PCOS is a common condition and is due to the presence of multiple cysts in the ovaries. These cysts can interfere with the normal functioning of the ovaries leading to various symptoms.
The common symptoms of PCOS are irregular or absent periods, weight gain, excess hair growth (hirsutism) due to raised male hormone androgen, acne, hair loss or thinning, and infertility.
In PCOS, the sacs or follicles in which eggs are produced become underdeveloped. These underdeveloped follicles do not release an egg which means that ovulation does not occur. This is the underlying cause for potential infertility that is associated with PCOS.
Most women with PCOS do not develop any significant symptoms. In those who develop symptoms, these usually start in late teens or early 20s.
The exact cause of PCOS is not known, and there may be a genetic component as it often runs in families.
There is currently no cure for PCOS. There are several treatments available that can alleviate the symptoms of PCOS. Contraceptive pills can work to control the symptoms of PCOS and these can be quite effective in helping with irregular periods, acne and excess hair growth.
The other common treatment of PCOS is a medication called metformin. This is usually given for the treatment of diabetes. Since PCOS is related to high levels of insulin in the body, metformin can help with that.
Lifestyle changes such as weight loss, healthy diet and regular exercise could be beneficial as well.
Most women with PCOs should be able to get pregnant with the appropriate treatment. Clomifene is a commonly used treatment option for women with PCOS as it promotes ovulation. Metformin can also stimulate ovulation.
If these treatments fail, IVF or a procedure called laparoscopic ovarian drilling (LOD) can be considered. LOD procedure leads to increased levels of FSH (follicle-stimulating hormone) and this can help restore the normal function of the ovaries.
For excess hair growth that is troublesome, anti-androgens such as cyproterone acetate, spironolactone and finasteride may be considered.
PCOS is thought to increase the risk of type 2 diabetes and high cholesterol level (hypercholesterolaemia) later in life. Effective lifestyle changes can help prevent these conditions.
If PCOS is suspected, it is best to see a doctor in person for further assessment and treatment.
Abdominal or stomach pains or cramps are quite common in pregnancy. The pains can feel different at different stages of the pregnancy, but they are not usually due to anything serious. However, in some women, there may be a serious underlying cause for the pains and further assessment would be required.
If the pain is mild and settles down on its own and if there are no other symptoms with it, it is likely to be benign and harmless. This type of pain can be dull or sharp, and it may be due to ligaments, constipation or trapped wind.
Ligament pain happens as the ligaments in the pelvic region stretch to support the growing baby. This is also called growing pains and can feel like a sharp pain or cramp on one side of the lower abdomen.
If growing pains are mild, treatment is not usually required. For more severe pains, paracetamol can be considered. Ibuprofen should not be taken in pregnancy.
Constipation is a very common presentation in pregnancy, and this occurs due to hormonal changes in early stages of pregnancy. As pregnancy progresses and the baby grows bigger, this can also lead to constipation.
To help prevent constipation, it is recommended to eat foods that are high in fibre such as wholemeal breads and cereals, fruit and vegetables, and pulses like beans and lentils, to drink plenty of fluids, and to do regular light exercises.
Trapped wind can be managed by eating several smaller meals throughout the day, eating and chewing slowly before swallowing, and avoiding swallowing air while eating.
Sometimes abdominal pain in pregnancy could be due to something more serious. The causes of serious abdominal pain are miscarriage, ectopic pregnancy, placental abruption, urinary tract infections or UTIs, pre-eclampsia, or premature labour.
A miscarriage is classified as a loss of pregnancy before the 24 weeks of gestation. The definition of miscarriage may vary from country to country.
Many early miscarriages before the 12 weeks of gestation happen because there is a problem with the development of the baby. The other causes are chromosomal disorders, hormonal imbalances, and medical conditions such as diabetes and clotting problems.
Most miscarriages occur during the first 12 weeks of gestation, and it is not possible to prevent them.
A miscarriage usually presents with vaginal bleeding, blood clots, discharge of fluid or tissue from the vagina, followed by cramps and lower abdominal pain.
Ectopic pregnancy is when the pregnancy takes place outside the uterus such as in the fallopian tube. This is usually considered a medical emergency as it can cause serious complications because the embryo cannot develop properly outside the uterus.
This is treated with medicines or surgery to remove the embryo before it causes serious problems.
The symptoms of an ectopic pregnancy usually occur between 6 to 8 weeks of gestation but can happen later.
The common symptoms are vaginal bleeding, brown, watery discharge, lower abdominal or pelvic pain, shoulder tip pain, and discomfort when going to the toilet.
Placental abruption is when the placenta starts to come away from the wall of the uterus or womb. This causes vaginal bleeding as well as abdominal pain. This requires urgent assessment in the hospital.
Urinary tract infections are common in pregnancy and may cause pain or burning on urination, abdominal pain, and high temperature. They can usually be easily treated with a course of antibiotics.
Pre-eclampsia is a condition that some women get in pregnancy. The exact cause of pre-eclampsia is not fully known, but it is thought to happen when there is a problem with the placenta.
It usually develops after 20 weeks of gestation or just after the baby is born. The common symptoms of pre-eclampsia are severe or persistent pain on the right upper abdomen, severe headache, vision problems, swollen feet, hands and face.
Pre-eclampsia usually requires hospitalization for appropriate management.
Premature labour is when there are signs of labour before 37 weeks of gestation. Premature labour can present with abdominal cramps or tightening. When this is suspected, it is recommended to go to the hospital or maternity unit.
It is highly advisable to go to the hospital if there is severe or persistent pain, vaginal bleeding, lower back pain, severe headache, dizziness, unusual vomiting, or pain on urination.
It is very common to get back pain or backache during pregnancy and this is not usually due to anything serious.
There are several causes of getting back pain during pregnancy.
Most women gain between 10 and 12 kg of weight in pregnancy, and this extra weight puts pressure on the spine and lower back, leading to back pain.
The ligaments in the pelvic region naturally become softer and stretch during pregnancy to accommodate the growing baby in the womb and to prepare for labour. This can put extra strain on the joints of the lower back and pelvis, causing back pain.
Back pain can also be due to hormonal changes which loosen ligaments and joints, reducing stability.
The growing belly shifts the centre of gravity which strains the back muscles, leading to back pain.
