HEALTH ADVICE

Click on the headings to learn more on each condition

ANTIBIOTICS

Antibiotics are important medicines for treating bacterial infections in both humans and animals. However, bacteria can adapt and ﬁnd ways to survive the effects of an antibiotic.

This means antibiotics are losing their effectiveness at an increasing rate. The more we use antibiotics, the greater the chance bacteria will become resistant to them and they can no longer be used to treat infections.

Antibiotic resistance is one of the most significant threats to patients’ safety in Europe. It is driven by overusing antibiotics and prescribing them inappropriately.

To slow down the development of antibiotic resistance, it is important to use antibiotics in the right way – to use the right drug, at the right dose, at the right time, for the right duration. Antibiotics should be taken as prescribed, and never saved for later or shared with others.

What is the problem?

Antibiotic resistance is an everyday problem in all healthcare settings across England and Europe. The spread of resistant bacteria in hospitals or community healthcare settings is a major issue for patient safety:

Infections with antibiotic-resistant bacteria increase levels of disease and death, as well as the length of time people stay in hospitals.
Inappropriate use of antibiotics may increasingly cause patients to become colonised or infected with resistant bacteria.
Few new antibiotics are being developed. As resistance in bacteria grows, it will become more difficult to treat infection, and this affects patient care.

What is causing this problem?

The inappropriate use and prescribing of antibiotics is causing the development of resistance.

Inappropriate use includes:

not taking your antibiotics as prescribed
skipping doses of antibiotics
not taking antibiotics at regular intervals
saving some for later
sharing antibiotics with others

Inappropriate prescribing includes:

unnecessary prescription of antibiotics
unsuitable use of broad-spectrum antibiotics
wrong selection of antibiotics
inappropriate duration or dose of antibiotics

How can it be addressed?

There are several ways antibiotic resistance can be addressed.

First, antibiotic prescribing should be made a strategic priority in hospitals by:

targeting antibiotic therapy
implementing structured antimicrobial stewardship plans
reviewing local surveillance and assessing microbiological data

Antibiotic prescribing should also be made a priority in primary care by developing an antibiotic stewardship tool for prescribers.

For more information, see https://www.nhs.uk/conditions/antibiotics/

ATHLETE’S FOOT

Information from patient.co.uk

Authored by Dr Mary Harding, 20 Jan 2015

What is Athlete’s foot?

Athlete’s foot is a skin infection caused by a fungus. Treatment with an antifungal cream usually works well. The tips given below may help to prevent athlete’s foot coming back after it has been treated.

Anyone can get athlete’s foot. It is more common in people who sweat more, or who wear shoes and socks which make their feet sweatier. Athlete’s foot can also be passed on from person to person. For example, this may occur in communal showers used by athletes or swimmers. A tiny flake of infected skin from a person with athlete’s foot can fall off whilst showering. It may then be trodden on by others who may then develop the infection. Once a small patch of infection develops, it typically spreads along the skin.

What does Athlete’s foot look like?

The skin between the little toes tends to be affected at first. A rash develops that becomes itchy and scaly. The skin may become cracked and sore. Large splits (fissures) in the skin between the toes can develop, which can be very painful. Tiny flakes of infected skin may fall off. The rash may spread gradually along the toes if left untreated. In some cases it spreads to the soles. Occasionally, the infection causes a scaling rash on the entire sole and side of the foot. In other cases it causes more of a blistering rash on part of the sole of the foot.

How should I treat athlete’s foot?

You can buy a topical antifungal treatment from pharmacies, or get one on prescription. Topical means it is applied directly to the area affected, i.e. the skin of the feet. There are various types and brands – for example:

terbinafine, clotrimazole, econazole, ketoconazole and miconazole.

They are usually creams, but can also be sprays, liquids or powders. These treatments are all good at clearing fungal skin infections.

Apply for as long as advised. This varies between the different treatments, so read the instructions carefully. Although the rash may seem to go quite quickly, you may need to apply the treatment for 1-2 weeks after the rash has gone. This is to clear the fungi completely from the skin,

An antifungal tablet is sometimes prescribed for adults if the infection does not clear with a cream, or if the infection is severe. Tablets are also sometimes needed if the infection is in many places on the skin in addition to the toes.

Not all treatments are suitable for everyone. Please check with your pharmacist before you purchase one.

How do I avoid getting athletes foot?

Keep your feet dry. The athlete’s foot fungus loves the warm and moist
Avoid sharing towels and communal bathing
Wash socks and shoes regularly
Use antifungal sprays to beat stubborn cases

How can I prevent athlete’s foot recurring?

Wash your feet daily, and dry the skin between your toes thoroughly after washing. This is perhaps the most important point. It is tempting to put socks on when your feet are not quite dry. The soggy skin between the toes is then ideal for fungi to grow.
Do not share towels in communal changing rooms. Wash towels frequently.
Change your socks daily. Fungi may multiply in flakes of skin in unwashed socks. Cotton socks and leather footwear are probably better than nylon socks and plastic footwear, which increase sweating.
Ideally, alternate between different shoes every 2-3 days to allow each pair to dry out fully after being worn.
Ideally, wear flip-flops or plastic sandals in communal changing rooms and showers. This prevents the soles of your feet coming into contact with the ground, which may contain flakes of skin from other people.
Ideally, when at home, leave your shoes and socks off as much as possible to let the air get to your feet. However, this may not be practical for some people.
If athlete’s foot keeps coming back, you may be able to prevent this by using one of the antifungal sprays or creams regularly as a precaution.

COMMON COLD - UPPER RESPIRATORY TRACT INFECTIONS

Information from patient.co.uk

Authored by Dr Mary Harding, 10 Nov 2016

What causes the common cold?

The common cold and most upper respiratory infections are caused by infection with germs (viral infections). They usually get better in a week or two.

How will I feel if I have a cold?

The common symptoms of a cold are a blocked (congested) nose, a runny nose and sneezing. At first there is a clear discharge (mucus) from the nose. This often becomes thick and yellow/green after 2-3 days. It may be difficult to sleep due to a blocked nose. You may feel generally unwell and tired and you may develop a cough or a mildly high temperature (a mild fever). In other upper respiratory tract infections (URTIs), cough is usually the main symptom. Other symptoms include fever, headache, aches and pains.

Symptoms are typically at their worst after 2-3 days and then gradually clear. However, the cough may carry on after the infection has gone. This is because swelling (inflammation) in the airways, caused by the infection, can take a while to settle. It may take 2-3 weeks, after other symptoms have gone, for a cough to clear completely.

How can I treat the common cold?

A main aim of treatment for an upper respiratory tract infection (URTI) is to ease symptoms whilst your immune system clears the infection. One or more of the following may be helpful:

Taking paracetamol oribuprofen to reduce a high temperature (fever) and to ease any aches, pains and headaches. Follow the instructions given with the medicine carefully and do not take more than the advised dose. (Only give these medicines to children under the age of 5 years if they have a fever or appear distressed.)
Having plenty to drinkif you have a fever, to prevent mild lack of fluid in the body (dehydration).
If you smoke, you should try to stop for good. URTIs and serious lung diseases tend to last longer in smokers.
Steam inhalation. There is not very much evidence that this helps; however, some people find it useful. It is very important to be careful to avoid burns and scalds, particularly with children. Vapour rubs. Vapour rubs can be bought in pharmacies and supermarkets.
Sucking sore throat lozenges(available from pharmacies and supermarkets).
Warm drinks with honey and lemonmay help to ease a sore throat. (Do not give honey to babies less than 1 year old as it is not known if this is safe.)
Salt (saline) nose drops. These are nose drops made of a salty solution, which may help clear a blocked nose. They can be bought from a pharmacy.

Remember that cold and cough remedies often contain several ingredients. Be careful about taking more than one remedy in case you get too much of one ingredient.

Some cold and cough remedies may make you drowsy. If you use a decongestant nasal spray, do not use it for more than a few days. If you use a decongestant nasal spray for more than 5-7 days, you may feel that your nose is becoming more blocked. This is called a rebound effect.

What symptoms should I look out for?

Most upper respiratory tract infections (URTIs) do not cause complications and usually resolve as described. Sometimes the infection travels to other areas such as the lungs, sinuses or ears and can go on to become infected by bacteria. Therefore, see a doctor if symptoms do not start to ease within two weeks, or if you suspect that a complication is developing. In particular, symptoms to look out for that may mean more than just a URTI include:

If high temperature (fever), wheezing or headaches become worse or severe.
If you develop fast breathing, shortness of breath, or chest pains.
If you cough up blood or if your phlegm (sputum) becomes dark or rusty-coloured.
If you become drowsy or confused.
If a cough persists for longer than 3-4 weeks.
If you have returning (recurring) URTIs.
If any other symptom develops that you are concerned about.

CONSTIPATION IN ADULTS

Information from patient.co.uk

Authored by Dr Roger Henderson, 28 Jan 2016

What is constipation?

Constipation is a common problem. It means either going to the toilet less often than usual to empty the bowels, or passing hard or painful stools (faeces). Constipation may be caused by not eating enough fibre, or not drinking enough fluids. It can also be a side-effect of certain medicines, or related to an underlying medical condition. In many cases, the cause is not clear. Laxatives are a group of medicines that can treat constipation. Ideally, laxatives should only be used for short periods of time until symptoms ease.

Constipation is common. If you are constipated it causes one or more of the following:

Stools (faeces) become hard and difficult or painful to pass.
The time between toilet trips increases compared with your usual pattern. (Note: there is a large range of normal bowel habit. Some people normally go to the toilet to pass stools 2-3 times per day. For others, 2-3 times per week is normal. It is a changefrom your usual pattern that may mean that you are constipated.)
Sometimes, crampy pains occur in the lower part of your tummy (abdomen) You may also feel bloated and feel sick if you have severe constipation.

What are the causes of constipation?

