I’ve recently noticed ‘bald’ patches on my face where no stubble grows. Although it’s not causing me concern it’s very noticeable if I don’t shave every day. What’s causing them?

David Allan, via email.

This sounds like alopecia arrea, a condition where the immune system attacks hair follicles. This causes inflammation, which damages the hair production process.

It can affect both men and women of all ages and most commonly the scalp. Some people may develop the facial shape, which can cause a few small bald spots or more severe hair loss.

In about one in ten patients, the condition progresses either to alopecia totalis — loss of all scalp hair — or alopecia universalis, the complete loss of all hair from the scalp, face and body.

Some people, however, develop the facial form, which can cause one or two bald patches the size of small coins, or more widespread hair loss

Some people may develop the facial shape, which can cause a few small bald spots or more severe hair loss.

It’s possible that your scalp could become affected — research shows 46 per cent of men with bald patches on the face go on to lose hair from their heads.

It isn’t clear why the immune system attacks the hair follicles. We know that alopecia areata can be linked to other auto-immune conditions, which result from the body’s immune system attacking it.

Alopecia areata affects between 10 and 25% of people. This is caused by immune cells attacking the thyroid gland. It is possible that there is a genetic link.

Although it is distressing, Alopecia areata can be very treatable. Follicle damage is usually not permanent. Most people recover fully without any treatment — often within a year.

The treatment is centered on steroids like triamcinolone which reduce inflammation caused by immune system attack. Tiny amounts of steroid injections at multiple sites on the bald patch are better than creams.

This sounds like alopecia areata, a common condition in which the immune system malfunctions and attacks hair follicles. This causes inflammation that damages the hair production process

This sounds like alopecia arrea, a condition where the immune system attacks hair follicles. This causes inflammation and damages the hair-making process.

After a few weeks, new hair will usually start to grow. It is possible that the process needs to be repeated every four to six more weeks. However, it can be uncomfortable to administer multiple injections.

Thinning of the skin can be caused by the steroid, but this usually resolves in a few months. It can also affect skin pigment, resulting in white patches that can look worse than hair fall. These caveats aside, I would advise you to just leave it alone.

However, if your scalp is experiencing significant hair loss, your doctor should refer you to a dermatologist.

Since 18 months, my left ear crackles when I swallow and hurts when I blow my nose.

My GP diagnosed a blocked Eustachian tube and prescribed a nasal spray but that didn’t work. Another doctor prescribed ear drops which failed to help. What other remedies are available?

Andrea Ford, Willoughby Lincs.

The Eustachian tub connects the middle of the ear to the area just behind the nose.

It can be opened and closed to equalise the air pressure inside and outside of the head. It is usually closed, but it opens every time you chew, yawn, or swallow.

The Eustachian tube can’t open properly if it is blocked by mucus, such as from an allergy or infection. This can cause muffled sounds and even pain.

However, in your case, the Eustachian tube is not opening. It is closing.

Although it is not dangerous, it can cause the crackling sound that you describe.

That’s because the Eustachian tube also protects you from hearing the noises your body makes.

If it is ‘stuck’ open you could also hear your own breathing and heartbeat, and your voice may sound louder than normal.

Although it can be difficult to determine the cause, we know that allergies can cause chronic inflammation, which can lead to damage to the delicate lining of the tube. This can increase the risk of Eustachian tube dysfunction.

Weight loss is another factor, because as overall body tissue shrinks, the tube’s ability to close properly is affected. Stress, anxiety, and hormonal imbalances are all possible triggers.

Ear drops will not help you because they only trickle to the Eustachian tubes and not the eardrum. The symptoms may get worse if you use nasal drops to decongest.

Surgery is an option that involves inserting a grommet into your eardrum to ventilate your middle ear. This approach is similar to using a sledgehammer to crack a peanut.

You can rest assured that your symptoms are not caused by anything serious.

Write to Dr. Scurr

Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — include your contact details. Dr Scurr can not enter into personal correspondence.

Replies should be considered in a general context. Always consult your GP if you have any health concerns.

In my view: It’s vital your pills are reviewed

Regular reviews of a patient’s drug prescription list are an essential component of good medical care. They can be used to inform patients about the need to stop using drugs, change to safer medications, adjust the dose, or add new drugs.

Recently, the chief pharmaceutical officer for NHS England, Dr Keith Ridge, released a report which saw the Government pledge to reduce overprescribing, as it’s estimated that 15 per cent of people take five or more medicines every day.

Even if each medication is prescribed correctly, multiple medications can pose a danger. A lack of continuity of care — seeing the same doctor for regular treatment — means avoidable adverse drug events are all too easily missed.

The report found that around one in five hospital admissions in over-65s is caused by such events — a shocking statistic. These days, computer-generated prescriptions can detect potential adverse interactions before they happen and issue an alert, so it’s all the more surprising that so many complications continue to occur.

Most patients on multiple drugs are older — our metabolism changes as we age and there is decreased drug clearance due to the natural decline in both kidney and liver function.

Certain drugs, particularly anticholinergics (widely prescribed for bladder conditions and lung disease), are known to cause a decline and decrease in cognition and mobility. They are also linked with an increased chance of death.

You need to strike the right balance between over-prescriptions and under-prescriptions. This arguably requires the very elements that are currently missing in healthcare — continuity of care and precious time with the GP — so that an older patient’s mix of prescriptions can be regularly reassessed.