Emotional stress and fatigue may also lead to muscle tension, worsening back pain.
Back pain can be improved or prevented by following certain measures.
It is recommended to maintain a good posture and to keep the back straight and avoid slouching.
It is best to bend the knees and keep the back straight when lifting or picking something up from the floor.
Lifting heavy objects, sudden moves, and high heels should be avoided during pregnancy. Using chairs with good lumbar support, wearing flat shoes, and balancing the weight between 2 bags when carrying shopping is advised.
Getting enough rest, having a massage or warm bath, using a mattress that supports the back, prenatal yoga, stretching, and swimming classes to strengthen back muscles can also be beneficial.
During pregnancy, it is recommended to sleep on the left side to increase blood flow to the womb and baby. A pregnancy pillow between the knees for support can be considered.
For more severe back pain, paracetamol can be taken if there are no contraindications, and obstetric physiotherapy can also help.
It is strongly recommended to see a doctor or go to the hospital if there is severe back pain in second or third trimester as this could be a sign of early labour, high temperature, vaginal bleeding, pain on urination, or upper abdominal pain under the ribs.
Indigestion or acid reflux and heartburn are common symptoms that some women complain about in pregnancy. These are not usually due to anything serious and do not have an impact on the baby.
Indigestion and heartburn are caused by hormonal changes in pregnancy, and the growing baby pressing against and pushing the stomach upwards.
The risk of indigestion is increased if there was a history of it before the pregnancy, and in later stages of pregnancy.
The common complaints are stomach pain, burping or belching, feeling bloated or full, burning sensation or pain in the chest, nausea or vomiting. These symptoms usually come on after eating and drinking but could also occur more randomly.
Although indigestion and heartburn are common from 12 weeks of gestation onwards, they can happen at any point during pregnancy.
Indigestion and heartburn in pregnancy can be managed effectively with lifestyle changes and medicines that are safe to take in pregnancy.
Mild symptoms can be managed with changes to diet and lifestyle and by avoiding any triggers. It is not recommended to eat more than usual as this is not necessary or good for the baby or mother. Overeating and being very full may lead to indigestion, so it should be avoided.
Eating frequent small meals throughout the day rather than large meals 3 times a day can be more beneficial. It is better to avoid eating within 3 hours of going to bed at night as this can increase the risk of getting heartburn.
Sitting position while eating is important, and it is recommended to sit up straight to prevent extra pressure on the stomach. Avoiding excessive consumption of caffeine-containing drinks and foods that are rich, spicy or fatty can help with the symptoms of indigestion.
It is advisable to raise the head and shoulders when sleeping or lying down as this would stop stomach acid coming up the food pipe and lead to heartburn.
Smoking when pregnant is strongly discouraged as this can cause indigestion and can seriously affect the unborn baby as well as the mother. Smoking in pregnancy can increase the risk of premature babies, low birthweight, and sudden infant death syndrome or cot death.
Drinking alcohol in pregnancy can cause indigestion, and it can also lead to long-term problems in the baby. Therefore, it should be avoided throughout the pregnancy.
If lifestyle changes are not effective enough to manage indigestion and heartburn, medicines called antacids can be considered. These work by neutralising the acid in the stomach.
Not all antacids are safe in pregnancy and the correct one should be obtained from the pharmacy. Gaviscon is considered safe and can be taken while pregnant or breastfeeding.
It should be noted that antacids should not be taken within 2 hours of taking folic acid or iron tablets, as they can interfere with the absorption of these supplements.
The general advice is to see a doctor in person for further assessment if indigestion or heartburn is not controlled with lifestyle changes or medicines. The other symptoms that require a doctor’s assessment are hoarse voice, persistent cough, difficulty swallowing, swollen glands in the neck, unusual weight loss, pain or swelling in the stomach region.
Stretch marks are a very common occurrence in some women going through pregnancy and after giving birth, and they are not due to anything serious. They do not require any specific treatment as they are harmless and do not cause medical issues.
They are narrow, streak-like marks or lines that can appear on the surface of the skin. Depending on the skin colour of the person, stretch marks can be red, pink, purple or brown colour.
Stretch marks usually develop on the lower abdominal area but sometimes can appear on upper thighs and breasts as the pregnancy progresses.
It is common to get itchiness around an area where the skin becomes thinner before developing actual stretch marks.
Over the next few months after giving birth, the stretch marks or lines should gradually fade away and become less noticeable. In some women, they may not go away completely.
It is thought that hormonal changes in pregnancy can affect the skin, making it more prone to developing stretch marks.
The chances of getting stretch marks are higher if weight gain is more than average in pregnancy. Weight gain in pregnancy varies greatly from woman to woman and the average weight gain is about 10 to 12 kg.
It is not recommended to try to lose weight in pregnancy by dieting or eating less as it is important to have a balanced, healthy diet during pregnancy for the normal development of the baby.
There is currently no effective treatment to remove stretch marks. Some creams may help to remove these marks in some women, but their effectiveness is not clear and they may not work. And there isn’t concrete evidence to confirm that using creams and oils will prevent stretch marks from appearing in the first place.
A retinoid cream like tretinoin, or hyaluronic acid cream may be beneficial to treat stretch marks in some women, but these may not work for everyone.
Retinoid creams should not be used while pregnant as they may harm the baby.
The other treatments that can be considered to remove stretch marks are light therapy, laser treatment, or microdermabrasion where a thin layer of the skin is removed.
It should be noted that stretch marks do not just occur in pregnancy and they could also appear during puberty or when putting on weight when the skin is stretched.
It is very common for some women to get swelling in pregnancy, and this usually happens in the ankles, feet and fingers. This is due to increased fluid retention in the body as it retains more water to support the pregnancy.
The other causes of swelling in pregnancy are hormonal changes, pressure from the growing baby, and increased blood volume to support the baby.
Increased levels of the hormone called progesterone during pregnancy relax blood vessels, leading to fluid build-up. The growing baby can press on the veins, and this would slow blood return from the legs, leading to swollen ankles and feet.
The swelling in ankles, feet and fingers usually gets worse at the end of the day and in later stages of pregnancy. Throughout the day the extra fluid tends to build up in the lowest parts of the body, particularly in hot weather and after prolonged standing.
