MEDICAL CONDITIONS

Acne is a common skin condition, and it can happen anywhere on the skin. The most common sites include face and neck, shoulders, back and chest. 

Acne can present in various ways.

Blackheads: these appear black due to the presence of hair follicle and are small black or yellow bumps that occur on the skin. These are not filled with dirt or pus. 

Whiteheads: these look like blackheads and could be firmer. If these are squeezed, nothing usually comes out. 

Papules: these are small red bumps that can be sore and tender. 

Pustules: these are similar to papules with a white tip in the centre due to the presence of pus. 

Nodules: large hard lumps that occur under the skin and can be painful. 

Cysts: this is most severe type of acne spots. These may look similar to boils and are large pus-filled lumps. Cysts can lead to permanent scarring.

The exact cause of acne is not fully known and it is commonly linked to hormonal changes during puberty, positive family history, and menstrual cycle. 

The hormonal changes can produce larger amounts of oil (sebum) next to hair follicles, and this can lead to some bacteria in the skin to cause inflammation and pus. 

There is no conclusive evidence to suggest that acne is caused by bad hygiene or diet.  However, it is best to avoid any possible triggers or aggravating factors if known to play a role in acne. 

Frequent face washing can irritate the skin further so it should be avoided. Lukewarm water rather than very hot or cold water should be used.  It is best to use non-comedogenic facial products that are water-based rather than oil-based comedogenic products. 

It is advised to not pop or squeeze the spots or blackheads as this can cause scarring and infection. 

There are various acne treatments in the form of creams, gels and ointments. These include benzoyl peroxide, Clearasil, Adapalene (Differin),  Duac and Zineryt. 

Tretinoin 0.05 % cream, Clindamycin gel, or Dapsone 5 % gel are among other treatments of acne. 

Most of the these treatments are available over the counter. The general rule is to start with a mild treatment such as benzoyl peroxide and move on to a stronger treatment like tretinoin. 

Epiduo Gel is a combination of Adapalene and benzoyl peroxide, and it can be an effective combination to treat more resistant acne. This is only available on prescription from a doctor. 

Acnatac is another prescription only topical gel that can work well for acne, and it contains an antibiotic called clindamycin and tretinoin. 

If these do not work, the next step is to try an oral antibiotic such as lymecycline or doxycycline which generally work very well.

The last option is Accutane (Isotretinoin), and this is reserved for very severe acne and is only prescribed by a dermatologist.

The other treatment options for acne are photodynamic therapy, comedone extractor to remove whiteheads and blackheads, or chemical peels. 

If standard over the counter treatments do not work, it is best to see a doctor or dermatologist in person for further assessment. 

Bad breath or halitosis is a condition where the main symptom is bad smelling breath. In the absence of other symptoms, this is unlikely to be due to anything sinister. 

The most common form of bad breath is ‘morning breath’ which occurs due to normal oral bacteria build up overnight. 

The other causes of bad breath or halitosis are smoking, tonsil stones, not eating or drinking properly, prolonged hunger, having a diet rich in spices, poor mouth and dental hygiene, defective or unclean dentures, and gum disease or infection. 

In some people, acid reflux and Helicobacter Pylori bacteria, which is a bug that is present in the stomach, can cause halitosis.  

Sometimes the bad breath can be psychological (pseudo halitosis) and this is just a perception of bad breath without any objective cause or evidence. 

If a person has good mouth and dental hygiene and eats and drinks normally, the cause could be possible Helicobacter Pylori presence in the stomach. Helicobacter Pylori presence in the stomach can be checked with a test and treatment can be considered if the test is positive.  

To help with bad breath, it is recommended to avoid smoking, smelly foods, and to brush the teeth regularly. Oral hygiene is the best treatment for bad breath; and regular brushing, flossing, and drinking plenty of water can help. 

If dentures are worn, these should be cleaned regularly. 

The other treatments for bad breath include tongue scraping, and mouth washes such as chlorhexidine, Therabreath and Peridex. 

There are rarer causes of bad breath and these include chronic bronchitis, sinus infection, post nasal discharge, diabetes, kidney or liver disease. These are quite rare in the absence of other medical symptoms or previous history.

If conventional treatments do not work, it is recommended to see a doctor for further assessment. 

Bedbugs are small insects that usually live on bedding and furniture. They can hide in various places such as bed frames, mattresses, clothing, behind pictures, and under loose wallpaper. 

