My son is 11 and has started to develop acne. Surely he is too young?

Around 80% of 11 to 30 year-olds are affected by acne, although in boys the condition is most common in 16 to 19 year-olds.

Acne is a chronic skin condition, which causes spots to develop on the skin, usually on the face, back and chest. The symptoms of acne can be mild, moderate or severe. It can cause great distress and have an adverse effect on a person’s quality of life and self-esteem. Therefore, healthcare professionals recognise that the condition requires effective and sometimes aggressive treatment.

With treatment, the outlook for acne is generally good. Treatments can take between two to three months to work but, once they do, the results are usually effective.

Approximately 90% of people who seek treatment for acne will show at least a 50% improvement in their symptoms after three months. Once the symptoms are under control, additional treatments can be used to prevent the acne from recurring. This is known as maintenance therapy. The important thing is to prevent scarring. This is usually done through prompt treatment so it is worth discussing acne with your pharmacist in the first instance. If over the counter remedies are not working you can arrange an appointment with your GP and your son to discuss the range of options available.

I am a 60-year-old man and I have been feeling the need to go to the toilet much more often recently. However, once there, I find it difficult 'to go'. What might be the cause?

The first thing is that there is no cause for alarm. The symptoms you describe are very common in a man of your age and could be caused by a number of things.

What I would recommend is you visit your GP and arrange to have your prostate gland checked because prostate problems can present exactly these symptoms and it is worth ruling it out.

The prostate gland is a small gland in the pelvis found only in men. About the size of a satsuma, it is located between the penis and the bladder and surrounds the urethra. It is important to have your symptoms checked because any changes in the prostate should be checked professionally.

What is Addison's Disease?

Addison’s disease (also known as primary adrenal insufficiency or hypoadrenalism) is a rare disorder of the adrenal glands which are two small, pyramid-shaped glands that sit on top of the kidneys. Addison's disease affects the production of two hormones –cortisol and aldosterone – which help to regulate blood pressure.

Cortisol is released in stressful situations and helps to maintain your energy levels, your blood sugar levels and carbohydrate metabolism. Aldosterone maintains the balance of salt and water in your body, which helps to control blood pressure.

Each adrenal gland has inner and outer layers, each of which has a separate function; the inner area (the medulla) produces the hormone adrenaline while the outer layer (the cortex) produces cortisol and aldosterone . In Addison’s disease, usually the cortex of both adrenal glands has been destroyed. This disrupts the production of cortisol and aldosterone.

Symptoms

At first, the symptoms of Addison’s disease are similar to other more common health conditions such as depression or flu. Dehydration can also be an early sign due to the lack of aldosterone in the body.

Over time, these symptoms may become more frequent, or get worse and you may also experience further symptoms, such as dizziness, fainting, cramps, exhaustion and increasing skin pigmentation.

It is thought that stress such as an illness or accident can also trigger these symptoms, or cause them to get worse.

Diagnosis

Addison’s disease is usually caused by an autoimmune condition, where the immune system produces antibodies that attack the body. In diagnosing Addison’s disease, your GP will ask you about your symptoms and review your medical history. They are also likely to ask about your family to see if there is any history of autoimmune disorders.

Your GP will examine your skin for any evidence of hyperpigmentation (brownish discolouration of the skin). This will be particularly noticeable where your skin creases on your palm or in your elbow, and also on any scars. However, hyperpigmentation does not occur in all cases of Addison’s disease.

You will also be tested for low blood pressure (hypotension); this will probably be measured while you are sitting down and again shortly after you stand up. This is to see whether you have postural or orthostatic hypotension (low blood pressure when you change position).

If Addison’s disease is suspected, samples of your blood will be tested for the salt levels, sodium and potassium, and the hormone cortisol. A low sodium, a high potassium or a low cortisol level may indicate that you have Addison’s disease.

Treating Addison's disease

Management of Addison's is frequently led by a specialist called an Endocrinologist i.e. a doctor who has expertise in glands and hormones. In the majority of cases of Addison’s disease, treatment will involve corticosteroid (steroid) replacement therapy, which is ongoing for life. Corticosteroid medication is used to replace the cortisol and aldosterone that your body no longer produces. This is usually taken in tablet form (orally) once or twice a day. Synthetic glucocorticoids such as hydrocortisone are used to replace the cortisol. Other possible medicines are prednisolone or dexamethasone, though these are less commonly prescribed.

Aldosterone is replaced with oral doses of a mineralocorticoid, called fludrocortisone. Your GP may also ask you to add extra salt to your daily diet, although if you are taking enough fludrocortisone medicine this might not be necessary. Unlike most people, if you feel the urge to eat something salty, then you should eat it.

Addison’s disease should not affect your quality of life or how long you live. Your diet, exercise and daily routine can all continue as normal. However when you have illness such as colds or flu it may be necessary to change how much medication you take to allow you to cope with the extra challenge on your body. People with Addsion's should contact their GP if they fell unwell for advice.

You will usually need to have appointments with an endocrinologist every 6-12 months, although your GP can provide support and repeat prescriptions in between these visits. As long as you take your medication, the symptoms of Addison’s disease should be very well controlled.