If the swelling occurs gradually and there are no associated symptoms, this is not harmful to the baby or mother.
It is recommended to avoid standing for long periods and tight shoes and socks. Regular walks during the day or doing foot exercises and resting with the feet up as much as possible can help with the swelling.
Foot exercises are thought to improve blood circulation in the legs and reduce swelling in the ankles. These exercises involve bending and stretching the foot up and down 30 times and rotating each foot in a circle 8 times one way and 8 times the other way.
It should be noted that if the swelling comes on suddenly and there are other symptoms such as bad headache, upper abdominal pain, blurred vision, nausea or vomiting, this could be a sign of pre-eclampsia and urgent assessment is required.
Vaginal bleeding or spotting during pregnancy is quite common and it does not always mean that there is a problem with the pregnancy or risk of a miscarriage. However, in some women, it can be a sign of something dangerous or serious.
There are several causes of vaginal bleeding in pregnancy.
One of the common causes of bleeding in pregnancy is implantation bleeding, which occurs when the developing embryo implants itself in the wall of the womb or uterus. This can cause some harmless light bleeding called spotting.
This type of bleeding often happens around the time a period would have been due to take place. The implantation bleeding is usually very light and lasts a few hours. There may be light cramping with the implantation that lasts a short period of time.
Implantation bleeding usually occurs about 6 to 12 days after conception, and this would generally be around one to two weeks after sex, depending on the ovulation timing.
The other possible cause of vaginal bleeding in pregnancy is cervical changes. Hormonal changes in pregnancy can cause alterations to the cervix, and this may sometimes cause bleeding, particularly after sexual intercourse.
More serious causes of vaginal bleeding in pregnancy are miscarriage or ectopic pregnancy. These usually happen during the first 12 weeks of pregnancy or first trimester.
A miscarriage is classified as a loss of pregnancy before the 24 weeks of gestation. The definition of miscarriage may vary from country to country.
Miscarriage accounts for around 1 in 5 pregnancy losses. Many early miscarriages before the 12 weeks of gestation happen because there is a problem with the development of the baby. The other causes are chromosomal disorders, hormonal imbalances, and medical conditions such as diabetes and clotting problems.
Most miscarriages occur during the first 12 weeks of gestation, and it is not possible to prevent them.
A miscarriage usually presents with vaginal bleeding, blood clots, discharge of fluid or tissue from the vagina, followed by cramps and lower abdominal pain.
Ectopic pregnancy is when the pregnancy takes place outside the uterus such as in the fallopian tube. This is usually considered a medical emergency as it can cause serious complications because the embryo cannot develop properly outside the uterus.
This is treated with medicines or surgery to remove the embryo before it causes serious problems.
The symptoms of an ectopic pregnancy usually occur between 6 to 8 weeks of gestation but can happen later.
The common symptoms are vaginal bleeding, brown, watery discharge, lower abdominal or pelvic pain, shoulder tip pain, and discomfort when going to the toilet.
It should be noted that if vaginal bleeding occurs in the first trimester and the pregnancy ends, this should not prevent a woman from having a successful pregnancy in the future.
If the bleeding is mild and it stops quickly and there are no other symptoms, treatment is not usually required.
If there is a history of previous miscarriage and if the pregnancy has been confirmed with a scan, a medicine called progesterone can be considered to stop the bleeding in early pregnancy. This medicine is taken twice a day until 16 weeks of gestation.
Vaginal bleeding in later stages of pregnancy is not common. However, if bleeding happens, this could be due to cervical changes, vaginal infections, low-lying placenta called placenta praevia, or placental abruption where the placenta starts to come away from the wall of the uterus.
It is advisable to see a doctor or go to the hospital if there is unusual vaginal bleeding, abdominal pain, pain at the tip of the shoulder, vomiting, dizziness, urinary symptoms, or other concerning issues.
Nausea and vomiting are very common symptoms in early stages of pregnancy, and this is also called morning sickness. Nausea or vomiting can happen at any time of the day or night and not just in the morning.
Although morning sickness usually settles down by 16 to 20 weeks of gestation, it could take longer in some women. It does not harm or put the baby at any increased risk.
It is thought that hormonal changes in early stages of pregnancy lead to morning sickness. There are also risk factors for developing morning sickness, and these include first pregnancy, having twins or more, similar symptoms in previous pregnancy, history of motion sickness or migraine, positive family history, and being obese.
There is currently no cure for morning sickness in pregnancy, but nausea and vomiting can be controlled with certain lifestyle changes and medications.
For mild morning sickness, it is recommended to get plenty of rest as tiredness can make nausea worse, to avoid foods and smells that cause nausea, to eat plain food like dry toast or biscuit in the morning, to eat small and frequent meals, to eat cold foods rather than hot ones, and to drink plenty of fluids.
It is thought that ginger may help reduce nausea and vomiting, so foods and drinks containing ginger may be beneficial.
If lifestyle changes do not work, there are medicines that can be used in pregnancy, including the first 12 weeks of gestation, to help improve morning sickness. These include anti-sickness or anti-emetic medications, steroids, or a combination of both.
If one anti-sickness medication does not work, an alternative medication can be tried until the most suitable one is found.
In some women, nausea and vomiting can be very severe and significantly affect their daily life. This severe form of pregnancy sickness is known as hyperemesis gravidarum or HG. This is a serious medical condition and often requires hospital treatment due to risk of dehydration and malnutrition resulting from constant vomiting.
The exact cause of hyperemesis gravidarum is not fully known, and it is thought to be related to hormonal changes in pregnancy. Having positive family history or presentation in previous pregnancy are risk factors for developing it.
The main symptoms of hyperemesis gravidarum are severe, prolonged nausea and vomiting, dehydration, malnutrition and weight loss.
Unlike common form of morning sickness in pregnancy, hyperemesis gravidarum can continue throughout the pregnancy until the baby is born. However, the symptoms may get better at around 20 weeks of gestation.
Hyperemesis gravidarum can be treated with anti-sickness tablets, injections or suppository that is inserted into the bottom.
Severe cases may require hospital admission to have intravenous or IV fluids and anti-sickness medications.
Having hyperemesis gravidarum in a pregnancy can increase the risk of it happening again in future pregnancies.