Bedbugs are quite common, and their bites can cause an allergic reaction in the form of redness, spots and itching. 

The bite from bedbugs should not cause any major illness or other health problems. The bites usually resolve without any treatment in a week. 

The bite sites should be kept clean and dry. It is recommended to put something cool on the affected area to help with swelling and itching. 

There are several medications available that can be used to treat the symptoms of bedbug bites.

Over the counter antihistamines or anti-allergy medications such as loratadine, cetirizine or fexofenadine can help with redness, irritation and itching from the bites. 

Steroid cream called hydrocortisone, which is available over the counter, could also help to relieve the redness and itching. It is not advised to use steroid creams for more than 7 days at a time as these can thin the skin. 

It is recommended to wash all bedding and clothes on a hot wash at 60 degrees, and to clean and vacuum regularly. 

Putting affected clothing and bedding in a plastic bag and placing that in the freezer for 3-4 days could help get rid of the bedbugs as well. 

The other bugs that could cause a rash and itching are house dust mite, scabies, fleas, head lice, ants, spiders, and mosquitos. 

If the symptoms of bedbugs persist or if other types of bugs are suspected, it is best to seek advice from a professional to assess the property. Seeing a doctor in person for further assessment should also be considered.

Chronic fatigue syndrome (CFS) is also known as myalgic encephalomyelitis (ME). This is a chronic condition and the exact cause of it is not fully understood. It can affect both children and adults. 

CFS can affect different parts of the body. The most common symptom of this syndrome is extreme tiredness or fatigue. 

There is no specific test to diagnose CFS. The diagnosis is clinical, and it is based on the symptoms someone presents with and by ruling out other possible causes. Routine blood tests and urine test can be arranged as part of the initial assessment to rule out other possible causes of tiredness such as thyroid disease, anaemia, and vitamin deficiencies. 

CFS can present with extreme fatigue which can have detrimental effects on normal daily activities, school and work. There can also be problems with sleep, memory, concentration and thinking. 

The other possible symptoms of CFS are pain that can occur in different parts of the body and flu-like symptoms. 

There is currently no holistic treatment for CFS, and the aim is to relieve the symptoms of it. The treatment depends on the presenting symptoms.

For extreme fatigue, energy management is recommended to ensure the best use of energy without worsening the symptoms. 

Painkillers can be considered if there is associated pain and sleeping tablets for sleep difficulties. 

The other treatment options are CBT (cognitive behavioural therapy), and antidepressants. 

Some people find yoga, acupuncture, and massage helpful for controlling the feeling of fatigue.

Since CFS is a chronic illness, this can have an effect on mental and emotional health, leading to problems with work, relationships and family. 

It can be useful to talk to someone about this condition and this could be a family member, friend, or other people with CFS. 

If conventional therapies do not work, it is best to see a specialist for further input. 

 Cold sores are common and are caused by herpes virus, more precisely Herpes Simplex Virus Type 1 (HSV-1). 

These sores usually clear up without any treatment within 10-14 days. 

Cold sores or oral herpes can occur on the lips, front of the tongue, gums, inside of the cheeks, throat and roof of the mouth. Rarely cold sores can appear on the chin and neck. 

A cold sore usually starts with symptoms of tingling, itching and burning sensation. One or more painful blisters usually appear over the next 48 hours. 

The incubation period or the time to develop symptoms after an exposure for oral herpes is 2-12 days, although this can be a little longer in some people. 

Most people are exposed to oral herpes virus when they are children through skin to skin contact with someone who has a cold sore. 

This virus stays in the body for life once someone has been infected with it. 

It is more common to get flare ups of cold sores when the immune system is down, when there are other infections such as a cold or flu, during times of stress and anxiety, with poor diet, sunshine and sunbeds, and during periods. 

Cold sore or oral herpes is typically transmitted by oral-to-oral contact such as kissing and skin contact with an active sore. 

Cold sores are considered contagious from the moment the first signs of infection appear to when the sores have completely healed. 

Oral herpes or HSV-1 can cause genital herpes as well as cold sores. It is recommended to avoid oral sex until the cold sore has completely healed as it can cause genital herpes in your partner. 

It is advised to avoid kissing anyone while there are active cold sores. Hands should be washed thoroughly with soap and water after touching a cold sore. 

The treatment options are creams to reduce the pain, antiviral creams to speed up healing time, and cold sore patch to protect the skin. 

Over the counter cold sore remedies such as aciclovir (Zovirax) or Docosanol 10 % are available to treat the sores. 

