Thank you Dr Kownacki and Dr Murad for your replies. Dr Kownacki - I have been using the 15% strength of azelaic acid (Finacea gel) - is this not strong enough to see an effect and should I go up to a product that is 20% strength (e.g. Skinoren as you suggested) for a month or so before concluding t...

The British Association of Dermatologists patient information leaflet on melasma (March 2012) refers to creams that reduce the activity of the pigment-forming cells in the skin and lists hydroquinone creams as the most commonly used. However, when my GP looked in the BNF (in August 2013) he could no...

I would particularly like to thank Dr Shepherd, whose posts have been consistently clear, thoughtful, practical and considered and have shown a marked degree of empathy and humility. I have learnt a lot from his posts and have been pointed towards some new resources to consult in the future. Dr Shep...

I share Jon Denberry's concerns about the potentially ambiguous information about recovery from CFS after treatments in the PACE trial. In the interests of those who do not have access to the journal Psychological Medicine I would like to quote from and comment on two articles published by the PACE ...

Dr Miller wrote: The principle of GET is based on the fact that the people who make the best recovery from CFS/ME steer a compromise between over and under activity. People who fare badly either tend to drive themselves too hard and "crash" as is well described by several contributors or t...

@Alastair Miller said: "I agree that neither CBT nor GET are perfect and neither produce a cure in 100% which is clearly our goal." Please can you provide us with the research evidence that CBT or GET have produced a (well-defined and lasting) cure in anyone with robustly-defined ME (as op...

Dear Jessica Thank you for your reply - but unfortunately it left me more confused! You comment that "once scientific studies have taken into account deconditioning and abnormal perception of effort, muscle function is in fact normal". However, the 2013 study in Physical Therapy (the link ...

Thanks Chris - that's really interesting. It would be great if more research could be done in this area.

What is the current thinking/evidence on abnormal muscle function in ME? I'd love to believe the "it's just deconditioning" hypothesis, but my muscles now respond to exercise and to increases in exercise so differently from how they used to when I was training for a half marathon before I ...