It should be noted that sometimes urinary tract infections or UTIs, including kidney infection, can cause nausea and vomiting in pregnancy.
It is advisable to see a doctor in person if there is severe nausea or vomiting, very dark-coloured urine or no urination in more than 8 hours, pain or burning on urination, weakness, dizziness or fainting feeling, abdominal or back pain, high temperature, weight loss, or blood in the vomit.
Weight gain in pregnancy is very common and this occurs as the pregnancy grows during the 9-month period. The amount of weight gain in pregnancy varies greatly from woman to woman, and the average weight gain is between 10 kg and 12 kg. Most of the weight gain happens after week 20 of gestation.
The main reason for the weight gain in pregnancy is related to the growing baby in the uterus. The body also stores more fat in preparation to produce breast milk after the baby is born.
It is not recommended to eat excessively or to diet or eat less while pregnant as this is not necessary, and it can lead to health problems for the baby and mother. It is best to have a healthy, balanced diet throughout the pregnancy.
Excessive weight gain in pregnancy can lead to health issues such as high blood pressure and increased risk of gestational diabetes or pre-eclampsia.
Gestational diabetes is a type of diabetes that occurs in pregnancy due to elevated levels of glucose or sugar in the blood. This increases the risk of having a large baby. Gestational diabetes can also increase the risk of developing type 2 diabetes in the future.
Pre-eclampsia is a complication that can occur in pregnancy in some women, and a rise in blood pressure can be the first sign of it. In most women, pre-eclampsia is mild and does not cause any major health issues, but in some women, it can cause more serious complications.
Not gaining sufficient amount of weight in pregnancy or dieting can also cause health problems such as premature birth or low birthweight. Having a balanced diet is usually sufficient to keep an optimal weight in pregnancy. It should be noted that naturally slim women usually stay slim while pregnant and have healthy babies.
It is advisable to stay active and continue with daily activities while pregnant as this will prepare the body for labour and birth.
If there are concerns regarding unwanted weight gain or loss in pregnancy, it is recommended to see a doctor or midwife for further assessment.
Psoriasis is a chronic skin condition that causes red and crusty patches of skin with silvery scales.
Psoriasis can appear anywhere on the body, and it is more common on elbows, knees, scalp and lower back.
It affects men and women equally. It can start at any age, but it is more common in adults between 20 and 30 years old and between 50 and 60 years old.
The symptoms can range from mild to severe and there can be periods of no symptoms or flare ups.
The exact cause of psoriasis is not fully understood, and it is thought that it is caused by a problem with the immune system.
There are other risk factors or triggers that can increase the risk of getting psoriasis and these include genetics, injury to skin, throat infections, certain medications, smoking, and obesity.
Psoriasis is not contagious, and it cannot be spread from person to person.
The diagnosis is clinical but in rare cases, a skin biopsy may be required.
Psoriasis can cause psoriatic arthritis, and this can present with tenderness, pain and swelling in the joints and connective tissue. When this is suspected, blood tests and an X-ray may be required.
There is currently no cure for psoriasis, but there are several treatments available to control the symptoms and to improve the skin.
The common treatments for psoriasis are vitamin D analogues such as calcipotriene, corticosteroids, coal tar, anthralin, tazarotene, and Dovobet (corticosteroid + calcipotriene).
Topical treatments come in the form of creams and ointments applied to the affected parts of the skin. There are several brands available over the counter without a prescription and these can be tried first for mild psoriasis.
If topical treatments do not work and for more severe cases of psoriasis, other treatment options can be considered such as phototherapy, oral or injected medications.
Phototherapy involves exposing the skin to certain types of ultraviolet light which is thought to be beneficial for psoriatic skin.
There are two main types of specialised treatments for severe psoriasis. The first type is non-biological and usually given as oral tablets or capsules. The second type is called biological and usually given as injections.
The non-biological medications include methotrexate, ciclosporin and acitretin; and biological treatments are etanercept, adalimumab and infliximab. These are specialised treatments and can only be initiated by a dermatologist.
If psoriasis is suspected, it is advisable to see a doctor or dermatologist in person for further assessment.
There are many different types and causes of skin rashes. Most skin rashes are due to benign or harmless causes and do not require treatment. However, some rashes may require treatment or an assessment by a doctor.
Skin rashes can have different names depending on their nature and appearance.
Redness of the skin alone is called erythema.
If there are areas of red raised skin and scales or flakes, these are called plaques.
A rash or lesion that is reddish-purple colour and does not blanch or fade with pressure is called purpura.
Clear fluid-containing lesions or swellings are called blisters, and yellow fluid- or pus-containing lesions are known as pustules.
A hive rash appears as raised, itchy, red or skin-coloured bumps or welts. This type of rash is also called urticaria or nettle rash.
The common causes of an acute rash are allergic reaction, heat rash, burns, dry skin or irritation, scratching, animal, insect and plant bites, folliculitis, fungal infection, and cellulitis.
The other causes are usually due to chronic skin conditions and include eczema, contact dermatitis, psoriasis, chronic dry skin and lichen planus.
If the rash is mild and there are no associated symptoms, there is no need to suspect anything serious.
It is best to avoid any possible triggers or aggravating factors as this would prevent the rash from getting worse.
Some acute rashes can be relieved by over-the-counter antihistamines or anti-allergy medications such as chlorphenamine, loratadine, cetirizine or fexofenadine.
A steroid cream called hydrocortisone can also help some rashes and associated itching and irritation. This is usually available over the counter without a prescription. Steroid creams should not be applied to the skin for more than 7 days at a time as they can thin the skin.
Skin rashes that can be treated with an antihistamine and hydrocortisone cream include allergic reactions, hives or urticaria, insect and animal bites, and eczema.
If fungal infection is suspected or if there may have been an exposure, over the counter antifungal treatments such as clotrimazole (Canesten) or miconazole (Daktarin) can be tried.
Folliculitis and cellulitis are due to infection and inflammation of the skin, and mild cases may be treated with topical antibacterial creams such as Tribiotic cream, Germolene, Sudocrem Antiseptic Cream, Betadine Antiseptic Solution, Neosporin or Polysporin.
More severe cases of folliculitis and cellulitis will require treatment with oral antibiotics.
The presence purpura, particularly in babies and children, could be related to more serious illness such as meningitis and requires urgent medical assessment in the hospital.
