Life

Ask the GP: What to do about an unbearable itch and how to treat watery eyes

I have an itchy rash all over my body
I have an itchy rash all over my body I have an itchy rash all over my body

Q: 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?

AS

A: 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. 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.

Q: 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?

AL

A: 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.

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.

Q: OVER the past 12 months I’ve had a constant watery eye. Now it’s happened to the other one and it’s so annoying. I recently saw an optician who suggested bathing my eyes with pads dipped in hot water. But it’s made no difference. What more can I do?

MS

A: WATERY eyes have a variety of causes. Some are short-lived and will be obvious, such as infection of the cornea (keratitis), an allergy or a stye (an infection that leads to a tender lump near the eyelid).

In these cases, the watering is a result of an irritant to the eye causing excess tear production (one role of tears is to wash out dirt), and the watering will cease once the cause of irritation goes.

However, as the optician advised you to bathe your eyelids with pads soaked in hot water, this suggests they think you have dry eye syndrome. This might seem confusing — that dry eyes lead to excess tears — but let me explain.

Dry eyes are typically the result of a problem with the meibomian glands in the upper and lower eyelids. These glands secrete the oil that helps encase tears, minimising the evaporation of the watery fluid.

However, if the glands become blocked, the lack of oil means the tears evaporate more easily, causing dry patches on the eye itself.

In response, more tears are produced; but, missing the stabilising effects of oil, these then tend to spill over the eyelid edge.

Your optician suggested using hot water bathing — good advice as heat can help melt any thickened oil clogging the glands and improve the output of the gland, too. However, you need to continue for some weeks to see the benefit.

It may improve the results if you use an eye pad containing linseed (available from opticians and chemists) that can be warmed in a microwave. This can then be applied to the eyes, while reclining, for ten minutes twice daily.

Production of oil by the meibomian glands is improved by this technique, as it boosts the blood flow to the eyelid margins and the Meibomian glands are more active when the blood supply is greater.

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To contact the GP, email askthegp@irishnews.com. Include your contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your own GP with any health worries.