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A GUIDE TO THE TREATMENT OF COMMON AILMENTS

PharmWeb® - Copyright©1999. All rights reserved.

 

WARNING

These pages should only be used as a guide only. Seek advice from a healthcare professional if you are in any doubt about your health or any information in this section.

The information in these pages is based on current practices in the United Kingdom. The information may not be in line with health policies in other countries.

There are five factors to consider when considering a treatment for the common ailments described in these pages:

 

Who is the medicine going to be used by?

Is the medicine for use by one person or a group, if it is for a group is it suitable for all of the members of the group? Are any children going to be using the medicine, if so, is it suitable for use in their age group?

 

What are the symptoms?

Try to find out all of the symptoms affecting the person to be treated, no matter how embarrassing they may be, as they may be quite important.

 

How long has the person had the symptoms?

If the individual has had the symptoms for a considerable length of time it may be worth considering a visit to the doctor who can often treat with stronger medicines that will work much faster.

Have they tried anything else for this condition?

If the condition is stubborn and several remedies have already been used with no success it may be time to visit the doctor who can prescribe stronger medicines than those that are available from your chemist.

 

Do they take any other medicines for anything else?

Does the person to be treated take medication for any other reason. This may include medicines from the doctor, from the chemist or even herbal or homeopathic medicines. This is very important, some medicines affect each other when inside the body and may do more damage than good. Always check that it is safe to take a medicine before starting to use it, this can be done by telephoning or calling in at your nearest chemist.

COLD SORES

Cold sores on the lips of the mouth are caused by a virus called Herpes simplex.

Several factors may cause a cold sore to form, for example ultraviolet light may start a cold sore. Other causes are physical and emotional stress, other illnesses such as colds or flu may also encourage a cold sore to form. Women may also find that they get cold sores during or just before menstruation (period).

The development of a cold sore has several stages:

Tingle Stage - the skin tingles and itches before the sore appears

Blister Stage - a small patch of skin raises and forms a blister

Weeping Stage - the blister bursts to form a weeping sore

Scab Stage - natural healing occurs at the site of the sore

It is usual for a cold sore to only last about 10 days.

 

Treatment

There are several treatments available to ease the symptoms of cold sores. These are usually lip ointments applied to the sore to dry it out at the weeping stage. There is now also a newer treatment based on the antiviral drug aciclovir. This treatment is to be used at the tingle stage and acts to prevent the reproduction of the virus and so stop the formation of the sore. It must be applied early to be effective, it only reduces the severity of the sore once the sore is formed. The types of preparations listed above should not be used on genitals or eyes.

 

General Points

  • Avoid touching the sore, if you do touch it wash your hands well to prevent spreading the infection to other areas of your mouth or to other people.
  • Do not kiss anyone while you have a cold sore, this will inevitably pass on the virus.
  • Do not touch the eyes or genitals of yourself or another person if you think you have touched your cold sore. This will again prevent spreading of the virus.

COLDS AND INFLUENZA

 

Colds and Influenza (flu) are both caused by a virus that is passed from one individual to another through the air. Colds and flu are not the same thing, flu is much more dangerous, and can be fatal. However, due to the similarity of the symptoms the treatments available are similar for both the flu and the common cold.

The flu has additional symptoms which make it identifiable from a cold. The symptoms of a cold, of which some or all may be present, include:

  • Headache
  • Runny/Blocked Nose
  • Sore Throat
  • Runny Eyes
  • Slight Fever
  • Dry Cough

The flu has the following additional symptoms:

  • Fever (High Temperature)
  • Lethargy
  • Sweating
  • Aching of the entire body (particularly) the joints

 

Another way to differentiate a bad cold from a case of flu is the duration of the infection and subsequent recovery. An individual will take longer to recover fully from the flu than they would from a common cold.

It is possible to vaccinate against flu by monitoring the slight changes in the virus each year. However, when faced with the mas- sive variety of cold viruses it would be impossible to vaccinate against them all. This is why there is, as yet, no cure for the com- mon cold.

 

 

 

Flu

Cold

Duration of Infection

Over 2 weeks

7 to 10 days

Chance of catching the virus

Low

High

Chance of Reinfection

Very Low

Very High

Vaccination Available

Yes

No

Epidemics/Pandemics occur

Yes

No

Can it be Fatal

Yes

No

Treatment

There are many products on the market which contain an even greater variety of active ingredients. These active ingredients can be categorized into 3 areas and all treat the symptoms associated with a cold and flu.

