Tuesday 24 April 2018

Swollen knees and cracking skin

The knee joint is surrounded by capsule that protects the joint itself
The knee joint is surrounded by capsule that protects the joint itself

Dr Nina Byrnes

I have developed pain behind my knee. The area behind the knee also seems to be swollen and sore to touch at times. My leg is fine. Should I go to the doctor about this?

The knee joint is surrounded by capsule that protects the joint itself. This capsule is lined with a membrane called the synovium. The synovium creates fluid called synovial fluid which lubricates the joint. Bursae are fluid-filled pouches found near the area where muscle tendons and ligaments pass over bone; they act to further cushion the joint. The bursa at the back of the knee is called the popliteal bursa. A Baker's cyst is a fluid-filled cyst that occurs in this popliteal bursa.

Baker's cysts occur most commonly in young people aged four to seven, or in those aged 35 to 70. A Baker's cyst usually occurs in conjunction with inflammation or arthritis of the knee joint, but may also occur in a healthy joint. There is increased production of synovial fluid, putting pressure at the back of the joint, causing swelling to occur. Baker's cysts can also occur if there has been a tear or damage in the joint leading to inflammation.

Baker's cysts don't always cause symptoms and many people may not even know they have one. If they enlarge, they can cause pain and swelling behind the knee. There may be an ache around the knee or a sensation of fullness or pressure when standing.

With larger cysts, it may be difficult to bend your knee. More rarely, people notice a sensation of clicking and locking of the knee.

Baker's cysts can occasionally rupture. This may lead to pain and swelling of the calf. There may also be bruising and tenderness. The symptoms associated with a Baker's cyst can be very similar to those associated with a clot (DVT) in the lower leg, and so, it is important to visit your doctor to ensure there is no clot present. You may be referred for a scan which will rule out a DVT and will be able to identify a Baker's cyst if it is there.

Many Baker's cysts will resolve by themselves and don't require any treatment. If you have pain, applying ice may help. Taking over-the-counter medication, such as ibuprofen, may help reduce inflammation and pain.

If the cyst is large or causing a lot of pain or discomfort, you may require drainage or removal of the cyst. Steroid injections into the joint are also sometimes used.


The corners of my mouth are cracked, red and sore. I have tried using all kinds of lip balms and  treatments and nothing seems to work. Can you suggest any remedies or do I need more tests done?

You describe a condition called angular chelitis. This can cause uncomfortable cracking, redness, scaling, bleeding and ulceration of the corners of the mouth. Angular chelitis may occur on its own, but more commonly occurs in those who wear dentures or braces, or in children who use soothers or suck their thumb.

Angular chelitis may be caused by bacteria, candida infection, nutritional deficiency, or due to other conditions such as eczema, local allergy to nickel in metal braces, drooling or altered anatomy of the angles of the mouth. Those who suffer with chronic dermatitis or dry skin may be prone to licking their lips ,which can perpetuate the irritation and inflammation of the skin.

One of the more common causes is infection with staphylococcus. This is a bacteria that normally lives on the skin. When skin becomes red or inflamed and breaks down, this bacteria may increase leading to further inflammation and infection.

Your doctor will be able to prescribe fusidic acid cream which may settle things down.

Candida is another common cause and an anti-fungal cream may also help. A cream which combines fusidic acid, or an anti-fungal with hydrocortisone, are often more effective as they will also help reduce inflammation. The creams should be applied several times a day until infection resolves.

If simple creams are not working, it is worth having blood tests performed.

Nutritional deficiency, especially deficiency of vitamin B12 and iron, may be associated with angular chelitis. Eating a healthy well-balanced diet or taking supplements, if levels are very low, may also help improve things.

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