If there is a rash that does not resolve with conventional treatments, it is advisable to see a doctor in person.
Rashes are very common in babies and children, and most are due to benign or harmless causes. A high temperature or other symptoms may or may not accompany the rash.
Newborn babies can have milia which are very small spots that appear on the face, particularly the nose.
Millia can also affect older babies and children, and the spots could appear on the eyelids, forehead and nappy area.
Milia are harmless and do not require treatment, and the spots usually resolve within a few weeks, although they could last longer in older children.
Erythema toxicum is another rash that can occur in babies in the first few weeks after birth. This consists of raised red, yellow and white spots and usually appears on the face, body, upper arms and thighs.
This does not require treatment, and it goes away within a few weeks.
Molluscum contagiosum is a benign skin infection that causes spots on the skin. Although it can occur in any age group it is more common in children.
Molluscum contagiosum may only cause a rash on the skin without any other symptoms. It is caused by a virus called pox virus.
Molluscum lesions are flesh coloured, dome shaped papules with central dimpling.
The spots of molluscum contagiosum can be found anywhere on the body, although they are rare on the palms and on mucous membranes.
These spots are usually harmless and should not cause any associated health issues.
A rash on the bottom of babies is likely to be nappy rash. This can be treated at home with various remedies such as Metanium, Timodine or Sudocrem.
Spots or pimples on a baby’s upper body, forehead, scalp and cheeks may be due to neonatal acne. This appears six weeks after birth. No treatment is required for neonatal acne, and it usually goes away after a few weeks or months.
Yellow or white, greasy, scaly patches on a baby’s scalp can be due to cradle cap. This can be treated at home with an emollient or unperfumed baby shampoos.
One of the other causes of a rash in babies and children is slapped cheek syndrome. This presents with a rash on one or both cheeks plus a high temperature, runny nose, sore throat and headache. Older children may be able to tell when they have a sore throat or headache, whereas smaller children or babies usually point to their mouth or hold their head.
Slapped cheek syndrome is a benign condition and it can usually be treated at home without the need to see a doctor in person. Babies should continue with their normal feeds and children should have plenty of fluids to avoid dehydration.
The rash due to slapped check syndrome usually takes 1 to 3 weeks to resolve, but sometimes it can last longer.
The other common cause of rash is hand, foot and mouth disease. This presents with a rash or blisters on the hands and feet and ulcers in the mouth.
Hand, foot and mouth disease can be accompanied by a high temperature, sore throat and loss of appetite. These symptoms usually occur before the blisters appear.
This condition usually resolves on its own in 7 to 10 days without seeing a doctor and does not require antibiotics. Paracetamol can be given for high temperature and sore throat. Drinking cool fluids could help with the ulcers in the mouth.
A heat rash is also quite common, and it appears as small, raised spots that feel itchy or prickly.
This can be treated at home without seeing a doctor. It is recommended to wear loose cotton clothing, take cool showers and drink plenty of fluids.
An antihistamine such as chlorphenamine or Piriton and calamine lotion can help with a heat rash.
Eczema is another common skin condition in babies and children. This usually causes dry, scaly or cracked and itchy skin. Eczema is more common behind the knees, elbows and neck.
Eczema is a chronic condition and requires an assessment by a doctor for proper management. The usual treatments for eczema are emollients, steroid creams, and antihistamines.
A raised rash with itchy spots, patches or hives is likely due to an allergic reaction. Mild allergic rash can be treated at home with observation. An antihistamine such as chlorphenamine or Piriton can be considered if there is itching or irritation.
If there is a more severe rash, swelling around the mouth, cough or breathing difficulties, urgent medical help should be sought.
A rash that looks like a ring-shaped patch of skin is likely to be ringworm. This can be itchy, dry, scaly or swollen. Ringworm can appear anywhere on the body.
A ringworm can be treated at home with an antifungal cream, gel or spray.
If there is a rash with small, raised bumps that feels rough, this could be due to scarlet fever.
Scarlet fever usually starts with a fever, a sore throat and swollen lymph glands in the neck. A rash appears 12 to 48 hours after these flu-like symptoms.
With scarlet fever, there could be a strawberry tongue sign where it would look red, swollen and covered in small bumps.
Although the actual rash does not appear on the face, the cheeks can look red due to illness itself.
It is recommended to contact a doctor if there are symptoms of scarlet fever as this is usually treated with a course of antibiotics. If there is further illness or symptoms weeks after scarlet fever got better, this could suggest a complication such as rheumatic fever and further medical assessment will be needed.
Impetigo is characterised by blisters or sores that burst and leave a crusty, golden-brown patches, mainly around the mouth.
The red sores or blisters can be itchy and painful, and spread to other parts of the body.
Impetigo is very infectious. It is usually treated with topical antibiotic creams or oral antibiotics.
Scabies causes a very itchy rash with raised spots, which may first appear between the fingers.
Scabies in babies and children usually affects the feet and hands, often with blisters.
The treatment of scabies is with 5% permethrin cream or 0.5% aqueous malathion.
A rash consisting of small, itchy spots that turn into blisters and scabs is usually due to chickenpox. Chickenpox rash can appear anywhere on the body including inside the mouth.
Before or after the rash appears, there may be a fever, loss of appetite and aches and pains. Chickenpox is usually very itchy, and this can be distressing for children.
Chickenpox does not normally cause a major illness in children. They should stay away from nursery, school and crowded places.
Paracetamol can be considered for high temperature and aches and pains. Children should be encouraged to drink plenty of fluids to avoid dehydration. Cooling creams or gels and an antihistamine can be used to help itching and irritation.
Ibuprofen is not recommended in chickenpox as this may cause serious skin infections.
A more serious rash that can occur in babies and children is measles. This presents with a spotty rash on the head and neck and spreads to the rest of the body.
Measles can start with a fever, cough, runny nose, and red, sore and watery eyes. The rash usually appears a few days after these initial symptoms. There can be white spots inside the cheeks and on the back of the lips.
Measles is not very common due to childhood vaccination programme; but if there is any suspicion of measles, urgent medical assessment should be sought.
Measles is very contagious, and it is advisable to avoid contact with others until this is fully treated.
