Dr James Le Fanu: 20 September
There can seem at times to be a virtually infinite variation of even the simplest of human ailments. Consider for example, aquagenic pruritus, otherwise known as water-induced itching. This common condition is essentially a problem for the older age group, whose natural skin oils are depleted by bathing, thus resulting in a burning itch. Thankfully, the solution is simple enough; apply emollient creams to the wet skin after emerging from the bath or shower.
So that’s all straightforward enough until I read of a case described by dermatologist Dr Ronni Wolf of a relatively youthful man of 54 who ‘for years’ had experienced aquagenic pruritus starting about 10 minutes after exposure to water. The usual emollient creams had proved ine ffective so Dr Wolf suggested the rather di fferent treatment of adding baking soda to the bath water. A fortnight later, his patient profusely thanked him ‘for this miracle treatment that put an end to his su ffering’.
Commenting on Dr Wolf’s report, another dermatologist described four patients who responded to neither emollient creams nor baking powder. Rather, they had ‘seasonal’ water-induced itching, starting in late summer after the holidays and only on tanned parts of the skin. Their itching, he inferred, must be in some way related to the fading of the sun tan and found it could be corrected by further repeated exposure to ultraviolet light.
And there is more. Some with aquagenic pruritus find their symptoms improve in the summer and are exacerbated by the cold, dry months of winter – while for others it is reversed. From all this it emerges that there is not one but at least half a dozen types of this condition, each with its own specific remedy – so something that works for one group does not work for another. Treatment is thus often described as ‘unsatisfactory’ because most doctors, not being aware of its several forms, prescribe emollient creams that are ine ective and then have nothing else to suggest.
This, of course, places those seeking medical advice in an invidious situation, for if their doctors cannot be expected to know what the problem might be, where are they meant to turn? There are, however, a couple of useful pointers that should encourage them to look further.
The first lies in the details. Aquagenic pruritus is mainly a problem for the older age group for the reasons already outlined. But this would scarcely account for the symptoms of the 54-year-old patient described by Dr Wolf, who had experienced the problem for many years. Similarly, the description of pruritus being seasonal or limited to tanned parts of the skin suggests there must be some other explanation.
The second pointer lies in the response to treatment. Aquagenic pruritus should improve with emollient creams. If they are ine ffective, a variant of the condition must be considered.
Email drjames@lady.co.uk
It must be very unusual for someone in their 20s to be troubled by such severe cramps, suggesting there may be some underlying cause. The biomechanics of the foot can be a predisposing factor in those with flat feet or who do insufficient stretching after exercise.
There is no reason, given her daughter’s healthy diet, why she should be deficient in one or other of the minerals implicated in causing cramps, such as potassium, calcium and magnesium. She might, however, have a blood test just to ensure the levels are in the normal range. Bananas are a potent source of both potassium and magnesium – perhaps she should consider eating one a day as a preventive measure.
So that’s all straightforward enough until I read of a case described by dermatologist Dr Ronni Wolf of a relatively youthful man of 54 who ‘for years’ had experienced aquagenic pruritus starting about 10 minutes after exposure to water. The usual emollient creams had proved ine ffective so Dr Wolf suggested the rather di fferent treatment of adding baking soda to the bath water. A fortnight later, his patient profusely thanked him ‘for this miracle treatment that put an end to his su ffering’.
Commenting on Dr Wolf’s report, another dermatologist described four patients who responded to neither emollient creams nor baking powder. Rather, they had ‘seasonal’ water-induced itching, starting in late summer after the holidays and only on tanned parts of the skin. Their itching, he inferred, must be in some way related to the fading of the sun tan and found it could be corrected by further repeated exposure to ultraviolet light.
And there is more. Some with aquagenic pruritus find their symptoms improve in the summer and are exacerbated by the cold, dry months of winter – while for others it is reversed. From all this it emerges that there is not one but at least half a dozen types of this condition, each with its own specific remedy – so something that works for one group does not work for another. Treatment is thus often described as ‘unsatisfactory’ because most doctors, not being aware of its several forms, prescribe emollient creams that are ine ective and then have nothing else to suggest.
The first lies in the details. Aquagenic pruritus is mainly a problem for the older age group for the reasons already outlined. But this would scarcely account for the symptoms of the 54-year-old patient described by Dr Wolf, who had experienced the problem for many years. Similarly, the description of pruritus being seasonal or limited to tanned parts of the skin suggests there must be some other explanation.
The second pointer lies in the response to treatment. Aquagenic pruritus should improve with emollient creams. If they are ine ffective, a variant of the condition must be considered.
Email drjames@lady.co.uk
ONE A DAY TO KEEP CRAMPS AT BAY
This week’s medical query comes courtesy of a lady from Sussex writing on behalf of her 26-year-old daughter much troubled recently by prolonged painful cramps of the toes and soles of her feet. ‘She drinks plenty of water, keeps her feet warm and eats a good, varied diet.’ So what could be the explanation?It must be very unusual for someone in their 20s to be troubled by such severe cramps, suggesting there may be some underlying cause. The biomechanics of the foot can be a predisposing factor in those with flat feet or who do insufficient stretching after exercise.
There is no reason, given her daughter’s healthy diet, why she should be deficient in one or other of the minerals implicated in causing cramps, such as potassium, calcium and magnesium. She might, however, have a blood test just to ensure the levels are in the normal range. Bananas are a potent source of both potassium and magnesium – perhaps she should consider eating one a day as a preventive measure.