Valtrex (valacyclovir) can be used to treat cold sores as well. This is a prescription only medication. 

The cream should not be rubbed into the cold sore but rather dabbed on it instead. 

There are also electronic devices available at pharmacies that can treat cold sores with light or lasers, but their effectiveness can be variable. 

Antiviral creams can work better when applied at the first sign of cold sore appearing and they may not always work effectively after sores have appeared. 

It is recommended to use sunblock lip balm with sun protection factor (SPF 15 or more) if outside in the sun. It is best to drink plenty of fluids to avoid dehydration. Paracetamol can be used to alleviate the pain, burning and discomfort. 

Acidic and salty food can make cold sore worse and so should be avoided. 

If the cold sore does not heal within 10 days, if it is very large or painful, if there are complications such as swollen gums or mouth sores, or weak immunity,  it is advised to consult a doctor in person.

The doctor may prescribe oral antiviral medication to treat the cold sores. 

The most common cause of a cough or cold is viral illness. The use of antibiotics is not always required as these do not work against viruses. This type of viral infection can last up to 7-10 days. 

There may be a lingering cough in some people that could last a few weeks. 

 
If there are not any other major symptoms or breathing difficulties, a ‘wait and watch’ approach can be followed to see if the symptoms resolve on their own. 

Paracetamol or ibuprofen are available for a fever, aches and pains, provided there is no history of allergy to these medicines and no history of asthma or stomach issues. 

Ibuprofen is NOT recommended if there is history of asthma, stomach issues, heart disease or if on blood thinners.

 
Having warm drinks with lemon and honey, and steaming can help with the cough and any phlegm that might be present. 

There are various cough and decongestion medicines available over the counter, however, these don't always work. Steaming can be as effective as those cough medicines for some people. 

Common over the counter remedies that are available for cough and excess phlegm include Clarinase, Mucinex, Mucolit, Sudafed, Actifed or Brontex . These can break up the mucus or phlegm and help to remove it. 

 
For babies and children, saline drops and HydraSense for congestion and mucus; and Sterimar Breathe Easy or Benzydamine Oromucusal spray for breathing issues are available. 

If there are severe symptoms or if a person is unwell, it is recommended to see doctor in person for further assessment. 

Eczema is an inflammatory skin condition that can make the skin dry, itchy and flaky. There can be scaly patches, blisters and skin infections. 

The exact cause of eczema is not fully understood. Eczema often happens in people who have allergies, and it can be related to asthma and hay fever. It can also run in families. 

Another term for eczema is atopic dermatitis. 

Unfortunately, there is no cure for eczema at the moment. However, the symptoms of eczema can be managed well with various medications and measures. 

The usual treatments for eczema consist of emollients, steroid creams, and antihistamines. 

For common and uncomplicated eczema, the following regime can work. 

1. Topical emollients and lotions can be applied to the affected areas, and common choices are Aveeno, Oilatum, Diprobase, or Doublebase. 

2. Steroid cream such as hydrocortisone is known to help with eczematous rash and this is available over the counter. A steroid cream should not be used for more than 7 days at a time as this can thin the skin. It may be used for more than 7 days only if this has been recommended by a doctor. 

3. Antihistamine such as chlorphenamine or Piriton, loratadine, cetirizine, or fexofenadine are thought to help with the symptoms of eczema, particularly if there is excessive itching or irritation. 

Piriton and loratadine are available for young children, but a prescription may be required for under 2 year olds. 

It is not recommended to apply Calamine lotion for eczema as it may aggravate the situation. 

The other treatments that are available to treat eczema are tacrolimus 0.03 to 0.1 % ointment or pimecrolimus 1 % cream. These can only be prescribed by a doctor and are not available over the counter. 

Eczematous rash can be triggered by certain factors, and so it is advised to avoid any possible triggers and aggravating factors. These could be sweat, clothing, skin products, cold weather, perfumes, dust or smoke. 

The emollient can be used up to four times a day during flare ups. It can be used when the skin feels dry, and at nappy change in babies. Emollient is normally applied at the direction of hair growth and not rubbed in. 

Hydrocortisone 1 % is recommended for face and flexures for infants and children. 

Emollient can be continued during and after steroid treatment. 

Hydrocortisone 1 % cream once daily is safe to use on the eyelids, and periorbital area or around the eyes. 

For regular flare ups, hydrocortisone 1 % to the eyelids twice a week regime can work. Alternative treatment for eyelid eczema is topical tacrolimus 0.1 % or pimecrolimus 1 %. 