A red eye is a common complaint, and it is not usually due to anything serious, and it resolves on its own without any treatment.
There are several causes of a red eye and these can present in different ways.
A bright red area in the white of the eye is usually due to a small burst blood vessel. This is known as subconjunctival haemorrhage.
This can be caused by straining such as coughing, sneezing or heavy lifting. The other possible causes are rubbing the eyes, high blood pressure, blood-thinning medications, eye trauma, and rarely diabetes or clotting disorders.
Subconjunctival haemorrhage is a benign, harmless condition and does not usually cause any significant issues.
The redness or bloodshot eye can look bad, but this resolves over time without needing treatment.
Conjunctivitis is another common cause of a red or pink eye. This is an eye condition caused by infection or allergies. It can cause redness, gritty or burning feeling in the eyes, and sticky eyes where discharge sticks to lashes, itching and watering.
This is generally a harmless condition, and it usually gets better on its own in a couple of weeks.
It should be noted that conjunctivitis that produces sticky pus or red and gritty feeling is usually contagious.
Conjunctivitis that causes red and watery eyes is likely due to allergies like hay fever, and this is not contagious.
Conjunctivitis can be managed with a few simple measures. It is recommended to wash the eyelids with clean water. Holding a cold flannel on the eyes for a few minutes to cool them down can also be beneficial.
Wearing contact lenses and rubbing the eyes should be avoided until the symptoms have resolved.
For more severe cases of conjunctivitis, over the counter antibacterial eye drops or antihistamines can help with the symptoms.
The other cause of a red eye is dryness. It is common for people to get dry eyes, and this is not usually a serious problem.
Dry eyes can present with redness, itching, soreness, increased sensitivity to light, excess watering, gritty or blurry eyes.
The risk factors for getting dry eyes include being over the age of 50, contact lenses, prolonged exposure to computer screens, air conditioned or heated rooms, dry, windy or dusty environments, smoking or alcohol, and certain medications.
Rarely, medical conditions such as Sjögren’s syndrome, blepharitis, or lupus can cause dry eyes.
It is important to avoid any triggers of dry eyes. Eyedrops, gels, ointments or allergy medicines can help with dryness in the eyes.
Blepharitis is inflammation of the eyelids, and it causes swollen, itchy eyelids. It can also cause redness and gritty feeling in the eyes.
This is not usually serious, and it can often be treated by washing the eyelids every day. Eyedrops, eye pads and wipes are available and can be considered if necessary.
If there is a feeling of something in the eye, this could be due to a foreign body or ingrowing eyelash. This requires further assessment by a doctor in person.
A red eye without other symptoms such as pain and visual disturbance should resolve on its own without needing to see a doctor.
It is advisable to see a doctor in person for further assessment if red eye symptoms do not improve or get worse, there is pain or vision changes, and if red eye occurs in a child under 2 years of age.
Seborrhoeic dermatitis is a skin condition that causes red, flaky and itchy skin. It can affect the face, scalp and centre of the chest. It is also known as seborrhoeic eczema.
This condition can cause flaking or dandruff, redness, scaling or weeping rash on the scalp. It can cause redness, inflammation and crusting around inner parts of the eyebrows, creases beside the nose, near the cheeks, inside the ear canals and behind the ears.
Seborrhoeic dermatitis is quite common and it occurs more commonly in young adults. It can occur in infants as well and usually resolves without treatment over a period of a few months. Cradle cap in infants is likely to be related to this.
The exact cause of this condition is not fully known. A fungus called Malassezia that lives on the skin is thought to play a role in causing it.
It may occur in people with low immunity such as those with HIV infection, and in those with Parkinson’s disease. The other triggers could be cold weather, stress and tiredness.
Seborrhoeic dermatitis is not thought to be related to diet or run in families.
The diagnosis of seborrhoeic dermatitis is clinical and does not usually require testing. In rare cases or where there is a recurrent problem, a skin biopsy can be considered.
There is currently no cure for seborrhoeic dermatitis and the available treatments are aimed at controlling the symptoms. The likelihood of symptoms returning after treatment is quite high, and so it may be necessary to use the treatments continuously or for a long time.
The common treatments for seborrhoeic dermatitis include zinc pyrithione, selenium sulphide, antifungal medication and steroids.
For scalp seborrhoeic dermatitis, shampoos containing zinc pyrithione, selenium sulphide or ketoconazole can be used. These should be left on the scalp for 5 to 10 minutes before rinsing. Salicylic-based ointment is thought to be beneficial, and this can be rubbed in at night and washed off in the morning. Polytar scalp shampoo may also work for some people.
A scalp application containing a strong steroid can be considered for more severe cases.
For seborrhoeic dermatitis that occurs elsewhere on the body, a mild steroid cream with or without an antifungal medication can work well. An example of this cream is Canesten HC or hydrocortisone and clotrimazole. Hydrocortisone cream should not be used for more than 7 days at a time as it can thin the skin. It is best to leave 1 to 2 weeks between applications.
Washing the body with an antifungal shampoo such as ketoconazole shampoo could also help with the symptoms of redness, flaking and itching. The shampoo can be left on the body for 5 to 10 minutes before rinsing.
Medicated ear drops can be considered for symptoms affecting the ear canals.
An anti-fungal shampoo once a week can be used to reduce the chances of the rash coming back once the scalp has been cleared.
If there is dryness of the skin, a good moisturiser such as E45, Ultrabase or Diprobase can be applied.
If conventional treatments do not work, it is advised to see a doctor or dermatologist in person for further assessment and treatment.
More resistant cases may require treatment with oral antifungal medication or lymecycline antibiotic, or with tacrolimus ointment or pimecrolimus cream.
Seborrheic keratosis is a skin condition where there are benign harmless warty growths on the skin caused by unusual build-up of skin cells. Seborrhoeic keratoses are also known as seborrhoeic warts or basal cell papillomas.
This is not a cancerous skin disease, and it does not develop into skin cancer. There is usually no treatment required for the warts.
The growths can appear dark brown or black colour and give the impression that they are stuck on to the skin.
Seborrhoeic keratoses or warts can appear anywhere on the body and the common sites are face, scalp, chest, back and groin.
Seborrhoeic keratosis usually starts to appear after the age of 30. The underlying cause of seborrhoeic keratosis is not known fully, and it can run in families.