Not eating enough fibre (roughage)is a common cause.
Not drinking muchmay make constipation worse.
Some special slimming dietsare low in fibre and may cause constipation.
Some medicinescan cause constipation as a side-effect.
Various medical conditionscan cause constipation. For example, an underactive thyroid gland, irritable bowel syndrome, some gut disorders and conditions that cause poor mobility, particularly in the elderly.
Pregnancy. About 1 in 5 pregnant women will become constipated.
Some people have a good diet, drink a lot of fluid, do not have a disease or take any medication that can cause constipation; however, they still become constipated.

Tests are not usually needed to diagnose constipation, because symptoms are often typical.

However, tests may be advised if you have any of the following:

If regular constipation is a new symptom and there is no apparent cause, such as a change in diet, lifestyle, or medication. This is known as a ‘change in bowel habit’ and should be investigated if it lasts for more than about six weeks.
If symptoms are very severe and not helped with laxative medication.
If other symptoms develop. More worrying symptoms include passing blood from your bowel; weight loss; bouts of diarrhoea; night-time symptoms; a family history of colon canceror inflammatory bowel disease (Crohn’s diseaseor ulcerative colitis); or other unexplained symptoms in addition to constipation.

What can I do to ease and to prevent constipation?

ü Eat foods that contain plenty of fibre

ü Have plenty to drink

Aim to drink at least two litres (about 8-10 cups) of fluid per day. Most sorts of drink will do but alcoholic drinks can lead to a lack of fluid in the body (dehydration) and may not be so good.

ü Exercise regularly, if possible

ü Toileting routines

Do not ignore the feeling of needing the toilet. Some people suppress this feeling if they are busy. It may result in a backlog of stools which is difficult to pass later.

If lifestyle measures do not work you can try laxatives

For short-term uncomplicated constipation, you may even choose to treat yourself (without visiting the GP) by buying laxatives in the pharmacy or supermarket. In short-term constipation, laxatives can be stopped once the stools (faeces) become soft and easily passed again. These can be discussed with a Pharmacist.

You should probably visit your GP if you are struggling to manage short-term constipation yourself, or if you have longer-term (chronic, or persistent) constipation. You should use a laxative only for a short time, when necessary, to get over a bout of constipation. Once the constipation eases, you should normally stop the laxative. Some people get into the habit of taking a laxative each day ‘to keep the bowels regular’ or to prevent constipation. This is not advised, especially for laxatives which are not bulk-forming.

COUGH

Information from patient.co.uk

Authored by Dr Mary Harding, 23 Dec 2015

Coughing is an automatic reaction to try to clear your airways. The airway may be partially blocked by phlegm (mucus), smoke, chemicals that you breathe in or a foreign body. Everyone will cough occasionally to ‘clear their throat’.

The cough reflex protects the airways of your lungs. However, it is important to seek medical attention if you have a cough that lasts for more than three weeks. If you’re short of breath, cough up blood or have unexplained problems like weight loss or a high temperature (fever), you should see your GP urgently. The most common causes are mentioned below.

What causes cough?

Common causes of acute cough (lasting less than three weeks)

Upper respiratory tract infections.
Lower respiratory tract infections.
Asthma.
Irritants

Common causes of subacute cough (lasting three to eight weeks)

Airways that are slow to settle down after an infection.
Whooping cough.
Other infections which may cause a longer-lasting cough such astuberculosis (TB).

Common causes of chronic cough (lasting more than eight weeks)

Postnasal drip. This is a condition where phlegm (mucus) in the nose drips down the back of the throat when you lie down. It can be caused by anything which causes your nose to produce more mucus. This includes allergies, hay feverand nasal polyps as well as infections.
Acid reflux. Acid in the stomach washes up the food pipe and spills into the airways.
Undiagnosed or under-treated asthma causes cough.
Side-effects of medication. For example, angiotensin-converting enzyme (ACE) inhibitor medicines, which are used to treat high blood pressure, can cause cough.
Lung disease caused by smoking – chronic obstructive pulmonary disease (COPD). Lung damage causes cough and breathlessness to get steadily worse. This mainly affects smokers.
Irritants such as cigarette smoke. This may be your own cigarette smoke, or from being in contact with other people’s smoke (passive smoking).

Less common causes of cough

A foreign body. Food can go down the windpipe instead of the food pipe. Other objects may also be inhaled by accident, such as beads, particularly in children.
Lung cancer. This is more likely in smokers.
Cystic fibrosis. This is an inherited condition that affects the lungs and causes chronic cough.
In this condition, air gets trapped outside the lung, inside the chest.
Bronchiectasis. This is a condition where airways of the lungs are excessively widened and produce extra mucus.
A blood clot in the lung (pulmonary embolus).

What investigations may be advised?

The doctor will want to know how long your cough has lasted and whether you have any other symptoms. The doctor will particularly ask about symptoms which may suggest an underlying serious condition (‘red flags’).

Red flag symptoms that may suggest serious underlying disease:

What should I do if I develop a cough?

This will depend on how long the cough has lasted and how unwell you are feeling. If you feel well and the cough has not lasted long, you may not need to do anything but wait for it to settle. Simple remedies maybe help while you wait for it to go on its own, you can consult your Pharmacist for advice. See your GP if your cough lasts more than three weeks and is not improving. See your GP urgently if you feel very unwell, or if you develop red flag symptoms. Use your reliever inhaler as instructed if you have asthma.

You should call an ambulance (999/112/911) if you experience unexpected and severe cough and difficulty in breathing that lasts for more than a few minutes. Otherwise, you should call your GP if concerned.

What treatments may be offered?

Treatment will depend on the likely cause of your cough.

For acute coughs due to viral infections, simple remedies may be all that is needed. This might include inhaling steam, or honey and lemon to soothe your throat. If you feel unwell with a temperature or aches and pains, paracetamol or ibuprofen may help. The cough will go away with time on its own.

You will be strongly encouraged to stop smoking if you are a smoker. You will be offered inhalers if you have asthma. If the cough is due to tablets given for high blood pressure, you can switch to another type. If bacterial infection is likely, you may be prescribed antibiotics. A steroid nasal spray may help postnasal drip.

Losing weight, cutting out acid foods and alcohol and taking medicine to stop acid in the stomach may all help acid reflux.

You may be referred to a lung (respiratory) specialist for further tests. Most cases will be managed by your GP but you may be referred for further investigation and treatment at a hospital.

CYSTITIS (URINE INFECTION) IN WOMEN

Information from patient.co.uk

Authored by Dr Mary Harding, 24 Mar 2016

What is cystitis?

A urine infection in the bladder (cystitis) is common in women. A short course of medicines called antibiotics is the usual treatment. Occasionally it may improve without the need for antibiotics. Cystitis clears quickly without complications in most cases.

Cystitis can cause various symptoms. The main ones are:

Needing to pass urine urgently and more often.
Burning or stinging feeling when you urinate.
Blood in the urine.
Discomfort in your lower tummy (abdomen).
Feeling generally unwell and tired, with a raised temperature (fever).

What causes cystitis?

Women are much more likely than men to have cystitis, as the tube that passes out urine from a woman’s bladder (the urethra) is shorter and opens nearer the back passage (anus).

About half of women have at least one bout of cystitis in their lives. One in three women will have had cystitis by the age of 24. About 4 out of 100 pregnant women develop cystitis.

Apart from being female, other cystitis causes include:

Having diabetes mellitus.
Being pregnant.
Being sexually active.
Using spermicide with contraception.
Having had the menopause. The changes in the tissues of the vagina and urethra after menopause make it harder for them to defend against infection.
Having a catheter in your bladder.
Having abnormalities in your kidneys, bladder or urinary system.
Having an immune system which is not working well (for example, due to AIDS or medication which suppresses the immune system).

Can I be sure it is cystitis?

Some conditions cause symptoms that may be mistaken for cystitis – for example, vaginal thrush. Also, soaps, deodorants, bubble baths, etc, may irritate your genital area and cause mild pain when you pass urine.

Your doctor or nurse may do a simple dipstick test on a urine sample to check for cystitis. This can detect changes in the urine that may indicate an infection. It’s fairly reliable & usually no further test is needed. If the infection does not improve with treatment, or improves but then returns quickly, a urine sample is sent to the lab. This is to confirm the diagnosis and to find out which germ is causing the infection

Cystitis treatment

Treatment options include the following:

Antibiotic medication. A three- to five-day course of trimethoprim or nitrofurantoin is a common treatment for most women. Symptoms usually improve within a day or so after starting treatment. Sometimes your doctor may offer you a delayed prescription for antibiotics. You then need only pick up the prescription if your symptoms worsen, or do not improve, over the following few days.
Not taking any treatment may be an option if symptoms are very mild (and if you are not pregnant or if you have no other illnesses). Your immune system can often clear the infection. Without antibiotics, cystitis (particularly mild cases) may go away on its own in a few days. However, symptoms can sometimes last for a week or so if you do not take antibiotics.
Paracetamol or ibuprofen. These ease pain or discomfort and can also lower a high temperature (fever).

Have lots to drink is traditional advice to ‘flush out the bladder’. However, there is no proof that this is helpful. Some doctors and pharmacists feel that it does not help and drinking lots may just cause more (painful) toilet trips. Therefore, it is difficult to give confident advice on whether to drink lots, or just to drink normally.

There is no strong evidence that drinking cranberry juice or taking products that alkalise your urine (such as potassium citrate or bicarbonate) improve the symptoms of cystitis. These sorts of products are sometimes sold as a treatment for cystitis.

If your symptoms worsen or you develop a fever you should see your doctor. You should also see your doctor if your symptoms do not improve by the end of taking the course of antibiotics or if they come back within two weeks of the course finishing.

Note: if you are pregnant or have certain other medical conditions, you should always be treated with antibiotics to prevent possible complications.

DIARRHOEA

Information from patient.co.uk

Authored by Dr Laurence Knott, 01 Dec 2014

Diarrhoea can be of sudden onset and lasting for less than four weeks (acute) or persistent (chronic). This leaflet deals with acute diarrhoea, which is common. In most cases, diarrhoea eases and goes within several days but sometimes takes longer. The main risk is lack of fluid in the body (dehydration). The main treatment is to have lots to drink, which aims to avoid dehydration. You should also eat as normally as possible. See a doctor if you suspect that you are dehydrating, or if you have any worrying symptoms such as those which are listed below.

