For some months I have been developing tiny cuts or fissures about 1 cm long at the end of my thumbs and often on my fingers. They are extremely bothersome and sting all the time. The nurse prescribed mometasone furoate ointment that I have to apply twice daily, but this hasn't helped. The only thing that stops the pain is putting plasters on the ends of my fingers, but this makes small tasks difficult.
Mr W. McKenna, Uckfield, East Sussex.
+2
The preservative methylisothiazolinone used in liquid soap causes severe allergic reactions in some people
More and more patients are coming to see me with this. I feel for you, as I hear these cracks can be extremely bothersome and so painful they disturb sleep.
Until recently I, too, would have prescribed a steroid cream or ointment such as mometasone furoate, with a similar lack of success. I was giving it more in hope than anything, as I was not sure what was causing this problem.
However, a year or so ago I heard about a preservative, methylisothiazolinone, an ingredient routinely used in a variety of products from liquid soaps and shower gels to washing-up liquid, skin moisturisers, sun protection creams, even baby wipes.
This chemical, otherwise known as Kathon CG, has been increasingly used over the past ten years and is added to products to prevent growth of bacteria and yeasts.
But in many people it causes severe allergic reactions, and the incidence of contact dermatitis - inflammation of the skin caused by contact with an irritating substance - due to methylisothiazolinone has now reached epidemic proportions, according to a paper published in the journal Contact Dermatitis.
In 2013, the American Contact Dermatitis Society named it contact allergen of the year.
If you stop using any product containing this substance, I predict your hands will heal. Competely avoid liquid soaps; buy old-fashioned soap in tablet form for bathing or showering.
When you wash your hands, use a moisturiser, rather than soap, to help improve the condition of the skin. I suggest Dermol 500, or similar - no prescription needed. Massage it into your hands - especially the cracks - when they are still dry, then rinse it off.
If you do any washing-up, wear gloves without fail. Your hands will rapidly improve, though it may take a week or two to see full healing. Good luck!
+2
Dr Scurr believes the patient is suffering from metatarsalgia - inflammation of the joints in the feet
My younger brother Paul suffers from pain in the ball of the foot and it's getting worse. He can't walk very far without severe pain. His GP has told him to take paracetamol - and that's it. I fear he will end up not being able to walk at all.
Margaret Cox, by email.
From your description, I believe your brother is suffering from metatarsalgia - inflammation of the joints in the feet.
It affects the metatarsals, the long bones that connect to the toes. These bones join to the toes at the metatarsophalangeal junction - the ball of the foot.
The joints become inflamed due to a variety of causes, but most commonly as a result of high-impact sports, such as running or tennis. Wearing unsupportive or tight footwear can also cause it.
In your brother's case, I think he inadvertently altered the way he walked because of the Achilles tendon pain, so ended up putting more pressure on the balls of the feet than normal.
There are no tests for this condition. A doctor will normally make the diagnosis after examining the foot and listening to the history of the symptoms.
Sometimes an X-ray may be suggested if the GP thinks the patient might have osteoarthritis of the heads - or ends - of the metatarsals, as this can also cause pain in the balls of the feet.
The treatment of metatarsalgia involves first looking at your footwear: shoes should be broad-fitting and accommodating.
A padded insert called a metatarsal pad, which is placed under the ball of the foot, allows the joints to splay and reduces their tendency to be squeezed together when walking, which can make it painful. These pads can be bought from a chemist.
Better still, ask your brother to consult a chiropodist or podiatrist, as this is the kind of problem they specialise in.
It may be that special shoe inserts called orthotics will be recommended to take pressure off the ball of the foot.
They can be custom-made, but this is expensive. However, cheaper versions can be bought via the internet, and come in a variety of materials from cork to silicone rubber. Some trial and error may be necessary.
Ice packs can be soothing after activity that causes pain. Use a cold gel pack or a bag of ice, separated from the skin by a flannel or thin towel, for 15‑minute sessions once or twice daily.
I suggest painkillers such as the paracetamol suggested by the GP should be a last resort.
Metatarsalgia will take some weeks to settle, but it will do so if your brother wears properly fitted shoes and orthotics.
■ Dr Scurr's replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.
By the way... Long waits for ambulances mean home births could be more risky
THE Thursday before Christmas I received an emergency call at 5pm from the husband of a patient. His wife had fallen over outside their house and was unable to get up, so was lying in the road in the rain. An ambulance had been called 20 minutes earlier.
I went straight there, by which time her husband had got my patient into their car.
After a somewhat awkward examination, I could tell she had a fractured hip. She was also shocked, wet and cold from the rain. I started the engine of the car to provide some warmth and wrapped her in a blanket.
It was now 5.30pm and I called the ambulance service, confirming my patient had fractured her hip. I was told all crews were busy but a team would come as soon as possible.
Two hours later they arrived, expert and calm as always. By 8pm, three hours after her fall, my patient was in hospital. At 11pm, I received a call to say the X-ray had confirmed the fracture.
The purpose of this anecdote is to illustrate how long you may have to wait for an ambulance in an emergency, such are the pressures on the service.
Recently, Professor Julian Savulescu, a medical ethicist at Oxford University, and Professor Lachlan de Crespigny, a leading Australian obstetrician and gynaecologist, warned about the dangers of home births.
They said delays can be inevitable in the transfer of mothers and babies from home if an emergency occurs, and any hold-up may result in a disability affecting the child for life.
Indeed, a 2011 study found that babies born to first-time mothers at home are almost three times more likely to die or suffer a medical complication than those born in a hospital.
It is easy to assume that if the baby has a complication, such as problems breathing, an ambulance can be called and immediate transport to hospital will save the day.
But, as I can confirm, there may be difficulties. The same applies if the mother suffers a bleed after delivery or there are difficulties when the placenta is delivered or removed.
There is currently one home birth planned in my practice; there will be at least one skilled midwife present and I will be available.
Let's hope it takes place at a quiet and peaceful time of day, with not too much traffic and not too many ambulances waiting to unload into the clogged and overwhelmed A&Es.
I hope my nerves can stand it.
Read more: http://www.dailymail.co.uk/health/article-2551163/ASK-THE-DOCTOR-Liquid-soap-epidemic-sore-skin.html#ixzz2sJcBEgdD
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