These warts are very common, and most people develop 1 or 2 warts after the age of 50. The name can be confusing, and it should be noted that these warts are not the same as common warts and are not caused by HPV virus.
Seborrhoeic keratosis is not infectious and it does not spread to others. The growths remain for life once present. They can look unsightly and cause itching and irritation, but they should not cause any major health issues.
The diagnosis of seborrhoeic keratosis is clinical and tests are not usually required. Rarely, if there is any uncertainty or the possibility of skin cancer on or near the warts, dermatoscopy and skin biopsy may be required.
In the absence of symptoms, no treatment is needed. The growths can be left alone, and they may grow slowly over time.
If they cause symptoms such as itching, irritation or if they interfere with clothing or jewellery, they can be removed through various methods.
The treatment options are cryotherapy with liquid nitrogen, shave or curettage excision and laser surgery.
Once seborrhoeic keratoses have been removed, they do not usually come back.
If there is a new skin growth on the skin that looks suspicious, it is best to see a doctor in person for further assessment.
Shingles is an infection that causes a painful rash and blisters. It is caused by varicella-zoster virus which also causes chickenpox. Shingles causes inflammation of the nerves beneath the skin affecting one side of the body.
The first signs of shingles can be tingling, and pain which can be severe. A headache and general fatigue can be part of initial signs.
A blistering rash appears on the skin supplied by one or more nerves 1 to 3 days after the pain starts.
Rarely, shingles can cause pain without showing a rash.
Shingles can be triggered by stress, chemotherapy treatment, and certain medical conditions.
Shingles can appear anywhere on the skin and the common sites are chest and abdomen.
It is unusual to have shingles a second time.
Shingles does not spread to others, and it is not possible to get shingles from someone with shingles or chickenpox. But it is possible to get chickenpox from someone with shingles if the person has not had chickenpox or chickenpox vaccine before.
A mild rash of shingles without any other symptoms may not require treatment.
Otherwise, the main treatment for shingles is antiviral medication such as acyclovir. This is offered to people who have moderate to severe pain or rash, to those who have weakened immunity, and to those people who have a rash affecting other areas of the body apart from chest, abdomen and back.
The treatment for shingles needs to be given within 72 hours of the onset of the rash.
The other treatments of shingles are painkillers and steroids. Paracetamol can help with the shingles pain.
It is advised to keep the rash clean and dry to prevent further infection, to wear loose-fitting clothing, and to use a cool compress. It is not recommended to put on plasters or dressings that could stick to the rash. A non-sticky dressing can be used to cover the rash.
It is recommended to avoid school and work if the rash is active and weeping fluid, or until the rash has dried out.
Shingles can take up to four weeks to heal. The pain could stay longer, and it usually goes away over time.
It is advised to avoid pregnant women, those who have not had chickenpox before, people with weakened immunity, and babies less than 1 month old.
Shingles in pregnancy does not usually cause any complications in the mother or baby. But pregnant women with shingles need to inform their doctor in case treatment is needed.
If shingles affects the eye or multiple areas, it is advised to see a doctor promptly as expert management will be needed.
Shoulder pain is not usually due to anything serious if there has not been an injury or other symptoms with it.
The most common cause of shoulder pain is muscular strain from a mild injury or awkward position while sleeping. This type of pain should resolve within 2 weeks with home treatment.
If the shoulder pain does not improve after 2 weeks or there are other symptoms, there may be other underlying causes for it.
If the pain lasts weeks or months and there is stiffness with it, this could be due to frozen shoulder, osteoarthritis or rheumatoid arthritis.
Frozen shoulder is a common cause of shoulder pain, and it is characterised by pain in the shoulder that can be worse at night and while sleeping, and stiffness that makes it difficult to move the shoulder.
The exact cause of frozen shoulder is not clear, and it is thought to be related to inflammation of the tissue around the shoulder joint. Previous injury or surgery and diabetes can increase the risk of getting frozen shoulder.
Frozen shoulder can take several months or years to get better. The treatments for this condition include painkillers, steroid injections and physiotherapy.
Osteoarthritis is the most common type of arthritis. It is due to wear and tear of the cartilage in joints that occurs over time. The common symptoms are pain and stiffness, difficulty moving the shoulder, and more rarely swelling, tenderness and cracking sound when moving the shoulder.
Osteoarthritis is a chronic condition and there is currently no cure for it. Mild symptoms can be managed with simple painkillers, regular exercise and physiotherapy. More severe cases may require stronger painkillers to control the pain, or surgery to replace the damaged joint.
Rheumatoid arthritis is another chronic condition that could affect the shoulders to cause pain, swelling and stiffness. Unlike osteoarthritis, rheumatoid arthritis is an autoimmune disease that causes inflammatory changes in the joints.
The treatments for rheumatoid arthritis include conventional painkillers, specialised medicines, physiotherapy and surgery for very severe cases.
Shoulder pain that is aggravated while using the arm or shoulder could be related to tendonitis, bursitis or impingement.
Tendonitis is inflammation of a tendon after an injury, leading to pain, swelling and stiffness. This can be treated at home with painkillers if necessary, and it should get better within 2 to 3 weeks.
Bursitis is inflammation of bursa which are fluid-filled sacs that cushion the joints. This can cause pain, tenderness, redness and swelling of the shoulder. This can be treated with rest, ice packs and painkillers.
Shoulder impingement is a condition where a tendon inside the shoulder becomes swollen and rubs against tissue or bone. This can lead to pain while lifting the arm. It can be caused by injury, irritation, or wear and tear.
The treatment options for shoulder impingement are painkillers, physiotherapy, steroid injections, and surgery to prevent rubbing on the tissue or bone.
This type of pain usually gets better in a few weeks or months.
If shoulder pain is associated with tingling, numbness, weakness in the arm, clicking or locking, this could suggest shoulder instability or hypermobility.
Hypermobility is characterised by flexible joints. There can be pain and stiffness, recurrent sprains and strains, frequent dislocation of the shoulder, and poor co-ordination.
There is no cure for joint hypermobility, but the symptoms can be improved with painkillers and physiotherapy.
This condition usually affects children and young people and often gets better with increasing age.