What causes acute diarrhoea?

Infectionof the gut is the common cause. This is of sudden onset and is called acute infectious diarrhoea. Many bacteria, viruses and other germs can cause diarrhoea. Sometimes the germs come from infected food (food poisoning). Infected water is a cause in some countries. Sometimes it is just “one of those germs going about”. Viruses are easily spread from one person to another by close contact, or when an infected person prepares food for others.
Other causesare uncommon and include drinking lots of beer, side-effects from some medicines and anxiety.
Gut disordersthat cause persistent (chronic) diarrhoea may be mistaken for acute diarrhoea when they first begin – for example, diarrhoea caused by ulcerative colitis.

Do I need any tests?

Most people with acute infectious diarrhoea do not need to see a doctor or seek medical advice. Symptoms are often quite mild and commonly get better within a few days without any medical treatment.

However, in some circumstances, you may need to see a doctor (see below about when to seek medical advice). The doctor may ask you various questions – for example, about:

Recent travel abroad.
Whether you have been in contact with someone with similar symptoms.
Whether you have recently taken antibiotics.
Whether you have recently been admitted to hospital.

This is to look for possible causes of your diarrhoea. The doctor will also usually examine you, especially looking for signs of lack of fluid in the body (dehydration).

Tests are not usually needed. However, if you are particularly unwell, have bloody stools (faeces), have recently travelled abroad, are admitted to hospital, or your symptoms are not getting better, your doctor may ask you to collect a stool sample. This can then be examined in the laboratory to look for the cause of the infection.

When should I seek medical advice?

Seek medical advice in any of the following situations, or if any other symptoms occur that you are concerned about:

If you suspect that you are becoming lacking in fluid in the body (dehydrated).
If you are being sick (vomiting) a lot and unable to keep fluids down.
If you have blood in your diarrhoea or vomit.
If you have severe tummy (abdominal) pain.
If you have severe symptoms, or if you feel that your condition is getting worse.
If you have a persisting high temperature (fever).
If your symptoms are not settling – for example, vomiting for more than 1-2 days, or diarrhoea that does not start to settle after 3-4 days.
Infections caught abroad.
If you are elderly or have an underlying health problem such as diabetes, epilepsy, inflammatory bowel disease, kidney disease.
If you have a weakened immune system because of, for example, chemotherapy treatment, long-term steroid treatment, HIV infection.
If you are pregnant.

What is the treatment for infectious diarrhoea in adults?

Symptoms often settle within a few days or so as your immune system usually clears the infection. Occasionally, admission to hospital is needed if symptoms are severe, or if complications develop (see below).

The following are commonly advised until symptoms ease.

Fluids – have lots to drink

The aim is to prevent lack of fluid in the body (dehydration), or to treat dehydration if it has developed. (Note: if you suspect that you are dehydrated, you should contact a doctor.)

As a rough guide, drink at least 200 mls after each bout of diarrhoea (after each watery stool (faeces)).
This extra fluid is in addition to what you would normally drink. For example, an adult will normally drink about two litres a day but more in hot countries. The above advice of 200 mls after each bout of diarrhoea is in addition to this usual amount that you would drink.
If you have been sick (vomited), wait 5-10 minutes and then start drinking again but more slowly. For example, a sip every 2-3 minutes but making sure that your total intake is as described above.
You will need to drink even more if you are dehydrated. A doctor will advise on how much to drink if you are dehydrated.

For most adults, fluids drunk to keep hydrated should mainly be water. It is best not to have drinks that contain a lot of sugar, such as cola or pop, as they can sometimes make diarrhoea worse.

Rehydration drinks are recommended for people who are frail, or over the age of 60, or who have underlying health problems. They are made from sachets that you can buy from pharmacies. (The sachets are also available on prescription.) You add the contents of the sachet to water. Rehydration drinks provide a good balance of water, salts and sugar. They do not stop or reduce diarrhoea. However, the small amount of sugar and salt helps the water to be absorbed better from the gut into the body. Home-made salt/sugar mixtures are used in developing countries if rehydration drinks are not available but they have to be made carefully, as too much salt can be dangerous. Rehydration drinks are cheap and readily available in the UK and are the best treatment.

Anti-secretory medicines are designed to be used with rehydration treatment. They reduce the amount of water that is released into the gut during an episode of diarrhoea. They can be used for children who are older than 3 months of age, and for adults.

Eat as normally as possible

It used to be advised to not eat for a while if you had infectious diarrhoea. However, now it is advised to eat small, light meals if you can. Be guided by your appetite. You may not feel like food and most adults can do without food for a few days. Eat as soon as you are able – but don’t stop drinking. If you do feel like eating, avoid fatty, spicy or heavy food at first. Plain foods such as wholemeal bread and rice are good foods to try eating first.

Medication

Antidiarrhoeal medicines are not usually necessary. However, you may wish to reduce the number of trips that you need to make to the toilet. You can buy antidiarrhoeal medicines from pharmacies. The safest and most effective is loperamide. The adult dose of this is two capsules at first. This is followed by one capsule after each time you pass some diarrhoea, up to a maximum of eight capsules in 24 hours. It works by slowing down your gut’s activity. You should not take loperamide for longer than five days.

Note: do not give antidiarrhoeal medicines to children aged under 12 years. Also, do not use antidiarrhoeal medicines if you pass blood or mucus with the diarrhoea or if you have a high temperature (fever). People with certain conditions should not take loperamide. Therefore, read the leaflet that comes with the medicine to be safe. For example, pregnant women should not take loperamide.

Paracetamol or ibuprofen are useful to ease a high temperature or headache.

As explained above, if symptoms are severe, or continue (persist) for more than several days, your doctor may ask for a sample of the diarrhoea. This is sent to the laboratory to look for infecting germs (bacteria, parasites, etc). Sometimes an antibiotic or other treatments are needed if certain bacteria or other infections are found to be the cause. Antibiotics are of no use for infectious diarrhoea caused by viruses and may even make things worse.

Preventing spread of infection to others

Some infections causing diarrhoea are very easily passed on from person to person. If you have acute diarrhoea, the following are also recommended to prevent the spread of infection to others:

Wash your hands thoroughly after going to the toilet. Ideally, use liquid soap in warm running water but any soap is better than none. Dry properly after washing.
Don’t share towels and flannels.
Don’t prepare or serve food for others.
Regularly clean the toilets that you use. Wipe the flush handle, toilet seat, bathroom taps, surfaces and door handles with hot water and detergent at least once a day. Keep a cloth just for cleaning the toilet (or use a disposable one each time).
Stay off work, college, etc, until at least 48 hours after the last episode of diarrhoea or being sick (vomiting).
Food handlers: if you work with food and develop diarrhoea or vomiting, you must immediately leave the food-handling area. For most, no other measures are needed, other than staying away from work until at least 48 hours after the last episode of diarrhoea or vomiting. Some special situations may arise and sometimes longer time off is needed. Specialist advice may be needed for some uncommon causes of infectious diarrhoea. If in doubt, seek advice from your employer or GP.
If the cause of acute diarrhoea is known to be (or suspected to be) a germ called Cryptosporidiumspp., you should not swim in swimming pools for two weeks after the last episode of diarrhoea.

Can infectious diarrhoea be prevented?

The advice given in the previous section is mainly aimed at preventing the spread of infection to other people. However, even when we are not in contact with someone with infectious diarrhoea, proper storage, preparation and cooking of food and good hygiene help to prevent it.

In particular, always wash your hands:

After you go to the toilet.
Before you touch food.
Between handling raw meat and food ready to be eaten. (There may be some germs (bacteria) on raw meat.)
After gardening.
After playing with pets (healthy animals can carry certain harmful bacteria).

The simple measure of washing hands regularly and properly is known to make a big difference to the chance of developing infectious diarrhoea.

You should also take extra measures when in countries of poor sanitation. For example, avoid water and other drinks that may not be safe and avoid food washed in unsafe water.

EARACHE

Information from patient.co.uk

Authored by Dr Mary Harding, 24 Apr 2015

Middle ear infection (otitis media)

Otitis media is an extremely common cause of earache in children. It can occur in adults, but is unusual. It is most common in children of preschool age. It often occurs following a common cold.

Children with otitis media have a painful ear and often a high temperature (fever). Mostly otitis media gets better on its own and is treated with painkillers only. However, if it is not improving after a few days or if your child is very young, your doctor may consider antibiotic medication.

Infection in the ear canal (otitis externa)

Otitis externa is an infection of the outer part of the ear, the ear canal. This type of infection is more common in adults than in children. It is more common in people who swim. It also may occur in people who have skin conditions such as eczema around the ear.

If you have otitis externa your ear may feel sore or itchy. There may be a discharge coming out of your ear. Your ear may feel blocked and you may not be able to hear as well as usual.

The treatment for otitis externa is usually ear drops or an ear spray. You will normally need to see your doctor for a prescription. However, there are ear drops called acetic acid ear drops (EarCalm®) available over the counter which can treat most cases of otitis externa. If you have had it before and recognise the symptoms, you may be able to purchase these from the chemist. However, if this is the first time, you should see a doctor to confirm the diagnosis. If your symptoms do not improve within a few days f its use you should see your doctor.

Wax

Our ears produce a waxy substance to protect our ear canals. Normally this naturally moves out of your ear on its own. However, sometimes a plug of wax can form, blocking your ear canal. This makes you feel deaf on one or both sides and can be uncomfortable. You also sometimes hear popping sounds or a ringing in your ear when you have wax stuck in your ear. Occasionally it can make you feel dizzy.

Never try to remove earwax with a cotton bud. This can push the wax further into your canal and cause a blockage.

Wax can usually be removed with oils or ear drops. Warmed olive oil or sodium bicarbonate ear drops (available from a chemist) applied three times a day usually help. If this does not remove the wax, you may need to see the nurse at your GP surgery. They may need to flush your earwax out with water (called irrigation).

