Q: I have had itchy, flaky ears for over a year. My doctor has prescribed lotions, creams, and ear drops, but nothing has helped. I am embarrassed by the flaky skin on my clothes and my ugly ears.
My GP won’t refer me to a dermatologist. He says my ear canals are too small, which is causing the problem.
Helena Vernon, Surrey.
A: Itchy, flaky ear canals are not an uncommon problem. Most often, it is caused by a localized form of eczema.
Usually the complaint disappears after a prescription for a steroid, in the form of drops or an ointment.
Often, doctors also prescribe an antifungal agent at the same time, as this type of eczema may be due to an overgrowth of the Malassezia yeast, which occurs naturally on the skin.
Itchy, flaky ear canals are not an uncommon problem. It is usually caused by a localized form of eczema. (Stock photo)
When it comes to psoriasis, this treatment will improve symptoms within a few weeks and can be continued long-term. (Stock photo)
In your case, not only are both ears affected, but it is quite severe, as is the fold behind your ears and the ear canals. If this was a form of eczema, I would expect it to clear up with one of the treatments your doctor has probably prescribed – so it sounds like you haven’t been properly diagnosed yet.
I wonder if the problem is psoriasis, an autoimmune disease caused by a combination of genetic and environmental factors that causes an intense inflammatory response, an overproduction of skin cells, and itchy, flaky patches.
I would suggest that you see your doctor to explain that the itching and flaking in and around your ears has not gone away and that it has been suggested that it may be psoriasis. If they are still reluctant to refer you to a dermatology clinic, ask if they can at least prescribe you Dovobet or Dovonex, both of which contain calcipotriol, a form of vitamin D (Dovobet also contains a steroid; Dovonex does not) which reduces the amount of cells your skin makes.
In the case of psoriasis, the symptoms will improve within a few weeks with this treatment. This treatment can also be continued in the long term.
Q: I am 65 and have had a sharp pain in my left groin when I stand up for a number of years. Recently I have also had a constant pain in my inner thigh. Would physical therapy help?
Liz Griffiths, by email.
From your description I suspect you have early osteoarthritis of the hip. This causes pain, stiffness and restricted movement – usually the pain starts when you stand up from a sitting position, before radiating into the knee when you walk.
You should see your GP. He or she may 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 see your GP, who may refer you for x-rays of both hips to confirm this diagnosis. (Stock photo)
What you need is an assessment by a specialized physiotherapist so that he/she can design an individual exercise program, taking into account factors such as muscle loss and abnormal gait.
Osteoarthritis of the hip is common, affecting one in four people by age 85, but it can develop decades earlier, so at age 65 it is the most likely cause of your symptoms.
A major risk factor is being overweight. So if this is a problem for you, losing weight can not only reduce pain but can also help with recovery after joint replacement surgery, if that is needed later.
However, it is quite possible that physical therapy will provide sufficient improvement to allow hip replacement surgery to be postponed.
So the short answer is yes, it is definitely worth asking for a referral for physiotherapy – something you should discuss with your GP, along with a request for a hip scan.
There may be a waiting list for physiotherapy through the NHS, so you may want to consider paying for this yourself.
In my opinion… Keep the rogue cyclists in check
More should be done to ensure that cyclists not only improve their own health, but also don’t endanger the rest of us. (Stock photo)
I have treated two injured cyclists this week, both injured in central London while cycling on the pavement.
The first fell from his bicycle when he hit his head on a protruding awning in front of a shop, breaking several ribs.
The second fell on his outstretched hand as he avoided a pedestrian and crashed as he came off the sidewalk and down a steep curb. He broke his wrist and, because he was not wearing gloves, suffered deep abrasions to his palm.
I thought of these two patients when I read that Louise Haigh, the new Transport Secretary, said that the government was planning unprecedented levels of funding for cycling.
Yes, cycling should be encouraged, but perhaps we should remind her and cyclists that the list of penalties in the Road Traffic Act includes a £500 fine for cycling on the pavement – and also that injuring a pedestrian on the pavement while cycling is a criminal offence, not a civil offence.
More needs to be done to ensure that cyclists not only improve their own health, but also do not endanger others.