Shoulder pain that is sudden and severe could be due to fracture or broken bone, shoulder dislocation or ruptured tendon. This type of pain requires more urgent assessment by a doctor or in the hospital.
For simple shoulder pain, it is recommended to stay active and perform gentle exercises, to sit with a cushion behind lower back, to rest the arm on a cushion in the lap, and to take painkillers if needed.
It is not advisable to stop using the shoulder completely, to put exertion or a lot of weight on the shoulder, or to perform strenuous exercises that could cause further damage.
The general advice is to see a doctor for further assessment if shoulder pain does not resolve after 2 weeks or if there are other symptoms such as swelling, stiffness and numbness.
Sickle cell disease refers to a group of inherited or genetic conditions that affect the oxygen-carrying red blood cells in the body. The most serious type of these conditions is called sickle cell anaemia.
Sickle cell disease is more common in people with an African, Caribbean, Middle Eastern or South Asian family background.
People with sickle cell disease produce abnormal crescent or sickle-shaped red blood cells. This is the reason that this condition is called sickle cell disease.
These abnormally shaped red blood cells do not live as long as healthy blood cells. They can get stuck in small blood vessels in various parts of the body and block blood flow, leading to pain or sickle cell crisis.
Sickle cell disease is a genetic condition, and it is caused by a fault in a gene that affects how red blood cells develop. It is passed on in an autosomal recessive way which means that a copy of the faulty gene from both parents is needed to cause sickle cell disease.
People with one faulty gene can be carriers but would not have sickle cell disease themselves. This is known as having the sickle cell trait.
Sickle cell disease is a lifelong condition, and it can be mild or cause serious symptoms in some people. Mild sickle cell disease may not cause any major symptoms or have a significant impact on a person’s daily life.
Since this is a genetic condition it can present with problems from early childhood. However, some children may not have severe or frequent symptoms and can lead normal lives most of the time.
The common symptoms of sickle cell disease are anaemia leading to fatigue, tiredness and shortness of breath, painful episodes or sickle cell crises that can be severe and last for days or weeks, and increased risk of infections.
There are rarer problems that can occur with sickle cell disease, and these include lung disease, stroke and delayed growth.
Sickle cell disease can be detected through screening during pregnancy or soon after birth. It is also possible to have blood tests at any age to check for sickle cell disease and the faulty gene causing it.
Sickle cell disease is a chronic condition and people would need treatment throughout their lives.
It is recommended to drink plenty of fluids and stay warm to prevent painful episodes or sickle cell crises. Painkillers such as paracetamol can be considered for these painful episodes.
Some people with sickle cell disease may require daily antibiotics and regular vaccinations to reduce the risk of infections.
A medication called hydroxycarbamide or hydroxyurea and regular blood transfusions are among other treatments available. An emergency blood transfusion is usually performed for severe anaemia.
The only cure for sickle cell disease is a stem cell or bone marrow transplant, or gene therapy to fix the faulty gene involved.
One-time gene editing therapy has recently been approved in England for people with very severe forms of sickle cell disease. Gene editing therapy is also available in USA, European Union and Canada.
Clinical trials show that gene therapy can produce functional cure in 96.6 % of the patients with sickle cell disease. This is a groundbreaking success and can help thousands of people around the world who suffer from this condition.
A groundbreaking gene therapy for the treatment of sickle cell disease has been approved in England.
Studies find that there is a ‘functional cure’ in 96.6 % of patients receiving this treatment. The approved gene therapy is known as exagamglogene autotemcel or exa-cel, which is also called Casgevy.
Sickle cell disease is an inherited blood disorder. This condition is characterised by abnormal crescent or sickle shaped red blood cells. These sickled cells can get stuck in small blood vessels and block blood flow, causing pain or sickle cell crisis.
Gene editing therapy involves collecting stem cells from a person. These cells are then edited in a laboratory to produce normal non-sickling red blood cells. The edited cells are then put back into the person.
Exa-cel or Casgevy uses a person’s own edited cells. This means there is no risk of rejection by the body.
It should be noted that this one-time gene editing therapy would be available for patients aged 12 and over with specific severe forms of sickle cell disease, and who are suitable for a stem cell transplant but without a matched donor.
Exa-cel was approved in the United States in December 2023 for the treatment of sickle cell disease in patients aged 12 years and older. It is also available in European Union, Canada and Saudi Arabia.
Gene therapy is being used for transfusion-dependent beta-thalassaemia and spinal muscular atrophy or SMA as well. It is hoped that gene therapy will be available to treat other genetic conditions such as cystic fibrosis and Duchenne muscular dystrophy.
Sore throat is a very common presentation, and this is usually a harmless symptom and not due to anything serious.
The most common cause of a sore throat is viral infection. There are several different viruses that go around and cause viral throat infections. This type of viral infection can last up to 7 days.
A sore throat infection can have a different name depending on which part of the throat is affected.
Tonsillitis is an infection that is related to tonsils.
Laryngitis infection involves the part of the throat that contains the vocal cords.
Both conditions are usually caused by common viruses. Antibiotics are not usually required for viral infections as they do not work against viruses.
Glandular fever or infectious mononucleosis is another viral infection affecting the throat, but it is caused by a different virus called Epstein-Barr Virus. Antibiotic treatment is not required for glandular fever unless there is secondary bacterial infection.
Strep throat is a bacterial infection of the throat caused by streptococcus pyogenes bacteria. This is normally treated with a course of antibiotics.
Sore throat can present with other symptoms such as throat pain, dry and scratchy throat, redness in the throat, bad breath, high temperature, mild cough and enlarged lymph glands in the neck. High temperature is more common in children than adults.
Most cases of sore throat can be managed at home without seeing a doctor.
Paracetamol can be taken for the sore throat or pain. Difflam throat spray can also help with sore throat.
It is recommended to gargle with warm, salty water, to drink plenty of fluids to avoid dehydration, to eat cool and soft foods, to suck ice cubes and ice lollies, and to avoid smoking.
Warm drinks with lemon and honey can soothe the pain.
Over the counter medicated lozenges containing a local anaesthetic or antiseptic can also be beneficial.
Antibiotics can be considered if sore throat persists and there are signs of bacterial infection.
It is recommended to see a doctor if a sore throat continues more than 7 days and if there is very high temperature or history of weakened immune system.