A common cold

Sometimes a common cold can cause earache without there being an infection in the ear itself. This is due to the excessive mucus you produce when you have a cold. Some of this may collect in the middle ear, putting pressure on the eardrum and causing earache. This will normally improve on its own. Treatments that may help the earache in this case are:

Steam inhalation.
Decongestants (not suitable for children under 6, and for children under 12 only with advice from your doctor). Should only be used for a a few days as they can have a rebound effect.
Simple painkillers.

Foreign bodies

All sorts of objects can get stuck in ears. This is particularly common in children, but can also occur in adults. Foreign bodies which can get into ears include beads, seeds, toys, bits of cotton bud and insects. This may cause earache, deafness, or a discharge. You (or someone else) may be able to see the foreign body in the ear canal. Never try to remove a foreign body yourself, as you may push it deeper into the ear canal. This might damage the eardrum. It is best to see your doctor. Foreign bodies can usually be removed with forceps or by flushing them out with water (irrigation).

Trauma or injury

Poking things into your ear, such as cotton buds or sharp objects, can cause damage to the ear canal. (To avoid damage avoid poking anything in your ear, even if it itches or you think you have wax there.) This can cause soreness which usually goes away on its own. It may go on to get infected, however. So if the pain does not settle, or if you start to have a discharge, see your doctor.

The eardrum can be torn (perforated) by objects poked into the ear. This can also happen due to other injuries such as a very loud noise or a slapped or boxed ear. Other more serious head injuries can also cause damage to the eardrum. A perforated eardrum usually causes a very sudden and severe pain. There may be some bleeding from the ear or you may not be able to hear as well. A perforated eardrum usually heals up on its own very well. However, if the pain or other symptoms do not settle, you should see your doctor

Flying

The changes in pressure as a plane starts to descend commonly cause pain in the ear. This usually settles quickly. If pain carries on a few days after flying, you should see a doctor.

Boils, spots and pimples

Boils, spots and pimples can occur on the ear just like anywhere else on your body. If they are on the outside of the ear, you will be able to see them. If they are in the ear canal you may not be able to see where the pain is coming from. A small spot or boil will usually improve on its own with warm bathing and an antiseptic cream. However, if it is very large or red or painful, you may need to see a doctor for advice. It may need an antibiotic cream, an antibiotic medicine, or lancing with a needle.

Pain coming from somewhere else (referred pain)

Referred pain is pain felt in one part of the body from a problem elsewhere in the body. Sometimes a pain in the ear is nothing to do with the ear but is coming from somewhere else

Shingles

Shingles is a condition where the virus which causes chickenpox (the varicella-zoster virus) is reactivated in just one nerve. It causes pain and a rash in the area of skin that nerve supplies. If you think you might have shingles around the ear, see a doctor as soon as possible. If treatment is required, it works best if it is started early. Not all cases of shingles need treatment

What should I do if I have earache?

If you feel well in yourself and have an earache, you may be able to treat yourself with simple painkillers. Paracetamol or ibuprofen, if you can take it, usually works well for ear pain. However, a person with earache should see a doctor if:

They are unwell in themselves with other symptoms such as a high temperature (fever), a rash, being sick (vomiting), confusion or drowsiness.
They are younger than 3 months.
They are younger than 6 months and have a temperature of more than 38°C.
They are younger than 2 years and have pain in both ears.
The earache has not improved after four days.
The ear is discharging.
There is something stuck in the ear.
The pain is very severe and simple painkillers are not helping.
They have other illnesses which might affect their ability to fight off an infection.

HAY FEVER

Information from patient.co.uk

Authored by Dr Mary Harding, 27 Jul 2015

Will it help if I avoid pollen?

It is impossible to avoid pollen totally. However, symptoms tend to be less severe if you reduce your exposure to pollen. A high pollen count is a count above 50.

The following may help when the pollen count is high:

Stay indoors as much as possible and keep windows and doors shut.
Avoid cutting grass, large grassy places and camping.
Shower and wash your hair after being outdoors, especially after going to the countryside.
Wear wraparound sunglasses when you are out.
Keep car windows closed and consider buying a pollen filter for the air vents in your car. These should be changed at every service.

What are the commonly used treatments?

The commonly used hay fever treatment options are:

Antihistamine nasal sprays
Antihistamine tablets
Steroid nasal sprays
Eye drops.

If your hay fever symptoms are not controlled on the medication that you are taking after 2-4 weeks, you should discuss this with your doctor. You may need to try a different treatment or add in another treatment.

If you are taking hay fever medication regularly and your hay fever is well controlled on your current treatment, you should continue this treatment until the end of the pollen season.

Antihistamine nasal spray

A dose from an antihistamine nasal spray can rapidly ease itching, sneezing and watering (within 15 minutes or so). It may not be so good at easing congestion. Antihistamines work by blocking the action of histamine. This is one of the chemicals involved in allergic reactions. A spray can be used as required if you have mild symptoms. It can also be taken regularly to keep symptoms away.

Antihistamine tablets (or liquid medicines)

Antihistamines taken by mouth (tablets or liquids) are an alternative. They ease most of the symptoms but may not be so good at relieving a blocked nose (nasal congestion). Antihistamines taken by mouth are good if you have eye symptoms as well as nasal symptoms. They are also usually given to small children instead of a nasal spray. A dose usually works within an hour. Therefore, one can be taken as required if symptoms come and go. One can also be taken regularly if symptoms occur each day.

There are several types and brands of antihistamines that you can buy at pharmacies or get on prescription. Older antihistamines such as chlorphenamine work well but make some people drowsy. So, they should not be taken if you are driving or operating machinery. There are several newer ones that cause less drowsiness. Ask your pharmacist or doctor for advice. Commonly used ones include:

If you are pregnant or breast-feeding, you are usually advised to try to avoid antihistamines, if possible. Treatment with a steroid nasal spray is usually tried first (see below). An antihistamine may sometimes be used if your symptoms are not controlled. Discuss with your doctor or pharmacist if you are pregnant or breast-feeding and have hay fever.

Antihistamine medicines such as loratadine and cetirizine may be used by children from the age of 2.

Steroid nasal sprays and drops

A steroid nasal spray usually works well to clear all the nasal symptoms (itch, sneezing, watering and congestion). It works by reducing inflammation in the nose. A steroid nasal spray also tends to ease eye symptoms. It is not clear how it helps the eye symptoms – but it often does. Steroid nasal drops are also sometimes used.

It takes several days for a steroid spray to build up its full effect. Therefore, there is no immediate relief of symptoms when you first start it. In some people it can take up to three weeks or longer to be fully effective. So do persevere. (It is best to start taking it a few weeks before the hay fever season is likely to begin if you know that you have hay fever.)

A steroid nasal spray tends to be the most effective treatment when symptoms are more severe. It can also be used by adults in addition to antihistamines if symptoms are not fully controlled by either alone.

You need to use the spray each day over the hay fever season to keep symptoms away. However, once symptoms have gone, the dose of a steroid spray can often be reduced to a low maintenance dose each day to keep symptoms away. There are several brands which you can buy at pharmacies, or get on prescription. Side-effects or problems with steroid nasal sprays are rare (read the packet leaflet for details).

Eye drops

If necessary, you can use eye drops in addition to other treatments:

Mast cell stabilisereye drops. These drops are thought to work by stopping the release of histamine from certain cells called mast cells. You need to use them regularly to prevent symptoms.
Antihistamine eye dropswork quickly, so you can use them as required to ease a flare-up of eye symptoms. You can also use them regularly if needed. It is best not to use them for more than six weeks at a time, however. There are several different ones including antazoline, azelastine and epinastine.
Anti-inflammatory eye drops, such as diclofenac, are also sometimes used for hay fever.

Other nasal sprays

The following are sometimes used. They tend to be used if there are problems with any of the above treatments. Sometimes one is used as an add-on treatment in addition to one or more of the above treatments if symptoms are not fully controlled:

Sodium cromoglicate nasal spray. Like steroid sprays, it takes a while to build up its effect and needs to be taken regularly. It is thought to work by stopping the release of histamine from certain cells. One disadvantage is that it needs to be taken 4-5 times a day (steroid sprays are taken 1-2 times a day). This appears to be the safest medicine to use for hay fever in the first three months of pregnancy.
Ipratropium bromide nasal spraymay be worth a try if you have a lot of watery discharge. It has no effect on sneezing or congestion.
Decongestant nasal spraysthat you can buy at pharmacies are not usually advised for more than a few days. They have an immediate effect to clear a blocked nose. However, if you use one for more than 5-7 days, a rebound, more severe congestion of the nose often develops. One may be useful for a few days to clear a blocked nose when you first use a steroid nasal spray. The steroid can then get to the lining of the nose to work. Don’t use decongestant nasal sprays for more than seven days.

If your symptoms are not settling with these over the counter measures which you can speak to your Pharmacist about then see your Doctor

HEAD LICE

Information from patient.co.uk

Authored by Dr Mary Harding, 24 Aug 2016

What are head lice?

Head lice are small insects which live in human hair and feed on blood from the scalp. Their eggs are called nits.

How can I tell if I have them?

Not all scalp itching is caused by head lice, and head lice don’t always cause an itch. So the only way of telling for sure whether you have head lice is to see a live louse. If someone has quite a lot of lice, you may sometimes be able to see them just by looking through their hair.

The best way to check for lice, however, is with a special nit detection comb. These combs have very fine teeth designed to pull out lice. If you have head lice, when you comb through hair, one or more tiny little beasties come out on the comb. You can buy the special comb from your chemist.

How can I get rid of them?

You can get rid of head lice either by a combing method, or by the use of insecticides which you can buy from a chemist. Everyone in the house who has got confirmed head lice should be treated at the same time. Most insecticides need to be used twice, and combing has to be done several times over at least two weeks.

How can I avoid getting them?

