Q: MY SISTER has huge red, raised patches of skin all over her body, including her upper legs. She says the itching is unbearable. Her doctor mentioned guttate psoriasis and suggested applying E45 cream. She is 78 years old and has had a lot of stress. Her advice would be appreciated.
A: PSORIASIS IN GUSTATAS is a skin condition that is usually triggered by a bacterial infection, such as strep throat or a sinus infection, but some people are also genetically more prone to it.
Within a few weeks of infection, numerous red spots, usually between 2mm and 15mm in size, suddenly emerge on the trunk and upper arms and legs, and sometimes on the face, hands, and feet. feet. In some cases, these patches can be itchy.
Guttate psoriasis is the result of the immune response, which had been fighting the infection, wrongly directing its attention to the skin. Stress can also play a role.
In about 60 percent of cases, guttate psoriasis resolves on its own within weeks or months.
However, in about a third of cases, it leads to chronic plaque psoriasis, which typically causes larger patches of scaly, itchy, raised skin due to an overproduction of skin cells. This is also triggered by an overreaction of the immune system.
Plaque psoriasis has a strong genetic element. You say in your longest letter that you have this particular shape, and I suspect your sister may have it too.
E45 is an emollient, a medical moisturizer that can help soothe the skin but does not address the cause of the symptoms. However, corticosteroids (applied as a cream or ointment) or calcipotriol, an ointment derived from vitamin D, can help reduce the underlying inflammation of both guttate and plaque psoriasis.
There is also a topical combination medication containing the steroid betamethasone and calcipotriol, called Dovobet, which studies have confirmed to be highly effective.
The difficulty with this type of treatment is that the rash tends to be widely distributed over the body, making daily applications relatively impractical.
An alternative treatment is phototherapy, which involves exposing the skin to a specific wavelength of ultraviolet light that slows down the turnover of skin cells. However, that will require a referral to a specialist dermatology unit from your GP.
If they can’t help, careful exposure to the midday sun for up to 10 minutes could improve significantly, but it’s critical that your sister doesn’t stay outside too long to avoid getting burned. Using sunscreen creams would block beneficial UVB light.
If your sister shows no signs of improvement, another visit to the GP is required.
Q: IN THE PAST YEARS, if I get water in my ear when taking a shower, I end up with a smelly yellow discharge. The ofloxacin drops clear the infection, but I want to know what is causing this?
A: YOU SAY in your longest letter that the problems with your ear date back 50 years to an infection that ultimately required surgery.
There are two features in your history that point me to a probable diagnosis. The first is that if he gets water in his ear an infection is likely to follow, and the second is that he mentioned that he also has a perforated eardrum.
My opinion is that you have silent mastoiditis, a chronic infection of the mastoid air cells, causing only occasional symptoms.
The mastoid bone (the area of the skull immediately behind the ear) has a spongy honeycomb structure made up of mastoid air cells, small air-containing cavities that protect the ear and regulate pressure within the middle ear.
Normally, a small perforation of the eardrum will heal, but not when there is ongoing infection in the middle ear cavity or mastoid air cells.
In that case, the water in the ear will pass through the perforation and cause a flare-up of any low-grade infection in the mastoid (left over from the original infection 50 years ago).
There are no ear drops for this type of infection, so ofloxacin eye drops are used. These contain a powerful antibiotic that suppresses infection when it occurs, but is insufficient to fully penetrate the sponge-like mastoid air cells, and thus low-grade infection has never been completely eradicated.
I suggest you discuss your medical history with your new doctor, since it says you just moved, and seek a referral to an ear specialist.
The most likely outcome is that you will be referred for a CT scan of the mastoid bone to confirm or rule out silent chronic mastoiditis.
If my suggested diagnosis is correct, I may need another surgery. The operation years ago may not have been radical enough to remove all of the infected bone. I hope this helps.
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