 

  • Analgesics

Analgesics are included in cold and flu preparations to treat symptoms such as the headache, shivering, fever, aches and pains. Since its market introduction under the trademark Aspirin® in the year 1899, acetylsalicylic acid has attained a leading position world-wide in the prescription-free therapy of painful, inflammatory and feverish states. The substance’s tolerability and special pharmacological traits allow for an easy controlling of therapy.

 

Care with Analgesics

Care must be taken to avoid other forms of Paracetamol while taking cold and flu preparations. Examples of other sources of paracetamol include painkillers and other cold and flu preparations. More information on paracetamol is available at the Paracetamol Information Centre page.

Also, remember to take cold and flu preparations containing aspirin or ibuprofen with or after food to avoid the main side effect of these drugs, an upset stomach.

 

  • Decongestants

Decongestants help to alleviate the symptoms associated with the nose and eyes. They reduce blood flow to the nasal lining and therefore slow the production of catarrh. This will help with a blocked and runny nose and also with running eyes as this symptom is connected with the catarrh in the nose. Decongestants must only be taken for short periods, up to a maximum of 7 days. Always follow the instructions that come with decongestants and never exceed the stated dose. Decongestants must also be avoided by people taking medication for blood pressure, thyroid dysfunction and diabetics. There is a range of decongestant free cold and flu preparations especially for these patient groups. Always check with your Pharmacist if you are unsure if a medication is suitable for you to use.

 

-Cough Suppressants

Cough Suppressants are included to relieve the symptoms of coughing and the sore throat. More information on cough suppressants can be found on the Dry Cough page.

 

Influenza Vaccines

The flu vaccine has been available for some time, however, it is not effective at halting epidemics or pandemics. For this reason it is only recommended for administration to those who are at most risk from the disease. The recommendations include those people suffering from:

  • Chronic Respiratory Diseases (eg. asthma, emphysema, chronic obstructive pulmonary disease)
  • Chronic Heart Failure
  • Chronic Renal Failure
  • Diabetes Mellitus
  • Immunosuppression (whether disease or drug induced), and
  • Residents of Residential/Nursing Homes

 

  • Residents of other long-stay facilities
  • Healthcare workers with a high chance of exposure

The flu virus has two distinctive antigens or markers on its surface that make it readily distinguishable to our immune system, these are called haemagluttinin and neuramidase. The vaccines that are available make use of these. A safe form of these markers is injected into the person undergoing the vaccination. The markers are injected in one of two forms depending on the manufacturer of the vaccine.

Some vaccines use an inactivated viral particle, called a split virion, which would have been broken up into tiny fragments of the original virus, each piece will contain a sample of the markers and this will allow the vaccinated individual to gain resistance to the virulent strain of the virus. The remaining vaccines work in the same way as the split virion but they purify the markers much more so that only the markers are injected. This type of vaccine has no benefit over the split virion method of vaccine manufacture and there is no price difference.

Both vaccines offer 70 to 80% protection from the wild virus although this level may be lower in the elderly. Vaccine usage should be avoided in those individuals who are pregnant and also by those who have an allergy to hens eggs since eggs are involved in the manufacturing process of the vaccine.

 

PharmWeb® - Copyright©1994-2002. All rights reserved.

 

COUGHS

 

There are two basic types of cough, Chesty and Dry. A chesty cough is characterized by the presence of mucous or phlegm on the chest, which is absent in the dry cough. The action of coughing is therefore of benefit in the case of a chesty cough as the mucus needs to be removed from the chest. However, in a dry cough there is no benefit to coughing.

Chesty coughs are further divided into Productive and Non-Productive. An individual with a productive chesty cough will notice the presence of mucus on the chest because they are coughing some of this phlegm off their chest. In the case of a non-productive cough the mucus is not being removed from the chest despite the coughing. If any phlegm coughed up is colored green/ yellow or contains any blood it is important to consult a doctor.

If you are still unsure which type of cough you have, talk to your pharmacist about your symptoms, you could use Simple linctus until you are sure which type of cough you have as it can be safely used in both types of cough, both chesty and dry.

