For years, I have suffered hot, burning legs at night. It used to be from the knee to the foot – now it’s often from the hips down. My GP has not been able to identify the cause. Can you help?
Sandra Fuller, Isle of Wight
Dr Martin Scurr replies: From the description of your symptoms and the fact that, in your longer letter, you mention the skin of your legs is hot to the touch, I suspect you have erythromelalgia.
A condition that can affect all ages, this causes an intense sensation of burning, usually in both legs as well as, in some cases, the hands – and visible redness of the skin which also often feels hot to the touch.
Any increase in body temperature – due to, for example, exercise or stress – can trigger the burning sensations.
But many people also find the symptoms are worse at night, when the heat builds up under the bedclothes, and can be eased only by deliberate cooling of the legs, such as by hanging them out of bed.
It’s thought to be related to problems in the nerves or smaller blood vessels – which may be genetic in some cases (around 5 to 15 per cent of the time, according to estimates).
Certain drugs, such as calcium channel blockers (e.g. amlodipine) used to treat high blood pressure can also cause it (these drugs dilate the blood vessels). So, too, can diabetes, which may affect nerve function, and autoimmune diseases such as rheumatoid arthritis.
In very rare cases it might be a sign of a bone marrow disorder (which causes blood clots). But in most cases there is no obvious cause.
Cooling can help – applying cold packs to the skin or immersing your legs in cold water are the best ways to ease the sensations. However, avoid doing this for protracted periods as this could damage the skin.
Elevating the legs might also aid you by encouraging better blood flow.
There are some medications that may help, including painkillers during a flare-up or antidepressants (it’s not clear how these work but they do benefit some patients). It is a question of trialling what might work best with the help of your GP or a referral to a specialist.
I’m 76 and my foreskin seems to have shrunk, no longer retracting over the penis and making a full erection very painful – if not impossible. Can it be treated?
Name and address supplied
Dr Martin Scurr replies: These symptoms are typical of male genital lichen sclerosus, an inflammatory disorder of the foreskin.
It’s thought to be caused by an autoimmune reaction, where the immune system overreacts to something fairly innocuous, such as a viral infection, and attacks healthy tissue.
Symptoms include itching, soreness, cracking and even bleeding of the skin, leading to progressive tightening of the foreskin as you describe. This is called phimosis. Treatment with a strong topical steroid ointment (e.g. clobetasol 0.05 per cent) will, over time, provide relief by suppressing the inflammation.
Meticulous genital hygiene is essential – but use a moisturising emollient such as Diprobase or Dermol, rather than soap.
Some patients don’t respond well to steroid cream, and may need to be switched to a product containing tacrolimus, which suppresses the immune system.
If neither of these treatments work, it may be necessary to undergo a circumcision, which will cure the problem.
In my view… medical shorthand can lead to errors
When I was a medical student in the 1970s, the emphasis was on precision in language, whether describing a medical problem or presenting a case to the senior doctors on a hospital ward round.
This was considered to be a medical virtue. But, yes, now it’s all abbreviations and acronyms (such as PoTS for postural orthostatic tachycardia syndrome). This is partly about time – and the use of technology involving keyboards and phones.
But I fear it has brought with it sloppy, inaccurate thinking and this leads to errors.
Take MS, which can mean mitral stenosis (a heart valve problem), multiple sclerosis or morphine sulphate.
It’s not just diagnosis: some of the medication errors owing to this laxity that have been reported include medics reading IU (international units, a dose for nutrients) as IV (intravenous), and there have been legal cases on these mistakes alone.
Always be cautious when you’re being given an explanation that involves an acronym or an abbreviation – and perhaps ask for the healthcare professional to explain it. This could prevent an error in thinking about a diagnosis or an error in prescribing.
Send your questions to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email drmartin@dailymail.co.uk – include your contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context. Always consult your own GP with any health worries