There is no magical anti-lice option that is guaranteed to stop you getting head lice. The main tricks are:

Check school children regularly for head lice.
Girls should tie their hair up at school so it comes into contact with other hair less.
If one person in the house has head lice, everyone else should be checked. Those who have head lice should then be treated.

INSECT BITES AND STINGS

Information from patient.co.uk

Authored by Dr Nick Imm, 18 Dec 2015

What may happen after an insect sting or bite?

A small local skin reaction – most cases

Most people will be familiar with the common local skin reactions caused by insects.

An insect sting– typically causes an intense, burning pain. This is quickly followed by a patch of redness and a small area of swelling (up to 1 cm) around the sting. This usually eases and goes within a few hours.
An insect bite– you may not notice the bite (although some can be quite painful, particularly from a horsefly). However, saliva from the insect can cause a skin reaction such as:
Irritationand itch over the site of the bite.
A small itchy lump (papule)which may develop up to 24 hours after a bite. This typically lasts for several days before fading away. Sometimes some redness (inflammation) surrounds each papule.
A whealis a red, slightly raised mark on the skin which is often itchy but temporary. It may develop immediately after being bitten. A wheal lasts about two hours but is often followed by a small itchy solid lump which develops up to 24 hours later. This can last for several days before fading away.

Occasionally, small skin reactions following an insect bite persist for weeks or months. A persistent skin reaction is particularly likely following a tick bite. Severe allergic reactions (described below) are rare after insect bites – they are more common after insect stings.

A localised allergic skin reaction – occurs in some cases

Some people have an allergic reaction to the venom in a sting. A localised reaction causes swelling at the site of the sting. This becomes larger over several hours and then gradually goes away over a few days. The size of the swelling can vary but can become many centimetres across. The swelling may even extend up an entire arm or leg. The swelling is not dangerous unless it affects your airway. However, if it is severe, the skin may break out in blisters.

A generalised (systemic) allergic reaction – rare but serious

The venom can cause your immune system to react more strongly. This may cause one or more of the following:

Itchy skin in many parts of the body, followed by an itchy blotchy rash that can appear anywhere on the body.
Swelling of your face which may extend to the lips, tongue, throat and upper airway.
A sense of impending doom.
Tummy (abdominal) cramps and feeling sick.
Dilation of the blood vessel, which can cause:
- General redness of your skin.
- A fast heart rate.
- Low blood pressure, which can make you feel faint or even cause you to collapse.
Wheezing or difficulty in breathing due to an asthma attack or throat swelling.

A generalised reaction will usually develop within 10 minutes of a sting. It can be fairly mild – for example, a generalised itchy rash and some mild facial swelling.

In some cases it is severe and life-threatening – for example, severe difficulty breathing and collapse. This severe reaction is called anaphylaxis and without quick treatment you would soon become unconscious. A small number of people die every year as a result of this kind of severe reaction, usually because they do not obtain treatment quickly enough.

If you think you are having an anaphylactic reaction you need to call an ambulance straightaway and obtain immediate medical help.

If you have many bee or wasp stings at the same time, this can also cause serious illness. This is usually directly due to the high dose of venom, rather than to an allergy.

Skin infection

Occasionally, a skin infection develops following a bite, particularly if you scratch a lot, which can damage the skin and allow germs (bacteria) to get in. Infection causes redness and tenderness around the bite. Over a period of several days, this may spread and, sometimes, can become serious.

Transmitted diseases

Most insects in the UK do not transmit other diseases. The main exception is a type of tick which carries a germ called Borrelia burgdorferi which causes Lyme disease. If this germ gets into your skin it can travel to various parts of your body and cause inflammation of the joints (arthritis), inflammation of the tissues around the brain (meningitis) and other problems. See separate leaflet called Lyme Disease for more details. In hot countries, mosquito bites transmit certain germs which can cause diseases such as malaria.

What is the treatment for an insect sting or bite?

If stung by a bee and the stinger is still in place – scrape it out:

Scrape out a bee sting left in the skin as quickly as possible. Use the edge of a knife, the edge of a credit card, a fingernail, or anything similar.
The quicker you remove the sting the better; so use anything suitable to scrape out the sting quickly.
Do not try to grab the sting to pluck it out, as this may squeeze more venom into the skin. Scraping it out is better.

Note: wasps, hornets or yellow jackets do not leave a stinger in the skin when they sting.

If any symptoms of a generalised allergic reaction develop (see above) then:

Call an ambulance immediately.
If you have been issued with an adrenaline (epinephrine) pen, use it as directed straightaway.
You may be given oxygen and injections of adrenaline (epinephrine), steroids and antihistamines in hospital to counter the allergic reaction.
Some people require a fluid ‘drip’ and other intensive resuscitation.

If there is a localised allergic reaction (swelling around the site of the sting) then:

Take an antihistamine tablet as soon as possible. You can buy these at pharmacies, or obtain them on prescription. Antihistamines block the action of histamine, which is a chemical that is released by certain cells in the body during allergic reactions.
Use a cold compress to ease pain and to help reduce swelling. For example, use a cold flannel or an ice pack.
Painkillerssuch as paracetamol or ibuprofen can help to ease the pain.
Continue with antihistamines until the swelling eases. This may be for a few days.
See a doctor if the swelling is severe. Your doctor may prescribe a short course of steroid tabletsto counter the inflammation.

If there is no allergic reaction (most cases) then:

A cold compress will ease any pain and help to minimise any swelling – for example, use a cold flannel or an ice pack.
A painkiller such as paracetamol or ibuprofen may help if you have any pain.
If it is itchy, you may not need any treatment, as itching often soon fades. However, sometimes an itch persists for hours or days. No treatment will take the itch away fully but the following may help:
Crotamiton ointment(which you can buy at pharmacies) is soothing when rubbed on to itchy skin.
A steroid cream may be useful– for example, hydrocortisone which you can buy at pharmacies or obtain on prescription. A doctor may prescribe a stronger steroid cream in some cases.
Antihistamine tablets may be useful if you have lots of bites. In particular, a sedative antihistamine at night may help if the itch is interfering with sleep. A pharmacist can advise on which types of antihistamine are sedative and can help with sleep.

Tick bites

The tick usually clings to the skin. Remove the tick as soon as possible after the bite, using fine tweezers or fingernails to grab the tick as close to the skin as possible. Pull it gently and slowly straight out and try not to squeeze the body of the tick. Clean the site of the bite with disinfectant. (Traditional methods of tick removal using a burned match, petroleum jelly, or nail polish do not work well and are not recommended.)

See a doctor if you develop a rash which spreads out from a tick bite over the following week or so. Also, if you develop an unexplained high temperature (fever) within a month of the tick bite. These symptoms may be the first sign of Lyme disease and need checking out.

Infection

If the skin around a bite or sting becomes infected then you may need a course of antibiotics. This is not commonly needed.

MOUTH ULCERS

Information from patient.co.uk

Authored by Dr Mary Harding, 31 Aug 2016

What are mouth ulcers?

Mouth ulcers are painful sores that can occur anywhere inside the mouth. This leaflet is about the most common type of mouth ulcers, which are aphthous mouth ulcers. At least 1 in 5 people can develop aphthous mouth ulcers at some stage in their lives. Women are affected more often than men.

There are three types:

Minor aphthous ulcersare the most common (8 in 10 cases). They are small, round, or oval and are less than 10 mm across. They look pale yellow but the area around them may look swollen and red. Only one ulcer may develop but up to five may appear at the same time. Each ulcer lasts 7-10 days and then goes without leaving a scar. They are not usually very painful.
Major aphthous ulcersoccur in about 1 in 10 cases. They tend to be 10 mm or larger across. Usually only one or two appear at a time. Each ulcer lasts from two weeks to several months but will heal leaving a scar. They can be very painful and eating may become difficult.
Herpetiform ulcersoccur in about 1 in 10 cases. These are tiny pinhead-sized ulcers, about 1-2 mm across. Multiple ulcers occur at the same time but some may join together and form irregular shapes. Each ulcer lasts one week to two months. Despite the name, they have nothing to do with herpes or the herpes virus.

Aphthous ulcers usually first occur between the ages of 10 and 40 years. They then come back (recur) but there can be days, weeks, months, or years between each bout of ulcers. The ulcers tend to recur less often as you become older. In many cases, they eventually stop coming back. Some people feel a burning in part(s) of the mouth for a day or so before an ulcer appears.

What causes aphthous mouth ulcers?

The cause is not known. They are not infectious and you cannot ‘catch’ aphthous mouth ulcers. In most cases, the ulcers develop for no apparent reason in people who are healthy.

In some cases the ulcers are related to other factors or diseases. These include:

Injury – such as badly fitting dentures, a graze from a harsh toothbrush, etc.
Changes in hormone levels. Some women find that mouth ulcers occur just before their period. In some women, the ulcers only develop after the menopause.
Stopping smoking – some people find they develop ulcers only after stopping smoking.
A lack of iron, or a lack of certain vitamins (such as vitamin B12and folic acid) may be a factor in some cases.
Rarely, a food allergy may be the cause.
Mouth ulcers run in some families. So, a genetic factor may play a part in some cases.
Stress or anxiety is said to trigger aphthous mouth ulcers in some people.
Some medications can cause mouth ulcers. Medication can cause mouth ulcers in various ways and may not necessarily cause the aphthous type of ulcer. Examples of medicines that can cause mouth ulcers are:
- Nicorandil.
- Anti-inflammatory medicines(for example, ibuprofen).
- Oral nicotine replacement therapy.
- Certain tablets which are left to dissolve in the mouth, when they are supposed to be swallowed whole. For example, aspirincan do this if kept to dissolve against a gum. Alendronate, taken to treat ‘thinning’ of the bones (osteoporosis), can also cause mouth ulcers if it is not taken according to the instructions.
- Some street drugs such as cocaine.

Mouth ulcers are more common in people with certain conditions – for example, Crohn’s disease, coeliac disease, HIV infection and Behçet’s disease. However, these ulcers are not the aphthous type.

