Dr Stuttaford’s replies cannot apply to individual cases and should be taken in a general context. Please consult your GP if you suffer from any health or special conditions. I have suffered from sore patches on my face for years, which were recently diagnosed as perioral dermatitis. My GP told me to wash my face with soap and water but this conflicts with the limited information on the web, which advises the use of soap-free products. Could you please help? Helen Chappell, Bournemouth
Perioral dermatitis is always a trial. It is particularly distressing to patients because when they meet new people the newcomer tends to centre their gaze on the triangle around the nose and mouth, and this has led people to be sensitive about their lips, teeth, nose and eyes.
Your doctor has the advantage of being able to look at your face, and so he may well be right but, in general, patients who have tender skin, eczema, dermatitis and other problems, are advised to avoid any form of scented soap, and some dermatologists go so far as to say that patients should avoid even simple medicinal soaps. Conversely, if your face gets very messy, the only way to clean up something which is unsightly may be with something rather stronger than plain water. In dermatological clinics, they hand out large jars of various soapless solutions with which people with sensitive skins are able to wash. I should have a word with your local pharmacist and ask him what he has in stock.
My brother and my son-in-law both suffer badly from psoriasis. They have tried various treatments which are effective in the short term only. I have read about Raptiva which I believe has received approval in the US. What is your opinion on this? My son-in-law is a type-1 diabetic. Sue Slevin, Guildford, Surrey
Raptiva is not a name which is in the British standard list of drugs, or in the current edition of the Pharmacopoeia, but I suspect that we are talking about one of the new immunomodulatory drugs. These are indeed very useful in carefully selected patients. In the UK it would be prescribed only by dermatologists in hospitals accustomed to using them. I have a strong suspicion that they will play an even larger part in the treatment of psoriasis and many forms of arthritis as well. I would recommend that your son-in-law talks to his GP and dermatologist about this.
My father has a very itchy, recurring skin rash on his elbows, knees, etc. The consultant has diagnosed this as pityriasis lichenoides and prescribed some cream which has not relieved the itching. I have coeliac disease, and can't help wondering whether my father really has dermatitis herpetiformis. Please could you explain the differences between the two conditions, and give us some advice as to how we could proceed - my father has no confidence that his skin problems can be "cured" and refuses to see the consultant again. Catriona Hanson, Bingley, West Yorkshire
This is a very technical question. Pityriasis lichenoides chronica is a term applied to a group of skin complaints which are known, or were known, as parapsoriasis. Although the skin troubles look like psoriasis and lichenoide, the other details of the skin complaints don’t fit with this diagnosis. It is a clever idea of yours that your father might be suffering from coeliac disease, and has dermatitis herpetiformis. Dermatitis herpetiformis is a blistering eruption of the skin (hence the name herpes – like the herpes one develops in cold sores). As you know, it can appear at any time in life, but is most common in one's thirties or forties. It is most frequently seen on the knees, elbows, buttocks and areas where the clothing has been rather tight. It can, however, erupt on any part of the skin.
Diagnosis can be difficult if the itchy blisters have been scratched. As it occurs only in people who have gluten sensitivity, it might well be worthwhile for your father to have tests for coeliac disease because, as you know, dermatitis herpetiformis may occur even if other evidence of coeliac disease is so slight that the disease could be considered sub-clinical. I think it is relevant that you have coeliac disease, and I wonder if your father has told his doctor this.
My daughter has had eczema since infancy. She’s now 33. It bothers her tremendously, and is especially troublesome on her hands, fingers, face and neck. She’s now taking flax oil to see if it will help. What else can she do? She knows about soaps, their dangers, and risky perfumed lotions, etc. She watches her diet carefully (she has asthma, too) and takes every precaution not to aggravate either her asthma or eczema. Anything else she can consume to help? PS, she lives in a humid climate. Pat Reid, Calgary, Canada
If your daughter has had eczema since infancy and has failed to respond to standard treatments, and the dermatitis is causing her a great deal of trouble, she should talk to her dermatologist. It is possible that he might consider that she would be a candidate for topical immunomodulatory treatment with a new ointment called Tacrolimus - in the UK it is marketed as Protopic. She should, of course, keep going with all her other precautions.
I'm male, in my thirties and over the last five years or so I have been developing an ever-worsening skin problem. It all started with slight flaking of the skin around the top/sides of my nose and now has extended to the tops of my cheeks, around my sideburns, in my eyebrows, between my nose and mouth and also in the centre of my chest. After some digging on the web I found that my symptoms seemed to be identical to those caused by seborrheic dermatitis, but I have seen my GP about it and she said she wasn't convinced. She gave me Eumovate cream which appears to help somewhat, but I am still concerned with the cause of this problem and don't want to have to use the Eumovate constantly, as I have read that it is not recommended. Without applying a lot of moisturiser after showering, my skin is very dry and flaky. It is also often red and itchy. This has done nothing for my self-esteem. It seems somehow related to the greasier areas of my skin and my hairline, but not exclusively. I did have bad acne as a teenager and I wonder if this has somehow had a knock-on effect. I'm fed up with this and it's making me miserable; I wonder if you have any suggestions? Name and address withheld
I was sorry to hear about your skin problems. Obviously, as I haven’t seen you, I cannot give an opinion, but it does seem to me as if you are describing something which could be seborrheic dermatitis. This skin trouble affects any areas where the skin is well oiled, and is the result of a sensitivity to yeast called pityrosporum. Pityrosporum reacts with the oil produced by the sebaceous glands. The dermatitis may either be dry or greasy, but either way there is scaling, just as is found with dandruff in the scalp. In particularly severe cases you may find the classic little spots along the hairline, on the nose, eyebrows, eyelids and also on the chest, in between the ribs. With some people, the eyelids themselves are affected.
