DR SCURR: How to cure mysterious itchy lumps – and the condition that can cause doctors to misdiagnose them

Question: My husband suffers from small itchy bumps on his lower legs, arms, waist and groin. Our doctor treats him with Epimax cream, which keeps his skin hydrated, but does nothing for the irritation. He finds it difficult to sleep. When he scratches them, they crack and cry.

Helen Sears, by email.

Dr. Martin Scurr replies: What you are describing sounds like urticaria, also called nettle rash. Up to 20 percent of us will suffer from this condition at some point, with raised itchy patches that can resemble hives.

When it comes to skin conditions, you should examine the skin carefully and, if necessary, take a cotton swab to confirm the diagnosis.

I say this because urticaria is common, which means it can be too easily diagnosed when the problem is something else, such as contact dermatitis (an allergic reaction to washing powder or latex in rubber gloves, for example) or a reaction to medications (for example, aspirin or some antibiotics) and some immune-mediated skin conditions.

Indeed, in replying to your letter I was reminded of how difficult it can be to diagnose a rash. I once had a patient who asked me to visit her in the hospital, where she had spent weeks with complications following surgery for a broken leg sustained in a bicycle accident. She had an extremely itchy rash, not much different from the description you gave.

The orthopedic specialists who treated her were unable to help her and she was in distress.

I think I recommended an emollient similar to the one prescribed for your husband – assuming she had some kind of eczema related to the detergent used in washing the hospital sheets, or some other allergen around the time of her hospitalization or surgery.

I couldn’t 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 plague caused by mites that burrow just beneath the surface of the skin and cause severe itching, rashes and skin ulcers. It is spread by contact with the skin, but also through infected bedding or clothing, even towels. Left untreated, skin ulcers can lead to serious complications.

Since it is not clear what your husband has and he feels extremely worried about it, I think he should be referred to a dermatologist.

Question: I am a 67 year old woman. I find it difficult to pee early in the morning, but the rest of the day is fine. Why is this?

Name and address provided.

Dr. Martin Scurr replies: The inability to urinate right away – an uncommon problem in women (in men it is often related to an enlarged prostate) – may be due to an anatomical change in the pelvis that affects urine flow, or a response to medications.

With the first we are usually talking about a prolapse of the uterus, bladder or rectum, due to weakening of the pelvic floor. The risk factors for this are childbirth, age and obesity. The prolapse can kink the urethra (the tube leading from the bladder to the outside), resulting in a slow urine flow and a feeling of incomplete emptying.

Getting active at the start of the day can alleviate any structural disturbance in the pelvis and allow normal urinary function.

The second possible cause is medication that disrupts bladder function. Certain medications can cause urinary retention or difficulty initiating urination. These include antipsychotics, some antidepressants, antihistamines and some treatments for high blood pressure.

Taking any of these in the evening may cause problems with urination the next morning, which will decrease over time.

I would discuss all this with your GP: if medication is not an option, I would recommend a referral to a gynecologist and examination 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 to the emergency room at night to see a patient suffering from hemophilia, an inherited blood clotting disorder.

From time to time he would hemorrhage and be immobile with severe pain.

The treatment consisted of an injection of the clotting factor he was missing. The regular IVs were life-saving, but when the imported blood products scandal broke a few years later, I thought about this patient and worried that he might fall victim to HIV or hepatitis C – and that I had accidentally given him an IV . with infected blood products from the US

The dangers of these products were first discussed in 1974. In 1983, a study confirmed that the risk of a hemophiliac contracting hepatitis C from untreated clotting factor was 100 percent after initial treatment.

But over the years, experts and authorities continued to insist that there was no conclusive evidence that HIV or hepatitis C could be transmitted in this way. So the import continued.

Now that these experts have rejected the evidence, are they now responsible? I think the answer is yes.