You should inform your doctor if you have any other symptoms in addition to the mouth ulcers. Other important symptoms would include skin or genital ulcers or joint pains and inflammation. Sometimes a blood test or other investigations are advised if other causes of mouth ulcers are suspected.

What are the treatments for aphthous mouth ulcers?

Treatment aims to ease the pain when ulcers occur and to help them to heal as quickly as possible. There is no treatment that prevents aphthous mouth ulcers from coming back (recurring).

No treatment may be needed

The pain is often mild, particularly with the common ‘minor’ type of aphthous ulcer. Each bout of ulcers will go without treatment.

General measures include

Avoiding spicy foods, acidic fruit drinks and very salty foods (such as crisps) which can make the pain and stinging worse.
Using a straw to drink, to avoid the liquids touching ulcers in the front of the mouth. (Note: do not drink hot drinks with a straw, as you may burn your throat.)
Using a very soft toothbrush. See a dentist if you have badly fitting dentures.
If you suspect a medication is causing the ulcers then a change may be possible. For example, if you are using oral nicotine replacement therapy (nicotine gum or lozenges), it may help to use a different type instead such as patches or nasal spray.
Salt (saline) mouthwashes. Dissolve half a teaspoon of salt in a glassful of warm water, swish around your mouth and spit it out. This can be done as often as needed and may be soothing. Do not swallow the salt mouthwash.

Some medicines may ease your symptoms from the mouth ulcers

Chlorhexidine mouthwash(Corsodyl® or Chlorohex®) may reduce the pain. It may also help ulcers to heal more quickly. It helps to prevent ulcers from becoming infected. Unfortunately, it does not reduce the number of new ulcers. Chlorhexidine mouthwash is usually used twice a day. It may stain teeth brown if you use it regularly. However, the stain is not usually permanent and can be reduced by avoiding drinks that contain tannin (such as tea, coffee, or red wine) and by brushing teeth before use. Rinse your mouth well after you brush your teeth, as some ingredients in toothpaste can inactivate chlorhexidine.
Steroid lozenges(Corlan® pellets) may also reduce the pain and may help ulcers to heal more quickly. By using your tongue you can keep a lozenge in contact with an ulcer until the lozenge dissolves. A steroid lozenge works best the sooner it is started once an ulcer erupts. If used early, it may ‘nip it in the bud’ and prevent an ulcer from fully erupting. The usual dose is one lozenge, four times a day, until the ulcer goes. Use for no more than five days at a time.
Soothing protective pastes. These products, such as Orabase®, help to cover the ulcer temporarily to protect it.
A painkilling oral rinse, gel, or mouth spraymay help to ease pain. The effect of these painkilling medicines is unfortunately short-lived. These can be bought at pharmacies. For all these products, follow the directions in the packet very carefully. Examples include:
- Benzydamine spray or mouthwash (Difflam®)
- Products containing a temporary numbing agent (local anaesthetic) called lidocaine.
- Choline salicylate gel (Bonjela®). The adult form of Bonjela® should not be used in children under the age of 16 due to a potential risk of Reye’s syndrome if it is overused. This is the same reason why aspirin cannot be used in children too. Bonjela® products for children no longer contain choline salicylate and have been reformulated with lidocaine.

You can buy all of the treatments listed above from pharmacies, without a prescription. Your doctor may suggest trying other treatments if the above do not help or where the pain and ulceration are severe. Examples include:

Painkilling tablets.
Steroid inhalers such as beclometasone, usually used for asthma, can be helpful when sprayed onto the lining of the mouth.
A soluble tablet containing the steroid betamethasone can be dissolved in water and used as a mouthwash.
A course of steroid tablets.
A course of an antibioticsuch as doxycycline.

Occasionally using steroid preparations in this way can give you thrush in the mouth as a side-effect.

When should I see a doctor?

Aphthous mouth ulcers can be painful and are often a nuisance but are not serious. Occasionally a mouth ulcer can become secondarily infected with germs (bacteria). In this case you may notice increased pain or redness, or you may be feeling unwell with a high temperature (fever). Secondary bacterial infections are not common but may need treatment with antibiotic medicines.

Remember, not all mouth ulcers are aphthous ulcers. Other types of ulcer canoccur in the mouth and mouth ulcers can be a sign of an underlying illness or disease.

Important: cancer of the mouth can sometimes start as an unusual mouth ulcer that does not heal. You should see a doctor or dentist if you have a mouth ulcer that has lasted for more than three weeks without sign of healing, or is different in any way. This is especially important if you are a smoker. Your GP or dentist may refer you urgently to a specialist. A small sample (biopsy) of the ulcer may be taken in clinic and examined, to exclude cancer.

SPRAINS AND STRAINS

Information from patient.co.uk

Authored by Dr Mary Lowth, 20 Jan 2015

A strain refers to a painful condition brought about by inflammation, overuse (or using in an unbalanced way), and overstretching/tearing of muscles or tendons or joints.

A sprain is an injury to the band (ligament) which connects two or more bones to a joint. A sprain is usually caused by the joint being forced suddenly outside its usual range of movement. A severe sprain may look and feel like a break (fracture), and it can be difficult for health professionals to tell the difference between the two.

Following a sprain or strain the usual advice is to pay the PRICE (Protection, Rest, Ice, Compression, and Elevation) and avoid HARM (Heat, Alcohol, Running, and Massage) for the first 48-72 hours after injury. Most sprains and strains heal within a few weeks.

Note: this leaflet does not advise on how to distinguish what injury you have. For example, if you have an injury, it is sometimes difficult to tell if you have a bone fracture, or other more serious injury. Therefore, see a doctor or nurse if you suspect that you have a fracture or other more serious injury. This leaflet assumes you know that you have a sprain or strain (for example, having been told by a doctor or nurse) and nothing more serious.

What about medication?

You may not need any medication if the injury is mild and you can tolerate the pain. If needed, painkiller options include the following:

Paracetamol and codeine

Paracetamol is useful to ease pain. It is best to take paracetamol regularly, for a few days or so, rather than every now and then. An adult dose is two 500 mg tablets, four times a day. If the pain is more severe, a doctor may prescribe stronger painkillers such as codeine, which is more powerful, but can make some people drowsy and constipated.

Anti-inflammatory painkillers

These medicines are also called non-steroidal anti-inflammatory drugs (NSAIDs). They relieve pain and may also limit inflammation and swelling. You can buy some types (e.g., ibuprofen) at pharmacies, without a prescription. You need a prescription for some others – e.g., naproxen. Side-effects sometimes occur. Stomach pain, and bleeding from the stomach, are the most serious. Some people with asthma, high blood pressure, chronic kidney disease, and heart failure may not be able to take anti-inflammatory painkillers. So, check with your doctor or pharmacist before taking them, to make sure they are suitable for you.

There has been debate about whether anti-inflammatory painkillers may delay healing. This is partly because some inflammation is a necessary part of the healing process, and partly because they may very slightly increase bleeding. Current advice from UK guidelines is to put off taking this type of painkiller until 48 hours after the actual injury, when bleeding should have completely stopped.

If you take anti-inflammatory medication, ibuprofen is recommended as the one least likely to cause side-effects.

Rub-on (topical) anti-inflammatory painkillers

Again, there are various types and brands of topical anti-inflammatory painkillers. You can buy one containing ibuprofen or diclofenac at pharmacies, without a prescription. You need a prescription for the others. There is debate as to how effective rub-on anti-inflammatory painkillers are compared to tablets.

Some studies suggest that they may be as good as tablets for treating sprains. Other studies suggest they may not be as good. However, the amount of the medicine that gets into the bloodstream is much less than with tablets, and there is less risk of side-effects.

When to see a doctor

A person with a sprain or strain is advised to seek medical advice if there is:

Lack of expected improvement after trying basic home management (for example, they have difficulty walking).
Worsening of symptoms (for example, increased pain or swelling).

You should see a doctor if there is any concern about the injury, or if the injury is severe. In particular, see a doctor if:

You suspect a bone may be broken or a ligament is ruptured.
You have a lot of tenderness over a bone.
The leg or joint looks out of shape (deformed) rather than just swollen. This may mean there is a break (fracture) or dislocation which needs urgent treatment.
There is loss of circulation in the foot (a numb, cold foot with pale or bluish skin). If this occurs, treatment is urgent.
The pain is severe.
You cannot walk or weight bear because of the injury.
Bruising is severe.
The joint does not seem to work properly or feels unstable after the pain and swelling have gone down. This may be a sign of an additional injury such as a torn tendon.
Symptoms and swelling do not gradually settle. Most sprains improve after a few days, although the pain often takes several weeks to go completely, especially when you use the injured joint.

Preventing ankle sprains

The ankle is the most commonly sprained joint as it faces great challenges for weight bearing and balance, particularly when moving fast over uneven ground. You can help to prevent ankle sprains by wearing boots that give ankle support rather than shoes when hiking across country or rambling over hills and uneven ground.

Exercises to build up the muscles around the ankle and to improve proprioception (described earlier under ‘Other treatments’) help to prevent ankle sprains. A physiotherapist can advise on these exercises.

After having an ankle sprain, it is best to build up the muscles around the joint with exercises. A physiotherapist can show you which are the best exercises to do. This is because the stronger the surrounding muscles, the less likely a sprain will happen again (recur).

Also, some exercises are designed to improve proprioception. This is the ability of your brain to sense movement and position of your body parts and joints such as the ankle. So, for example, good proprioception helps you to make immediate and unconscious minor adjustments to the way you walk when walking over uneven ground. This helps to prevent you overstretching ligaments and causing sprains.

TEETHING

Information from patient.co.uk

Authored by Dr Mary Harding, 10 Jun 2016

Teething occurs when the teeth emerge through the gums. It can be a frustrating time for many parents, as babies and children can become unsettled when they teethe. There are measures which you can take to improve symptoms of teething in your baby or child. These include using cooled teething rings and also some teething gels.

What is teething?

Teething is a normal part of growing for babies: it’s when the baby teeth push through the gums as they’re growing. It usually happens at 6 to 9 months of age. Your baby may be more unsettled than usual, dribbling or want to chew on something more than usual.

