ASK THE GP: What can I do about my unbearable itch? Dr Martin Scurr answers your health questions
For six months, I have had an itchy rash all over my body which started on my lower leg. I’m told it’s Grover’s disease. Steroid ointments and body washes prescribed by my GP haven’t helped, although antibiotics I took for another condition did. It is affecting my sleep — is there anything you can suggest?
Andrew Sinclair, Stenhousemuir, Falkirk.
Grover’s disease, technically called acantholytic dermatosis, is a rare and mysterious skin condition that mainly affects men in middle age or older.
The cause is unknown and there are conflicting reports about whether it is due to increased sweating (it can be triggered by a period of bed rest) or exposure to cold, dry air (one study noted that it is diagnosed far more frequently in winter than in summer).
Did you know? Grover’s disease, technically called acantholytic dermatosis, is a rare and mysterious skin condition that mainly affects men in middle age or older
Typically, there is a rash of red, raised, blistery spots and the torso is the most usual site of what can be almost intolerable itching. The limbs may be affected, too, but the face, palms and soles are usually spared.
The only way to diagnose the condition confidently is to have samples from two or three sites examined by a pathologist.
Most dermatologists suggest using moisturisers twice daily, along with high-potency steroid creams or ointments. Antihistamine pills are also said to help calm the itching.
A less commonly prescribed treatment that some patients have found effective is calcipotriol ointment, which is derived from vitamin D and generally used in the treatment of psoriasis. A prescription is necessary and it might be worth asking your GP to consider it.
I cannot think why your symptoms improved with antibiotics. This may have been a fluke. The good news is that the condition is normally temporary and resolves within six to 12 months.
My daughter has suffered heavy periods for most of her life. Eventually, endometriosis was discovered and she had a hysterectomy (she’d already had a daughter, now aged ten, via a caesarean). She has had pain, at times unbearable, from the region of the caesarean scar ever since. Why might this be?
Anne Logan, Longfield, Kent.
Endometriosis occurs when endometrium — the lining tissue of the uterus — is found elsewhere in the body, typically the pelvic region but also on the bowel, diaphragm and even in the chest cavity.
The tissue is subject to the hormonal variations of the menstrual cycle — so will bleed and cause inflammation.
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Always consult your own GP with any health worries.
It mainly results in pelvic pain, particularly dysmenorrhoea (period pains). Infertility and pain during intercourse are also common. The dysmenorrhoea often occurs a day or two before a period, and can continue beyond the bleeding.
In your longer letter, you say your daughter had a laparoscopy — a keyhole operation — during which surgeons found such advanced endometriosis that it was decided a hysterectomy was the best option. Her ovaries might have been removed at the same time, thereby pushing your daughter into menopause.
Once menopausal, the symptoms of endometriosis stop as the lack of oestrogen means no more endometrial tissue is formed and the tissue that is present will no longer bleed.
However, a caesarean can lead to tissue from the womb dispersing elsewhere. Endometrial tissues can lodge around the site of the caesarean scar and this can cause pain, which may not follow the menstrual cycle and which can be constant.
This sounds the most likely possibility in your daughter’s case, as the pain can persist even without oestrogen.
An ultrasound scan might help with a diagnosis, so your daughter should discuss this with her GP.
If it proves to be the case, there are effective treatments available, such as surgery.
IN MY VIEW: A ‘natural’ remedy can be harmful, too…
It still surprises me that people can be wary of taking medication that has been rigorously tested, yet relaxed about using products not so thoroughly investigated purely because they are ‘natural’.
A case in point is medicinal cannabis oil, which came to prominence with the story of Billy Caldwell. As you may recall, his mother was stopped at the UK border after trying to bring a cannabis product from Canada to help with Billy’s severe epilepsy.
It led to a change in the law which allowed specialist doctors — not GPs — to prescribe cannabis oil (quite different from the less potent cbd products in the High Street) in specific circumstances.
Now, increasing numbers of patients are demanding their GPs prescribe cannabis oil to them for pain relief (which they cannot).
Given the paucity of evidence we have about the benefits of cannabis oil in this respect, I am surprised so many are keen to try it. If it were a drug from a pharmaceutical firm, I doubt they’d be so enthusiastic.
It may yet prove to be beneficial, but there are 60 or more active compounds in the plant and we know little about most of them.
Here is what we do know: although there is some evidence of cannabis oil bringing pain relief in some conditions, such as the painful muscle spasms of multiple sclerosis, you need to treat 20 people to get a 30 per cent reduction in pain in one person.
Furthermore, you have to treat only six people to cause harm in the form of side-effects such as dizziness, dry mouth, nausea, fatigue and confusion.
So most doctors — still in the dark and awaiting better information and enlightenment — wisely adhere to the old principle: first, do no harm.