# GP Cover Letter: Recurrent Hand Skin Changes, Suspected Medicine Reaction, and Follow-Up Planning Date: Thursday 6 August 2026 Type: Cover Letter ## Current concerns The matters below are arranged in the order I would most like to address them. 1. Recurrent skin changes on the back of the right hand. 2. Formal review and documentation of the previous suspected naproxen-related medicine reaction. 3. Brief review of the continuing thirst, preference for salted water, and whether hormonal causes should be considered. 4. Reissue of the ADHD questionnaire and AQ-10 for completion before a future appointment. 5. Planning a separate future appointment to discuss DSD-related matters and what information or preparation may be required before any referral. The main priority for this consultation is the recurrent hand skin problem. I would like to discuss whether another short-term treatment could be tried as an interim measure and whether repeated recurrence now warrants specialist referral. I am not asking to begin detailed DSD discussion or hormone replacement therapy during this consultation. ## Details ### 1. Recurrent skin changes on the back of the right hand The original wound on the back of the right hand was treated in February 2026. After the wound closed, raised and itchy skin changes repeatedly returned in or near the same area. Previous short courses of Elocon improved the condition, but similar changes returned approximately three to four weeks after treatment stopped. On Monday 13 July 2026, an Urgent Treatment Centre prescribed Fucibet cream twice daily for seven days. The final application was used on the morning of Sunday 19 July. At the end of treatment: - the skin was smooth; - the surface was no longer raised; - the colour remained different from the surrounding skin. Approximately two weeks later, the skin began to become abnormal again. The current area remains unbroken, but it is marked, rough, raised, and different from the surrounding skin when touched. This appears to be approximately the fifth recurrence after treatment. I would appreciate advice on: - what the current changes may represent; - whether another treatment course or other interim treatment would be appropriate; - whether a longer-term management plan is needed; - whether repeated recurrence now warrants dermatology or another specialist referral; - what information, photographs, treatment history, or other evidence would be needed to support a referral. The current skin changes can be examined directly during the consultation. Related document(s): - **Recurrent Hand Skin Changes Record** ### 2. Previous suspected naproxen medicine reaction During the February 2026 acute episode, I developed numerous itchy red spots extending from the wrist towards the elbow while taking naproxen and flucloxacillin concurrently. The rash improved markedly after naproxen was discontinued while flucloxacillin continued. This timing makes naproxen my main suspected trigger, although I understand that causation has not been clinically confirmed and flucloxacillin cannot be completely excluded. I have not yet had the opportunity to review this formally with my usual GP since the reaction. I would appreciate advice on: - whether the suspected reaction should be entered in my medical record; - whether naproxen should be avoided in future; - whether precautions are needed with other NSAIDs; - whether any further medicine-reaction or allergy assessment is required. Related document(s): - **Recurrent Hand Skin Changes and Suspected Naproxen Medicine Reaction Record** - **Lift Movement and Pain Synchronisation Record** ### 3. Continuing thirst and preference for salted water Since around Monday 6 July 2026, I have experienced a period involving increased thirst, increased drinking and urination, fatigue, difficulty drinking plain water, and a preference or perceived need for water with added salt. Blood was taken on Tuesday 14 July after a GP issued a blood-test request. The more intense thirst later reduced, and a short episode of watery diarrhoea at the end of July resolved. However, I have continued to prefer tap water with added salt and remain reluctant to drink plain tap water. I would appreciate: - review of the available blood-test results; - advice on whether any further assessment is needed; - advice on whether continued use of self-prepared salted water is appropriate; - consideration of whether hormonal or endocrine causes may be relevant. I am not assuming that the symptoms are hormonal or related to DSD. I would like to understand whether this possibility should be considered before a future DSD-related discussion or referral. Related document(s): - **Excessive Thirst, Increased Urination and Salt Craving Record** - **Long-Term Health Summary** ### 4. ADHD questionnaire and AQ-10 Please could the following two questionnaires be reissued: - the ADHD questionnaire; - the AQ-10. I would like to complete them before a future appointment. I am not requesting detailed discussion of the questionnaire results during this consultation unless time allows. ### 5. Future DSD-related discussion and referral preparation I have DSD-related matters that I eventually wish to address, including the possibility of hormone replacement therapy. I had previously expected that the knee and skin problems would have settled sufficiently by this stage. Instead, the knee and wider musculoskeletal problems have continued, and the hand skin condition has repeatedly recurred. This has resulted in repeated short-term problems requiring attention. My current priority is to obtain a more stable management plan for the skin and musculoskeletal issues. I am not asking to begin hormone replacement therapy or a detailed DSD assessment today. I would instead like to arrange a separate future appointment and ask: - what information or records I should prepare; - whether any questionnaires, blood tests, or other preliminary steps are required; - what referral route may be appropriate; - whether the recent thirst-related symptoms or possible hormonal considerations should be reviewed first. My longer-term aim is to proceed with DSD-related care once the current health problems are sufficiently stable and there is a clearer management plan. ## Questions / Requests - Please assess the current recurrent hand skin changes. - Please advise whether another interim treatment is appropriate. - Please consider whether repeated recurrence warrants specialist referral and what evidence would be required. - Please formally review and document the suspected naproxen-related medicine reaction. - Please briefly review the continuing preference for salted water and whether hormonal or endocrine causes should be considered. - Please reissue the ADHD questionnaire and AQ-10. - Please advise how to arrange and prepare for a separate future DSD-related appointment. ## Notes Plain-text versions of the supporting documents are available at: **https://gp123.pages.dev/** The website contains patient-prepared plain-text documents only. Original NHS records, prescription labels, photographs, blood-test results, and other clinical records remain the primary evidence where applicable. The supporting documents preserve detailed observations and timelines so that this Cover Letter can remain focused on the priorities for this consultation. The documents do not establish that the skin, musculoskeletal, thirst-related, medicine-reaction, hormonal, or DSD-related matters share a common cause. Please ask me about any additional history or information that may assist the assessment. Please feel free to copy, adapt, or retain any relevant information for clinical documentation or referral writing. As I am not a healthcare professional, please verify any clinical information before relying on it. Thank you for reviewing this information.