Guttate psoriasis is a skin condition that is typically caused by a bacterial infection, such as strep throat or sinus infection; however, some individuals are also genetically predisposed to developing it.
Within weeks of the illness, multiple red spots, often between 2mm and 15mm in diameter, appear quickly on the trunk, upper arms and legs, face, hands, and feet. Occasionally, these areas can be irritating.
Guttate psoriasis is caused by the immune reaction, which had been battling the illness, focusing on the skin instead. Stress may also contribute.
In approximately sixty percent of patients, guttate psoriasis resolves on its own within weeks or months.
In around one-third of instances, however, it progresses to chronic plaque psoriasis, which is characterized by bigger areas of scaly, itchy, elevated skin caused by an overproduction of skin cells. This is also triggered by an immune system overreaction.
Plaque psoriasis does have a major hereditary element. You mention in your letter that you possess this particular form, thus I think that your sister may also possess it.
E45 is an emollient, which is a medicinal moisturizer that can help soothe the skin but does not treat the underlying reason. Corticosteroids (used as a cream or ointment) or calcipotriol, an ointment generated from vitamin D, can alleviate the underlying inflammation of guttate and plaque psoriasis, respectively.
Dovobet, a topical treatment containing the steroid betamethasone and calcipotriol, is highly effective by scientific tests.
This form of treatment is problematic since the rash tends to be widespread, making daily treatments impossible.
Phototherapy is an alternative treatment that includes exposing the skin to a specific wavelength of UV light, which reduces the turnover of skin cells. However, your primary care physician must refer you to a specialized dermatological center for this.
If they are unable to help, exposure to the sun around midday (here in the UK) for a maximum of ten minutes may bring about great improvement; however, your sister must not stay out longer than this to avoid sunburn. Applying sun protection creams would prevent UVB rays.
If your sister shows no indications of improvement, a second trip to the doctor is necessary.
Ken Mace hails from Nottinghamshire
You state in your extended letter that your ear issues date back fifty years to an illness that ultimately required surgery.
Two aspects of your medical history indicate a probable diagnosis. The first is that if water enters your ear, you are likely to develop an infection, and the second is that you have a perforated eardrum.
I assume that you have silent mastoiditis, persistent infection of the air cells of the mastoid that causes only intermittent symptoms.
The mastoid bone (the part of the skull immediately behind the ear) is composed of mastoid air cells, which are small air-filled cavities that protect the ear and regulate pressure within the middle ear.
Normally, a minor puncture of the eardrum would heal, but not if the middle ear cavity or mastoid air cells remain infected.
In such a circumstance, water in the ear will pass through the perforation and cause an infection in the mastoid to flare up (left over from that original infection 50 years ago).
Because there are no eardrops for this type of illness, Ofloxacin eye drops are utilized. These include a powerful antibiotic that suppresses the infection when it occurs, but because it is insufficient to fully permeate the sponge-like mastoid air cells, the low-grade infection has never been completely eradicated.
As you have recently relocated, I suggest you discuss your medical history with your new doctor and request a referral to an ear specialist.
Most likely, you will be referred for a CT scan of the mastoid bone to confirm or rule out the presence of silent chronic mastoiditis.
If my proposed diagnosis is accurate, you may require more surgery. It is possible that the operation performed years ago was not drastic enough to remove the entire diseased bone. I hope this is useful.
