Q: I have had itchy, flaky ears for over a year. My GP has prescribed ear lotions, creams and drops, but nothing has worked. I am embarrassed by the flaky skin on my clothes and my unsightly ears.
My GP won’t refer me to a dermatologist – he says my ear canals are small, which is what caused the problem.
Helena Vernon, Surrey.
A: Itchy, flaky ear canals are not an uncommon problem; they are usually caused by a localized form of eczema.
It usually goes away with a prescription steroid, in the form of drops or ointment.
Doctors often also prescribe an antifungal medication at the same time, on the grounds that this type of eczema may be related to an overgrowth of the Malassezia yeast, which is found naturally on the skin.
Itchy, flaky ear canals are not an uncommon problem; they are usually due to a localized form of eczema. (File photo)
If it is psoriasis, this treatment will improve symptoms within a few weeks and can be continued long-term. (File photo)
In your case, not only are both ears affected, but they are quite severely affected, as well as the crease behind your ears and your ear canals. If it were a form of eczema, you would have expected it to resolve with one of the treatments your doctor has probably prescribed, so it seems you have not yet received the correct diagnosis.
I wonder if the problem is psoriasis, an autoimmune disease caused by a combination of genetic and environmental factors, which causes an intense inflammatory reaction, an overproduction of skin cells and itchy, scaly patches.
I recommend that you consult your doctor to explain that the itching and scaling in and around your ears has not resolved and that it has been suggested that it may be psoriasis. If they are still reluctant to refer you to a dermatology clinic, ask them to at least prescribe Dovobet or Dovonex, which contain calcipotriol, a form of vitamin D (Dovobet also contains a steroid; Dovonex does not) that reduces the number of cells your skin produces.
If it is psoriasis, this treatment will improve symptoms within several weeks and can be continued long-term.
Q: I am 65 years old and for several years I have been suffering from sharp pain in my left groin when I stand up. Recently, I have also had constant pain in my inner thigh. Would physical therapy help?
Liz Griffiths, by email.
Based on your description, I suspect you have early stage hip osteoarthritis. This causes pain, stiffness and restricted movement; most commonly the pain is worse when rising from a sitting position and then radiates to the knee when walking.
You should see your GP so they can refer you for X-rays of both hips to confirm this diagnosis.
In the meantime, physical therapy can help. There is evidence that exercise can reduce pain and improve movement in people with hip arthritis.
You should go to your GP so he or she can recommend X-rays of both hips to confirm the diagnosis. (File photo)
What you need is an evaluation by a specialist physiotherapist so that he or she can develop an individualised exercise regimen, taking into account factors such as muscle wasting or an abnormal gait.
Hip osteoarthritis is common (one in four people aged 85 have it, but it can develop decades earlier), so at age 65 this is the most likely cause of your symptoms.
One major risk factor is being overweight. So if this is a problem for you, losing weight can not only reduce pain, but could also help recovery after joint replacement surgery, if it becomes necessary in the future.
But it is quite possible that physical therapy will allow enough improvement to be able to postpone hip replacement surgery.
The short answer is yes, it is certainly worth asking for a referral to physiotherapy, something that should be discussed with your GP, along with a request for a hip scan.
There may be a waiting time for physiotherapy on the NHS, so you may want to consider paying for it privately.
In my opinion… Rebellious cyclists need to be stopped
More should be done to ensure that, while improving their own health, cyclists do not endanger the rest of us. (File photo)
This week I have treated two injured cyclists, both in central London whilst cycling on the pavement.
The first fell off his bike when his head hit a shutter protruding outside a shop and fractured some ribs.
The second fell on his outstretched hand as he dodged a pedestrian and crashed as he left the sidewalk, going down a steep curb. He fractured his wrist and, as he was not wearing gloves, suffered deep abrasions to his palm.
I was thinking of these two patients when I read that Louise Haigh, the new Transport Secretary, said the Government is planning unprecedented levels of funding for cycling.
Yes, cycling should be encouraged, but perhaps we should remind her and cyclists that the Highway Code lists penalties for cycling on the pavement as a £500 fine, and also that injuring a pedestrian on the pavement while cycling is a criminal, not a civil, offence.
More should be done to ensure that, while improving their own health, cyclists do not put the rest of us at risk.