Although the milk teeth develop when the baby is growing in the womb, the teeth only start to grow throughout the gums when the baby is 6-9 months old (although it can be before or after these ages). When the teeth grow, special chemicals are released by the body, which causes part of the gums to separate and so allows the teeth to grow through.

The teeth grow throughout the gums in stages. Usually the lower front teeth come through first, followed by the top middle teeth. Other teeth follow over the following months. A child is usually aged around 2½ or 3 when they have their full set of first teeth.

What are the most common symptoms of teething?

Babies and children can vary greatly with the symptoms they can have when they are teething. For many babies, teething leads to mild symptoms that just last a few days. However, for others, teething is painful and can last much longer.

Symptoms of teething often occur a few days (or even weeks) before the tooth comes through the gum. Common symptoms and signs include:

Red and swollen gums.
Red flushed cheek or face.
Rubbing their ears on the same side as the tooth which is coming through.
Dribbling more than usual.
Waking more at night and generally being more unsettled.
Inconsistent feeding.
Rubbing their gums, biting, chewing or sucking more.

Although there is little evidence that diarrhoea is caused by teething, there often seems to be a change in the poo (stools) at this time. A very mild rise in temperature may possibly be a symptom of teething. Teething should not cause your child to become unwell. If your baby or child has a fever, diarrhoea or other symptoms and is unwell then you should see your doctor to check for another cause of their symptoms. (For example, an ear infection, chest infection or urinary infection.)

Treatment for teething

Many babies and children will have minimal or no symptoms when they are teething so will not need any treatment.

However, the following may be useful for those who are having symptoms:

General advice

Gently rubbing over the affected gum with your clean finger may ease the pain. Many children find that biting on a clean and cool object is soothing (for example, a chilled teething ring or a clean, cold, wet flannel). Chewing on chilled fruit or vegetables may help. However, teething biscuits (or rusks) should be avoided as they contain sugar.

Medicine to help the pain

If your child is in pain with his/her teething, then giving paracetamol or ibuprofenmay help. These should be given at the recommended doses for their age.

There is no evidence that complementary treatments are of any benefit for teething – for example, herbal teething powder.

Teething gels

There are teething gels available which contain a local anaesthetic or mild antiseptic (for example, Bonjela® or Calgel®). The local anaesthetic is usually lidocaine. Experts advise against using these gels for teething pain. This is because there is not much evidence that they help for very long and there is evidence that they can cause harm. There have been a number of cases where a baby has accidentally swallowed too much of the anaesthetic and had serious consequences, including death. If you do choose to use a teething gel, follow the manufacturer’s instructions closely to be sure it is safe.

There is no evidence that using gels which contain choline salicylate is of any benefit for teething. In addition, there is a risk of the salicylate leading to a liver condition, called Reye’s syndrome, in children (aged under 16 years). So, gels which contain choline salicylate should also be avoided.

THREADWORMS

Information from patient.co.uk

Authored by Dr Roger Henderson, 11 Nov 2014

What are Threadworms?

Threadworms are small, thin, white, thread-like worms between 2 mm and 13 mm long. They infect human guts (intestines). They are common in children, but anyone of any age can be affected. The image shows two female pinworms next to a ruler. The markings on the ruler are 1 mm apart.

Are threadworms harmful?

Not usually. Often, the worst thing about them is the itch and discomfort around the back passage (anus). This sometimes wakes children from sleep. Scratching may make the anus sore. Large numbers of threadworms may possibly cause mild tummy (abdominal) pains and make a child irritable.

In girls, threadworms can wander forwards and lay their eggs in the vagina or urethra (the tube through which you pass urine). A doctor may check for threadworms in young girls with a vaginal discharge, bedwetting, or problems with passing urine. Rarely, threadworms can cause other problems such as loss of appetite and weight loss.

How can I tell if my child has threadworms?

Threadworms look like thin, white, cotton threads. Sometimes you can see them in stools (faeces) in the toilet. If you cannot see threadworms in the faeces, but suspect your child has threadworms (if they have an itchy bottom), try looking at the child’s back passage (anus). You can do this with a torch in the late evening after the child has gone to sleep. Part the child’s buttocks and look at the opening of the anus. If the child has threadworms you can often see one or two coming out of the anus. Do not be alarmed! Ask a pharmacist for advice on treatment in the next day or so.

Your doctor may ask you to do a sticky tape test to confirm the presence of threadworms. To do this you press some clear see-through tape on to the skin around the anus first thing in the morning, before wiping or bathing. You then place the tape on a glass slide or put it in a specimen container. The tape is then sent to the laboratory to be looked at under a microscope to see if any threadworm eggs are stuck to the tape.

What is the treatment for threadworms?

All household members, including adults and those without symptoms, should be treated. This is because many people with threadworms do not have any symptoms. However, they will still pass out eggs which can then infect other people. If one member of a household is infected, it is common for others also to be infected. So, everyone needs treatment!

The common treatment is:

To take a medicine to kill the worms in your gut.
And, hygiene measures to clear eggs which may be around your back passage (anus) or in your home.

Note: for babies under the age of three months, only hygiene measures are possible, as no medicine is licensed for this age group.

Medication

Mebendazole is the usual treatment for people aged over six months. All household members, including adults and those without symptoms, should take a dose at the same time. Just one dose kills the worms. A second dose two weeks after the first is sometimes needed if the infection has not cleared (which may occur if you swallow some eggs after taking the medication).

You can buy mebendazole from pharmacies. You can also get it on prescription. If you are pregnant or breast-feeding then see the notes later.

Hygiene measures

Medication will kill the worms in the gut, but not the eggs that have been laid around the anus. These can survive for up to two weeks outside the body on underwear, bedding, in the dust, etc (as described above). So, hygiene measures aim to clear any eggs from the body and the home, and to prevent any eggs from being swallowed. This will then break the cycle of re-infection. After taking the first dose of medication for threadworms:

First, as a one off, aim to clear eggs from where they may be in your home. This means:
- Wash sleepwear, bed linen, towels, and cuddly toys. This can be done at normal temperatures so long as the washing is well rinsed.
- Vacuum and damp-dust your home. Throw out the cloth after use. Pay particular attention to bedrooms, including vacuuming mattresses, and where children play.
- Thoroughly clean the bathroom by damp-dusting surfaces, washing the cloth frequently in hot water. Throw out the cloth after use.
Then, every member of the household should do the following for two weeks:
- Wear close-fitting underpants or knickers in bed, and change every morning. This is so that if you scratch in your sleep, you will not touch the skin near the anus. (Also, consider wearing cotton gloves at night, as this may also help to prevent scratching with fingernails during the night.)
- Every morning have a bath, or wash around the anus, to get rid of any eggs laid overnight. You must do this straightaway after getting up from bed.
- Ideally, change and wash nightwear each day.

And general hygiene measures which you should always aim to do to prevent getting threadworms again:

Wash hands and scrub under the nails first thing in the morning, after using the toilet or changing nappies, and before eating or preparing food.
Try not to bite your nails or suck fingers, and discourage children from doing so.
If possible, avoid sharing towels or flannels.
Keep toothbrushes in a closed cupboard. Rinse well before use.

However, it may not be your home which is a main source of threadworm eggs. Your children may come into contact with eggs in schools or nurseries, particularly in the toilets if they are not cleaned properly. This is why your child may have recurring threadworms, even if your home and personal hygiene are of a very high standard.

VAGINAL THRUSH

Information from patient.co.uk

Authored by Dr Mary Harding, 01 Jul 2017

You do not always need a test to diagnose thrush. The diagnosis is often based on the typical symptoms and signs.

It is important that you do not assume that a vaginal discharge is thrush. There are other causes of vaginal discharge. It is reasonable to assume it is thrush if:

You have a vaginal and/or vulval itch.
Any discharge you have does not smell and is white or creamy.
You have no abnormal bleeding.

However, if you have assumed you have thrush and you have had treatment, but the symptoms have not gone away, you may need to have tests. See your doctor, who may examine you and may perform some tests.

If tests are needed they may include:

A test to see how acidic the vagina is (a pH test). The level of acidity gives an indication of whether a discharge is due to thrush or to bacterial vaginosis. This is the basis of the over-the-counter test for thrush. A test strip is placed into the vagina and then the colour change indicates if thrush is likely or not. A pH level of 4.5 or less suggests thrush. Some doctors may also use this test.
A swab. This is a stick with a cotton bud at the end of it. A sample of discharge is taken from the vagina and analysed in a lab. This indicates if you have thrush or another infection. It can also inform the doctor which type of candida you have.
Tests for other infections. Further swabs may be taken to be sure you do not have other types of vaginal infections.
Urine tests. Your urine may be checked for sugar. This is to check you do not have diabetes, as this would make you more prone to thrush. This might be done if you were getting repeated (recurring) episodes of thrush. Urine may also be checked for infection, as sometimes it can be difficult to distinguish between a urine infection and thrush.

Do I need to see a doctor if I get vaginal thrush?

If you have had thrush in the past and the same symptoms come back then it is common practice to treat it without an examination or tests. Many women know when they have thrush and treat it themselves. You can buy effective treatments without a prescription from pharmacies. You can read about these in the treatment section.

However, remember a vaginal discharge or vulval itch can be due to a number of causes. So, do not assume all discharges or itches are thrush. The following gives a guide as to when it may be best to see a doctor or nurse if you think that you might have thrush. If you:

Are under 16 or over 60 years of age.
Are pregnant.
Have treated yourself with a thrush treatment from the chemist, but your symptoms have not gone away.
Have abnormal vaginal bleeding.
Have lower tummy (abdominal) pain.
Are unwell in yourself in addition to the vaginal and vulval symptoms.
Have symptoms that are not entirely the same as a previous bout of thrush. For example, if the discharge has a bad smell, or it you develop ulcers or blisters next to your vagina.
Have had two episodes of thrush in six months and have not consulted a doctor or nurse about this for more than a year.
Have had a previous sexually transmitted infection (or your partner has).
Have had a previous bad reaction to anti-thrush medication or treatments.
Have a weakened immune system – for example, if you are on chemotherapy treatment for cancer or are taking long-term steroid medication for whatever reason.

