, now retired. Sometimes, hormone replacement therapy – such as testosterone injections – is offered.
For pseudo-gynaecomastia, losing weight will help reduce chest fat, and there are also cosmetic procedures to remove it.
In rare cases, breast reduction surgery may be available on the NHS, but only if it is a persistent problem that has caused severe psychological distress.
YOU DON’T HAVE TO LIVE WITH UNWANTED HAIR
Excessive hair growth in women is known as hirsutism.
It can be caused by high levels of the male hormone testosterone due to conditions such as polycystic ovarian syndrome, where small cysts form on the ovaries. As well as hirsutism, this can lead to infertility and weight gain.
However, in 95 per cent of cases, blood tests for testosterone will come back normal, says Dr Daron Seukeran, a consultant dermatologist at the private Sk:n Clinic in Harley Street.
Excessive hair growth in women is known as hirsutism. It can be caused by high levels of the male hormone testosterone due to conditions such as polycystic ovarian syndrome, where small cysts form on the ovaries
‘Most of these women just have increased sensitivity to testosterone hormones, not high levels of testosterone. In exceptionally rare cases, rapid hair growth over a couple of months can be due to an under-lying tumour producing testosterone,’ he says.
‘Women are most bothered by facial hair growth and some will have it so badly they will have a five o’clock shadow and could grow a beard.
‘By the time they get to see a dermatologist, they have tried plucking, and waxing and have either found it’s too time- consuming, causing skin irritation, or it just grows back too quickly.’
But it’s not just women who are seeking help for excess body hair, he adds. Men are increasingly bothered, too — particularly about chest and back hair. ‘They may have shaved or waxed before, but now they want treatments that last for longer.
‘Some women are very reluctant to start shaving facial hair as they wrongly believe it will increase hair growth,’ he adds. ‘It doesn’t. It’s just that all the hair regrows at the same timem, so it’s more noticeable.’
The prescription cream Eflornithine can be prescribed for facial hirsutism in women. It works by inhibiting an enzyme involved in hair growth. It slows down hair growth, but does not remove existing hair and can be prescribed by a GP. The oral contraceptive pill may also reduce hairiness by balancing hormones.
One of the newer treatments is laser hair removal: hair pigment absorbs the light energy which then destroys the hair follicle. ‘The effects can last far longer than other treatments,’ says Dr Seukeran.
‘Facial hair can be treated with six to eight 15-minute sessions.’
It costs around £600 (less if it’s a small area like the upper lip). The treatment is not available on the NHS.
THE DEFINITIVE GUIDE TO BLITZING SPOTS
This will come as no consolation to people who live with it, but acne is the most common skin condition — some 80 per cent of people will be affected by it between the ages of 11 and 30, and it accounts for 3.5 million GP visits every year
This will come as no consolation to people who live with it, but acne is the most common skin condition — some 80 per cent of people will be affected by it between the ages of 11 and 30, and it accounts for 3.5million GP visits every year.
Although commonly thought of as a teenage problem, for some unlucky souls acne can persist into middle age.
‘I have just seen a 46-year-old dentist and she is still suffering from this,’ says Dr Anton Alexandroff, a consultant dermatologist in Leicestershire and spokesperson for the British Skin Foundation. ‘At any age it can be very distressing, a cause of anxiety and social interaction problems and even depression.’
Acne is a collection of skin symptoms triggered by the male hormone testosterone stimulating more oil production. Every hair on the body grows out of its own follicle — or pore — which have tiny glands that produce an oily substance called sebum, designed to prevent hair and skin drying out.
When these sebaceous glands go into overdrive, excess sebum mixes with dead skin cells and plugs the follicle. The results can be limited to small blackheads and whiteheads.
But if these become infected by the normally harmless bacteria that live on the skin — known as P. acnes bacteria — tender red bumps called papules may develop, or what most of us would consider ‘spots’.
Adult acne cases seem to be on the increase, and experts don’t know why, says Dr Anjali Mahto, a consultant dermatologist at the private Cadogan Clinic in London and formerly London North West Healthcare NHS Trust. ‘The biggest causes are hormones and genetics, while stress and sugar consumption play a much lesser role,’ she says.
Crucially, poor hygiene is not to blame. Frequent washing will make no difference to your acne and could make your symptoms worse by aggravating your skin.
