DR SCURR: How to remedy generally misdiagnosed mysterious itchy lumps

Q: My husband suffers with small itchy lumps on his lower legs, arms, waist and groin. Our GP is treating him with Epimax cream — this keeps his skin moisturised, but does nothing for the irritation. He finds it difficult to sleep. If he scratches them they crack and weep.

Helen Sears, by email.

Dr Martin Scurr replies: What you describe sounds like urticaria — also known as hives. Up to 20 per cent of us will suffer this condition at some time, with raised itchy plaques that may look like nettle rash.

When it comes to skin disorders, you need to examine the skin closely and perhaps take a swab to confirm the diagnosis.

I say this because urticaria is common, which means it could too readily be given as the diagnosis when the issue is something else, such as contact dermatitis (an allergic reaction to washing powder or latex in rubber gloves, for instance) or a reaction to medications (to aspirin or some antibiotics, for example) and some immune-mediated skin disorders.

Itchy lumps on the skin can often be hives. An emollient cream might be recommended by doctors, but the condition can often be misdiagnosed

Indeed, in answering your letter, I was reminded just how tricky it can be to diagnose a rash. I once had a patient who asked me to visit her in hospital where she’d spent weeks with complications following surgery for a broken leg sustained in a cycle accident. She had a madly itchy rash, not dissimilar to the description you have given.

The orthopaedic specialists treating her had been unable to help and she was in distress.

I think I recommended an emollient similar to that prescribed for your husband — on the assumption that she had a type of eczema related to the detergent used in washing the hospital sheets, or some other allergen around the time of her hospitalisation or surgery.

I could not have been more wrong. When the patient left hospital she was seen by a dermatologist and the correct diagnosis was scabies.

This is a contagious infestation caused by mites that burrow just beneath the skin surface, causing an intense itch, a rash and skin sores. It is spread by skin contact but also via infected bedding or clothing, even towels. Untreated the skin sores can lead to serious complications.

As it’s not clear what your husband has, and he is experiencing tremendous anxiety about it, I believe that he should be referred to a dermatologist.

Q: I’m a 67-year-old woman. I find it difficult to pass urine first thing in the morning, but I’m fine the rest of the day. Why is this?

Name and address supplied.

Dr Martin Scurr replies: The inability to pass urine first thing — an uncommon problem in women (in men it’s often to do with an enlarged prostate) — could be down to an anatomical change in the pelvis affecting urine flow, or a response to medication.

With the first, typically we’d be talking about a prolapse of the uterus, bladder or rectum, as a result of weakening of the pelvic floor. The risk factors for this are childbirth, age and obesity. The prolapse may kink the urethra — the tube leading from the bladder to the outside — resulting in a slow urine stream and a sense of incomplete emptying.

Once you become active as the day begins, any structural disruption within the pelvis may ease and allow normal urinary function.

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

If you are taking one of these in the evening it could lead to problems with urination the following morning that then eases as time passes.

I’d discuss all this with your GP: if medication isn’t the issue, I’d suggest a referral to a gynaecologist and investigation such as a pelvic ultrasound scan.

In my view… 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 down at night to A&E to see a patient who suffered from haemophilia, an inherited blood clotting disorder.

Periodically he would experience a haemorrhage and would be immobile with severe pain.

The treatment was an injection of the clotting factor he lacked. The regular infusions were life-saving, but when the scandal of the imported blood products broke some years later I thought of this patient, and I worried he’d become a victim of HIV or hepatitis C — and that I’d inadvertently infused him with infected blood products from the U.S.

The dangers of these products were first raised in 1974. Then in 1983 a study confirmed that the risk of a haemophiliac contracting hepatitis C from untreated clotting factor was 100 per cent after the first treatment.

But over the years experts and those in authority continued to maintain that there was no conclusive evidence that HIV or hepatitis C could be transmitted this way. So importation continued.

Having dismissed the evidence, are those experts now accountable? I think the answer is yes.