Q: I have had itchy, scaly ears for more than a year. My GP has prescribed lotions, creams and ear drops but nothing has worked. I’m embarrassed by the flaky skin on my clothes and my unsightly ears.
My GP won’t refer me to a dermatologist; he said my ear canals are small, which has caused the problem.
Helena Vernon, Surrey.
A: Itchy, scaly ear canals are not an uncommon problem – typically it’s caused by a localised form of eczema.
It will usually clear up with a prescription of a steroid, in the form of drops or an ointment.
Doctors also often prescribe an antifungal at the same time, on the basis that this type of eczema can be linked to an overgrowth of Malassezia yeast, which is found naturally on the skin.
Itchy, scaly ear canals are not an uncommon problem – typically it’s caused by a localised form of eczema. (Stock photo)
If it is psoriasis, this treatment will improve the symptoms within several weeks and it can be continued long term. (Stock photo)
In your case, not only are both ears affected, but quite severely, as well as the crease behind your ears and the ear canals. If this was a form of eczema, I would have expected it to resolve with one of the treatments that your doctor is likely to have prescribed – so it seems you’ve not yet had the correct diagnosis.
I wonder if the problem is psoriasis – an autoimmune condition triggered by a combination of genetic and environmental factors, causing an intense inflammatory reaction, an overproduction of skin cells and itchy, scaly patches.
I recommend you consult your doctor to explain that the itch and scaling in and around the ears have not resolved and that it’s been suggested that it may be psoriasis. If they are still reluctant to refer you to a dermatology clinic, then ask that they at least prescribe Dovobet or Dovonex, which both contain calcipotriol, a form of vitamin D (Dovobet also contains a steroid; Dovonex does not) that reduces the amount of cells your skin makes.
If it is psoriasis, this treatment will improve the symptoms within several weeks and it can be continued long term.
Q: I’m 65 and for several years I’ve experienced a sharp pain in my left groin as I stand up. Recently, I have also had a constant ache down my inner thigh. Would physiotherapy help?
Liz Griffiths, by email.
From your description, I suspect you have early osteoarthritis of the hip. This causes pain, stiffness and restricted movement – most typically the pain flares when you get up from a seated position, before radiating down towards the knee as you walk.
You should see your GP, to be referred for X-rays of both hips and confirm this diagnosis.
In the meantime, physiotherapy may help. There is evidence that exercise can reduce pain and improve movement in people with hip arthritis.
You should see your GP, to be referred for X-rays of both hips and confirm this diagnosis. (Stock photo)
What you need is an assessment by a specialist physiotherapist so they can draw up an individualised exercise regimen, taking into account factors such as any muscle wasting and an abnormal gait.
Osteoarthritis of the hip is common – one in four of those aged 85 have it, but it can develop decades before – so, at 65, this is the most likely cause for your symptoms.
A major risk factor is being overweight. So if this is an issue for you, then not only can weight loss reduce the pain, but it could aid recovery after joint-replacement surgery, if that’s needed down the line.
But it may well be that physiotherapy will enable sufficient improvement that hip-replacement surgery can be deferred.
So the short answer is yes, it is certainly worth asking for a referral for physiotherapy – something to 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 might want to consider paying for it privately.
In my view… Rein in the rogue cyclists
More should be done to ensure that while boosting their own health, cyclists don’t put the rest of us in harm’s way. (Stock photo)
I’ve treated two injured cyclists this week – both hurt in central London when cycling on the pavement.
The first fell from his bike when his head hit a protruding sun blind outside a shop, and he cracked some ribs.
The second fell on to his outstretched hand when avoiding a pedestrian and crashing as he came off the pavement, down a steep kerb. 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 reading that Louise Haigh, the new Transport Secretary, said that the Government is planning unprecedentedly high levels of funding for cycling.
Yes, cycling is to be encouraged but perhaps we need to remind her and cyclists that in the Highway Code the list of penalties includes a fine of £500 for cycling on the pavement – and also that injuring a pedestrian on the pavement when cycling is a criminal offence, not a civil one.
More should be done to ensure that while boosting their own health, cyclists don’t put the rest of us in harm’s way.