Some women who develop acne may be overly sensitive to the male sex hormone testosterone or just be producing too much of it, explains Dr Howard Stevens a consultant dermatologist at The Skin Care Network in Chelsea.
‘Those who go to the gym and work out with weights, for instance, will build more muscle and their testosterone levels will soar, so they can become more susceptible to acne. The same can happen to men who start building muscle in the gym.’
Dr Mahto says: ‘The usual first line of treatment is over-the-counter products.’ These include products containing benzoyl peroxide, which attacks the bacterium P. acnes. It is available in various cleansers — such as Clearasil — as well as stronger, topical gels and lotions such as Acnecide.
Other over-the-counter options are products containing azelaic acid, which has an anti-inflammatory effect and retinoids (a type of ingredient derived from vitamin A) which gently exfoliate the skin to get rid of blackheads and whiteheads and reduces sebum production.
‘Nicotinamide products containing vitamin B, which have an anti-inflammatory effect, and anti-bacterial tea tree oil products can be useful,’ she adds.
GPs can offer prescription-only retinoid (vitamin A-derived) creams or antibiotic creams and oral antibiotics such as tetracycline. Under NICE guidelines, oral antibiotics should always be combined with a topical treatment.
Another treatment for women with acne is the combined contraceptive pill, which has been shown to improve acne by balancing hormones.
‘However, if these treatments are not working after several months you should be referred to a dermatologist, as there may be a risk of acne scarring,’ says Dr Mahto. ‘They can prescribe the drug Roaccutane, which is the gold standard treatment for cystic acne. (See box above.)
‘My go-to treatment for hormonal acne at the moment is an off-label use of the drug spironolactone — my patients love it because it gets good results.’
Although spironolactone is licensed for high blood pressure and fluid retention, it also has an anti-androgen effect — blocking receptors for hormones such as testosterone and limiting hormone fluctuation.
Because it’s a diuretic and can raise the amount of potassium in the blood, you need close monitoring for kidney function and potassium levels, but it’s usually well-tolerated long term.
Dr Howard Stevens says photodynamic therapy, where a light-sensitive medication and a light source are used to destroy bacteria and reduce the activity of the sebaceous glands, can also be effective in people with severe acne who have failed to respond to drug treatments or who can’t take Roaccutane.
‘It is expensive, though, at around £700 per treatment, and around three to four may be needed,’ he says.
At home hand-held red and blue light devices, such as the Neutrogena Visibly Clear Light Therapy Acne Mask (£59, amazon.co.uk), can also be beneficial for mild to moderate acne says Dr Mahto.
‘The blue light targets and kills the bacteria that cause acne and the red light reduces inflammation. It’s a temporary treatment to relieve symptoms.’
HidradenItis suppurativa (HS) are painful lumps or boils in the armpit, under the breasts, groin, buttocks, nape of the neck and inner thighs.
Sometimes, the boils are smelly and develop channels under the skin and leak pus and cause other boils to form.
HS is a chronic skin disease that affects around 1.3million people in the UK, affecting three times as many women as men. Although they form when a hair follicle is blocked, it’s not understood why.
Dermatologist Dr Adil Sheraz explains it’s an inflammatory skin condition that affects areas where the apocrine sweat glands are found. These glands, in the armpits, groin and under the breasts, produce an oily liquid full of fat and protein. They are often misdiagnosed as standard boils and more common in overweight people or smokers.
‘Some people I see are so embarrassed by them they don’t want to let me examine them.’
Treatment is focused on trying to control inflammation and infection, explains Dr Sheraz.
Hibiscrub, an antibacterial wash used by surgeons, can be used to clean the area — it’s available on prescription, but can also be bought over the counter from pharmacists; oral antibiotics may also be prescribed.
Alternatively, a combination of the antibiotics clindamycin and rifampicin may help. Other options include Roaccutane or the immuno-suppressant drug ciclosporin, which also has an anti-inflammatory effect.
Biologic drugs, made with proteins that mimic chemicals in the human body, including Humira (more typically used to treat rheumatoid arthritis), may also help — a review of studies in 2015 by the Cochrane database found 40mg weekly improved quality of life for people with HS.
A version of this article was published in the Daily Mail on August 21, 2017