And if you do treat yourself, see a doctor or nurse if the symptoms do not clear after treatment.

Topical thrush treatments

These are pessaries and creams which you insert into the vagina with an applicator. They contain anti-yeast medicines such as clotrimazole, econazole, miconazole or fenticonazole. A single large dose inserted into the vagina is often sufficient to clear a bout of thrush. Alternatively a lower dose is used for several days. You may also want to rub some anti-thrush cream on to the skin around the vagina (the vulva) for a few days, especially if it is itchy. In mild cases, or for girls under the age of 16, a cream for the skin may be all that is needed.

You can obtain topical treatments on prescription, or you can buy some of them without a prescription at pharmacies. Side-effects are uncommon, but read the information leaflet that comes with the treatment for full information.

In general, you can use these topical treatments if you are pregnant but you should always check with your doctor or pharmacist. Treatment is usually needed for longer during pregnancy.

Note: some pessaries and creams may damage latex condoms and diaphragms and affect their use as a contraceptive. You should use alternative methods of contraception during treatment and for several days afterwards.

Tablets

Two options are available. Fluconazole, which is taken as a single dose, or itraconazole which is taken as two doses over the course of one day. You can obtain these treatments on prescription; you can also buy fluconazole without a prescription from pharmacies.

Side-effects are uncommon, but always read the information leaflet that comes with the treatment for full information. Do not take these treatments if you are pregnant or breast-feeding. You may also want to rub some anti-yeast cream on to the skin around the vagina for a few days, especially if it is itchy.

Combination packs containing both the tablet and the cream are available. In severe infection, a repeat dose of the tablet may be suggested after three days.

Note: tablets and topical treatments are thought to be equally effective. Tablets are more convenient but are more expensive than most topical treatments.

If you are in a sexual relationship, there is no need to treat your partner too unless they also have symptoms.

Other things that may help
If you have thrush, you may also find the following things help to relieve your symptoms:

Avoiding wearing tight-fitting clothing, especially clothing made from synthetic materials. Loose-fitting, natural-fibre underwear may be better.
Avoiding washing underwear with biological washing powders or liquids and avoiding the use of fabric conditioners.
Avoiding using perfumed products around the vaginal area, such as soaps and shower gels, as these may cause further irritation.
Using a simple emollient every day as a moisturiser to protect the skin around the vulva.
Yoghurt containing probiotics, either eaten or applied to the vagina, may be helpful; however, there is not yet enough evidence to know if it is proven to be effective.

What if the treatment doesn’t work?

If you still have symptoms a week after starting treatment then see your doctor or nurse. Treatment does not clear symptoms in up to 1 in 5 cases. Reasons why treatment may fail include:

The symptoms may not be due to thrush. There are other causes of a vaginal discharge. Also, thrush can occur at the same time as another infection. You may need tests such as vaginal swabs (samples taken using a small ball of cotton wool on the end of a thin stick) to clarify the cause of the symptoms.
Most bouts of thrush are caused by albicans. However, about 1 in 10 bouts of thrush are caused by other strains of Candidaspp., such as C. glabrata. These may not be so easily treated with the usual anti-thrush medicines.
You may not have used the treatment correctly.
You may have had a quick recurrence of a new thrush infection. (This is more likely if you are taking antibiotic medication, or if you have undiagnosed or poorly controlled diabetes)

WARTS AND VERRUCAS

Information from patient.co.uk

Authored by Dr Mary Harding, 08 May 2015

What are warts and verrucas?

Warts are small rough lumps on the skin. They are caused by a virus (human papillomavirus) which causes a reaction in the skin. Warts can occur anywhere on the body but occur most commonly on hands and feet.

They range in size from 1 mm to over 1 cm. Sometimes only one or two warts develop. Sometimes several occur in the same area of skin. The shape and size of warts vary and they are sometimes classed by how they look. Examples are:

Common warts.
Plane (flat) warts.
Filiform (finger-like) warts.
Mosaic warts – when several warts join together.

Verrucas are warts on the soles of the feet. They are the same as warts on any other part of the body. However, they may look flatter, as they tend to get trodden in.

Note: anal and genital warts are different.

Who gets warts and verrucas and are they harmful?

Most people develop one or more warts at some time in their lives, usually before the age of 20. About 1 in 10 people in the UK have warts at any one time. Almost as many as 1 in 3 children or young people may have warts. They are not usually harmful. Sometimes verrucas are painful if they press on a sensitive part of the foot. Some people find their warts unsightly. Warts at the end of fingers may interfere with fine tasks.

Are warts contagious?

Yes – however, the risk of passing them on to others is low. When something is called ‘contagious’, it means it can be passed on by touching. You need close skin-to-skin contact to pass the virus on directly. You are more at risk of being infected if your skin is damaged, or if it is wet and macerated, and in contact with roughened surfaces. For example, in swimming pools and communal washing areas.

You can also spread the wart virus to other areas of your body. For example, warts may spread round the nails, lips and surrounding skin if you bite warts on your fingers, or nearby nails, or if you suck fingers with warts on. If you have a poor immune system you may develop lots of warts which are difficult to clear. (For example, if you have AIDS, if you are on chemotherapy, etc.)

To reduce the chance of passing on warts to others:
- Don’t share towels.
- When swimming, cover any wart or verruca with a waterproof plaster.
- If you have a verruca, wear flip-flops in communal shower rooms and don’t share shoes or socks.
To reduce the chance of warts spreading to other areas of your body:
- Don’t scratch warts or pick them.
- Don’t bite nails or suck fingers that have warts.
- If you have a verruca, change your socks or tights daily.

To treat or not to treat?

There is no need to treat warts if they are not causing you any problems. Half the number of children with warts will find they have disappeared within a year without any treatment. Two thirds will have gone within two years. The chance that a wart will go quickly is greatest in children and young people. Sometimes warts last longer, particularly in adults.

Treatment can often clear warts more quickly. However, treatments are time-consuming and some can be painful. Parents often want treatment for their children; however, children are often not bothered by warts. In most cases, simply waiting for them to go is usually the best thing to do.

On balance it is usually only worth treating a wart or verruca if it is troublesome. For example, if it is painful or you find it ugly and conspicuous.

What are the treatment options?

The most commonly used treatments are:

Salicylic acid.
Freezing treatment.

Each of these is now discussed further.

Salicylic acid

There are various lotions, paints and special plasters that contain salicylic acid. This acid burns off the top layer of the wart. You can buy salicylic acid at pharmacies, or your doctor may prescribe one. It usually comes as a paint or a gel. Read the instructions in the packet on how to use the brand you buy or are prescribed, or ask your pharmacist for advice. Usually:

You need to apply it each day for up to three months. Persevere – if you give up too soon, it will not work.
Before applying the salicylic acid, rub off the dead tissue from the top of the wart, with an emery file (or similar).
It is best if you soak the wart in water for 5-10 minutes before applying salicylic acid.
You should not apply salicylic acid to the face because of the risk of skin irritation which may cause scarring.
If you have diabetes or poor circulation, you should use salicylic acid only on the advice of a doctor.

If you put the acid on correctly each day you have a reasonable chance of clearing the warts within three months. Studies vary when trying to determine the success rate.

However, a review of lots of studies definitely showed evidence that salicylic acid is better than no treatment. It also showed it is the treatment option with the best evidence that it works. Tips for success include:

Try not to get the acid on the skin next to the wart, as it may become irritated. You can protect the nearby skin by putting some Vaseline® on the normal skin beforehand, or by putting on a plaster with a hole in it which just exposes the wart for treatment.
If the surrounding skin does become sore, stop the treatment for a few days until it settles. Then re-start treatment. There is also a small risk that you may get a skin allergy to the treatment. If this occurs, the surrounding skin becomes red and itchy.
It may take two weeks or more before you notice any improvement. It can take up to three months of daily applications for warts to go completely.
Acid lotions and paints are flammable. Keep them away from open fires and flames.

Freezing treatment (cryotherapy)

Freezing warts may also be effective. Many GPs and practice nurses are skilled at this. Liquid nitrogen is commonly used. The nitrogen is sprayed on or applied to the wart. Liquid nitrogen is very cold and the freezing and thawing destroys the wart tissue. To clear the wart fully it can need up to 4-6 treatment sessions, sometimes more. Each treatment session is a couple of weeks or so apart.

Freezing treatment can be painful. Sometimes a small blister develops for a day or so on the nearby skin after treatment. Also, there is a slight risk of scarring the nearby skin or nail or damaging underlying tissues such as tendons or nerves. It is not suitable for younger children or for people with poor circulation.

Again, the studies done on freezing treatment vary considerably in their results. Some seem to show it is more effective than salicylic acid; others show it does not have any convincing benefit. It is certainly more expensive than salicylic acid, however. Therefore many NHS services, such as some GP practices, no longer offer it as an option. This is because salicylic acid is cheaper and the evidence that it works is more convincing.

There are freezing treatments available over the counter, which you can apply yourself. However, these cannot provide such a cold freeze as liquid nitrogen. They are probably less effective, although again the results of studies are not totally clear.

Combined treatment

Another option is treatment with salicylic acid plus cryotherapy. In between the freezing sessions, you apply salicylic acid daily to your wart. You should not use the salicylic acid until any blistering, scabs or soreness from the cryotherapy have settled.

What about swimming?

A child with warts or verrucae should go swimming as normal. Swimming is a vital skill, which can save your life. Warts can be covered with waterproof plasters. A verruca can also be covered with a waterproof plaster. Some people prefer to wear a special sock which you can buy from pharmacies. However, this makes it very obvious that you have a verruca, may be embarrassing and has not been proved to make a difference.

British swimming organisations do not advise wearing the waterproof sock. The plaster should be enough. It is also a good idea to wear flip-flops when using communal showers, as this may reduce the chance of catching or passing on virus particles from verrucae.