Q: My husband suffers from small itchy bumps on his lower legs, arms, waist and groin. Our GP is treating him with Epimax cream; This keeps his skin hydrated, but does not relieve irritation. You find it difficult to sleep. If he scratches them, they crack and cry.
Helen Sears, by email.
Dr Martin Scurr responds: What you describe sounds like hives, also known as hives. Up to 20 per cent of us will suffer from this condition at some point, with raised, itchy plaques that can resemble a nettle rash.
When it comes to skin disorders, it is necessary to examine the skin closely and perhaps take a sample to confirm the diagnosis.
I say this because hives are common, meaning it could easily be given as a diagnosis when the problem is something else, such as contact dermatitis (an allergic reaction to washing powder or the latex in rubber gloves, for example) or a reaction to medications (such as aspirin or some antibiotics, for example) and some immune-mediated skin disorders.
Itchy skin bumps can often be hives. Doctors may recommend an emollient cream, but the condition can often be misdiagnosed.
In fact, in responding to your letter, I was reminded how complicated it can be to diagnose a rash. I once had a patient ask me to visit her in the hospital, where she had spent weeks with complications after surgery for a broken leg suffered in a bicycle accident. She had a very itchy rash, not unlike the description you have given.
The orthopedic specialists who treated her were unable to help her and she was distraught.
I believe I recommended an emollient similar to the one prescribed to your husband, assuming he had some type of eczema related to the detergent used to wash hospital sheets, or some other allergen at the time of his hospitalization or surgery.
I could not have been more wrong. When the patient left the hospital she was seen by a dermatologist and the correct diagnosis was scabies.
This is a contagious infestation caused by mites that hide just below the surface of the skin, causing intense itching, rash, and skin sores. It is transmitted by skin contact, but also through infected bedding or clothing, even towels. Untreated skin sores can lead to serious complications.
Since it’s unclear what your husband has and he’s experiencing tremendous anxiety about it, I think you should refer him to a dermatologist.
Q: I am a 67-year-old woman. I have a hard time urinating first thing in the morning, but I’m fine the rest of the day. Why is this?
Name and address provided.
Dr Martin Scurr responds: The inability to urinate in the first place, a rare problem in women (in men it is usually related to an enlarged prostate), could be due to an anatomical change in the pelvis that affects urine flow or a response to the medication.
With the first, we would typically be talking about a prolapse of the uterus, bladder or rectum, as a consequence of the weakening of the pelvic floor. Risk factors for this are childbirth, age and obesity. Prolapse can bend the urethra (the tube from the bladder to the outside), causing a slow stream of urine and a feeling of incomplete emptying.
Once you become active at the beginning of the day, any structural alterations within the pelvis can alleviate and allow for normal urinary function.
The second possible cause is medication that interferes with bladder function. Certain medications can cause urinary retention or difficulty starting urination. These include antipsychotics, some antidepressants, antihistamines, and some high blood pressure treatments.
If you take one of these at night, it could cause problems urinating the next morning, which will then improve over time.
I would discuss all of this with your GP – if the problem is not medication, I would suggest a referral to a gynecologist and investigation such as a pelvic ultrasound.
In my opinion… Who is responsible for this scandal?
When I graduated in 1973, my first job was at Westminster Hospital. Several times that year I was called at night to the ER to see a patient who suffered from hemophilia, an inherited blood clotting disorder.
He periodically experienced hemorrhage and became immobile with severe pain.
The treatment consisted of an injection of the clotting factor he was missing. Regular infusions saved his life, but when the imported blood products scandal broke a few years later, I thought about this patient and worried that he had become a victim of HIV or hepatitis C and that I had inadvertently infused him. with infected blood products from the US
The dangers of these products were first mentioned in 1974. Then, in 1983, a study confirmed that the risk of a hemophiliac contracting hepatitis C from an untreated clotting factor was 100 percent after the first treatment.
But over the years, experts and authorities continued to maintain that there was no conclusive evidence that HIV or hepatitis C could be transmitted this way. So the import continued.
After discarding the evidence, are these experts now responsible? I think the answer is yes.