Oral steroids for more severe cases or flare ups of eczema are available and can be prescribed by a doctor for a very short term. 

For recurrent infected eczema, chlorhexidine containing emollients, and bleach baths once or twice a week can help. 

Specialised treatments of eczema are available and these include ciclosporin, azathioprine, mycophenolate, alitretinoin, and methotrexate. 

There are very new treatments for eczema and these are JAK inhibitors, and biologic dupilumab. 

It should be noted that these treatments can only be prescribed by a dermatology specialist and only if the conventional treatments do not work. 

If conventional treatments and measures fail to control eczema, it is recommended to see a doctor for further assessment, and a referral to see a dermatologist for specialist management can be considered.

Endometriosis is a condition where tissue which is similar to the lining of the uterus appear in other places outside the uterus. This condition can affect women of any age who have periods.  

The exact cause of endometriosis is not fully known. It is thought to be associated with hormones, and it can present from puberty to menopause. 

Endometrial tissue is mainly found in the abdominal region around the ovaries and fallopian tubes, but it can affect bowels, bladder, diaphragm, and respiratory tract. 

Endometriosis causes pain as the patches of it break down and bleed during menstruation but cannot leave the body as in a normal period. 

The common symptoms are severe period pain, heavy periods, pain on urination and bowel movement, lower abdominal or back pain, pain during or after sexual intercourse, and extreme tiredness. 

Endometriosis can also cause low mood, anxiety and fertility issues. 

Period-related urinary symptoms such as pain on urination and blood in the urine could be due to endometriosis. 

Painful bowel movements or dyschezia during periods can be due to endometriosis. 

The gold standard diagnostic test is laparoscopy which involves looking inside the abdominal cavity directly via a camera. An ultrasound scan can be considered first to rule out other causes of pain. 

There is currently no cure for endometriosis, but there are treatments that can help with the symptoms. Painkillers such as paracetamol, ibuprofen and codeine can alleviate the pain. 

If these do not work, other medications such as amitriptyline or gabapentin can be considered. 

Hormonal treatments can suppress endometriosis and relieve symptoms. Combined oral contraceptive pill, desogestrel pill, oral or injectable medroxyprogesterone, or Mirena coil, or Zoladex (goserelin) can be considered. 

Combined pill can be taken as an extended pill-taking regime with only 4-day break. This could work but is an unlicenced method. It can be taken continuously to avoid any bleeding. 

The last resort is surgery where the endometriosis tissue is removed if conventional treatments do not work. 

Laparoscopic hysterectomy is the recommended choice of surgery for severe cases of endometriosis, and it involves removing the uterus. 

If the ovaries are removed due to endometriosis or as part of hysterectomy, treatment with HRT may be required until at least the age of 50 to reduce any unwanted symptoms. 

Not every gynaecologist is an expert in endometriosis, and therefore, it is best to see a gynaecologist that specialises in endometriosis

Fungal nail infections usually affect toenails, but the infection can sometimes grow on fingernails. 

The infection causes brittle, discoloured and thicker looking nails. Although the infection itself is not serious it can look unsightly and can take a long time to treat fully. 

There are various over the counter medications that can be used to treat fungal nail infections. These treatments usually contain amorolfine, terbinafine or itraconazole. 

The medicine is brushed on the affected nails, and it should be used daily or weekly, depending on the type.  

As fungal nail infections can take a long time to clear the treatment may need to be continued for 6 to 12 months. And it can take several months before an improvement is seen. It is therefore advised to persevere with the treatment and the affected nails should be filed down to help clear the infection.

If conventional over the counter treatments do not work, it is best to see a doctor in person for further assessment and treatment. 

Sometimes a sample from the affected nails can be taken to confirm the diagnosis or to determine the exact type of infection. 

Oral antifungal medication can be considered for resistant cases of fungal nail infections. These medications are not suitable for people who have liver or kidney disease. 

Very severely infected or deformed nails may need to be removed surgically under local anaesthetic. 

Fungal nail infections can be prevented with a few simple measures. The nails should be kept short and the feet clean and dry. It is recommended to wear clean socks every day, to wear flip-flops in showers at the gym or pool, to wear well fitting shoes, and to treat athlete’s foot promptly before it spreads to the nails. 

It is best to avoid sharing nail clippers or scissors and towels, and to avoid other people’s shoes or those that cause hot and sweaty feet.