Common health questions answered: keratosis pilaris, shingles vaccine updates, post-stroke incontinence, knee osteoarthritis, and grey area drinking

A health Q&A roundup from GP Dr Ellie Cannon covers several everyday concerns, starting with a stubborn red rash on the arms and moving through vaccines, incontinence after a stroke, knee osteoarthritis, and patterns of alcohol use.

Keratosis pilaris is a common, harmless condition that causes red bumps on the upper arms, and it can also appear on the legs, buttocks, and back. The bumps may feel rough to the touch and can itch, particularly when the skin is dry in winter. The condition arises from a buildup of keratin, a protein in the skin, which can block hair follicles and create goosebump-like patches. It affects more than four in ten adults, making it a frequent concern for many readers seeking guidance on management.

The first line of treatment is regular emollient moisturisers. Products containing salicylic acid, such as CeraVe SA, help soften and flatten the bumps, while moisturisers with urea can be similarly useful. If over-the-counter options do not provide relief, prescription creams that soften the skin, including steroids and retinoids, may be recommended. Regular gentle exfoliating scrubs, short lukewarm showers, and using a humidifier to add moisture to the air can also help. For a definitive diagnosis, a GP can confirm keratosis pilaris, often using virtual consultations that involve sending pictures of the rash.

Turning to shingles vaccination, readers are told that the NHS has shifted away from the older Zostavax vaccine, which offered about 40 percent protection that waned over time. Since 2023, the NHS has been offering Shingrix, a more effective option, with estimates reaching up to 97 percent efficacy and longer-lasting protection. However, eligibility remains limited. The current NHS rollout covers people aged 70 to 80, as well as those turning 65, with vaccination capped at the 80th birthday due to limited long-term data for older patients. Those who received Zostavax in the past decade are not eligible for Shingrix under current rules.

There are exceptions. As of the start of this month, adults 18 and over who are severely immunosuppressed can receive Shingrix regardless of age. If before 2013 someone had Zostavax and now meets NHS criteria for vaccination, or if severe immunosuppression has developed since the old jab, they can also receive Shingrix. For individuals who cannot obtain the vaccine on the NHS, private purchase is possible, with most pharmacies offering the two-dose course for about £460. Anyone over 50 may pay for the vaccine, even if they have previously received Zostavax. Patients are advised to discuss options with a GP to navigate eligibility rules.

Incontinence after a stroke is another area readers inquire about. Hormone replacement therapy, or HRT, is not a reliable solution for stroke-related incontinence. Oestrogen can help bladder symptoms when incontinence is tied to menopause, but it does not address brain-damage–related incontinence caused by a stroke. NHS local bladder services typically provide pelvic floor exercises and guidance to manage urinary leakage after a stroke, and patients are encouraged to seek these services where available.

For knee osteoarthritis, natural approaches are emphasized. Weight loss, physiotherapy, and regular exercise are well-supported strategies to reduce pain, improve function, and lower the risk of requiring knee replacement surgery. While many patients report benefit from supplements such as glucosamine and chondroitin, the medical evidence for these remedies is inconclusive. The overall message is that non-surgical strategies deserve emphasis before considering surgery, and patients are encouraged to pursue a plan with their clinician.

Grey area drinking has emerged as a focal point in conversations about alcohol use. The NHS advises no more than 14 units per week for adults, but many people exceed this level and do not identify as dependent. These individuals fall into the grey area category, where the risk of health issues persists even without apparent dependency. Practical steps suggested include keeping a weekly alcohol diary to identify patterns and setting drink-free days to reduce consumption. Readers who think they might be in this category are invited to reflect on their drinking and consider steps to cut back.

Readers who want to ask Dr Ellie Cannon a question are encouraged to email DrEllie@mailonsunday.co.uk. The column notes that while Dr Cannon cannot engage in personal correspondence, responses should be understood as general guidance. The overarching takeaway from these topics is to seek professional evaluation for a diagnosis when appropriate, and to discuss management options with a healthcare provider to tailor care to individual health needs.