Types of cough are:

 

Dry Coughs

Dry coughs are best treated with a medicine that stops the urge to cough. The cough has no purpose and the irritation on the chest is more nuisance than benefit. There are several medicines available which have just this action. The medical term for a cough suppressant is an antitussive. Even though you may have a dry cough, it is still difficult to decide which medicine to use as the choice in this area is so wide. As such, rather that dealing with individual products, we will look at the agents within these products. The main ones are codeine, pholcodine and dextromethorphan.

Codeine

Codeine is not common nowadays due to its potential to abuse, however some chemists may still sell it in the form of a linctus (syrup like medicine) called codeine linctus. It works by suppressing the urge to cough. It is very effective but has some draw- backs. It can cause constipation, however, this is reversible upon discontinuing use of the product. Pholcodine Pholcodine is now the recommended replacement for codeine linctus, it is just as effective but manages to avoid the problems

that are encountered with the use of codeine. Again it is usually available in liquid form, but can be taken as tablets and capsules along with other active ingredients. For example, cold and flu remedies often have pholcodine as an ingredient.

Dextromethorphan

Dextromethorphan is less common than the other two ingredients, however it is just as useful. It is available in a liquid form, however it does not usually get used in cold and flu products.

 

Productive Chesty Coughs

Productive and Non Productive coughs are very similar and as such have similar treatments. The best way of dealing with these coughs is to aid the natural coughing process which is attempting to remove the phlegm from the chest. This is done by use of agents which break the mucus up and make it more runny. Productive coughs only require gentle assistance from agents such as glycerin. These types of medicines are known as demulcents. Glycerin is found in medicines such as glycerin, honey and lemon. This is popular for this type of cough because of its pleasant taste - unlike most other medicines! There is also the aniseed flavored simple linctus which can also be used for this cough type.

 

Non-Productive Chesty Coughs

Productive and Non Productive coughs are very similar and as such have similar treatments. The best way of dealing with these coughs is to aid the natural coughing process which is attempting to remove the phlegm from the chest. This is done by use of agents which break the mucus up and therefore make it easier to cough the mucus off the chest. Another ingredient often added to products for chesty coughs is Cetylpyridinium which has a breath freshening action since catarrh can affect the odor of the breath.

There are four agents available which have expectorant properties:

  • Ammonium Chloride
  • Guaiphenesin
  • Diphenhydramine
  • Ipecacuanha

Medically these agents are describe as Expectorants.

 

Ammonium Chloride

This expectorant is used in the more traditional remedies available for chesty coughs. It is often mixed with creosote, menthol or other ingredients to supplement its activity.

 

Guaiphenesin

This is the most popular expectorant used in current medicines for non-productive chesty coughs. It is often accompanied by other ingredients for example decongestants, these help reduce nasal congestion.

 

Diphenhydramine

This is possibly the second most popular ingredient. Again it is often accompanied by other active ingredients in formulations that

also acts to combat nasal congection.

 

Ipecacuanha

This ingredient is usually added to products containing glycerin. For example glycerin, honey and lemon with ipecacuanha.

 

General Advice for Coughs

There are some simple things you can do that will relieve the symptoms of coughs.

  • Inhaling steam helps to break up any phlegm on the chest in the case of a chesty cough. It may also soothe the chest in the case of a dry cough. The steam can also be fragranced with menthol or Olbas Oil to help breathing. Taking a hot bath or shower will expose your chest to natural steam.
  • During the night when coughs are often most trouble, use of a vaporizer in the bedroom may help you get a restful nights sleep.

Eye Conditions

There are two problems with the eyes that can successfully be treated with products from a chemist. These are conjunctivitis and tired eyes.

 

  • Conjunctivitis

Conjunctivitis is a condition where the conjunctiva (or surface of the eye) becomes inflamed. This will make the white part of the eye appear reddened due to an increase in blood supply. There is usually an over production of tears during conjunctivitis often described as watering of the eye. There may also be some discomfort which can be itchiness or a gritty feeling. The symptoms above are common to the two types of conjunctivitis, they are allergic and infective. The difference between these two types is the cause and one extra symptom. Infective conjunctivitis has the extra symptom which is a yellowish colored dis- charge from the eye, this usually encrusts the eye making it difficult to open the eyes in the morning after sleep.

Allergic conjunctivitis is caused when the sufferer of an allergy comes into contact with the cause of their allergy. For example, hay fever sufferers and pollen. If pollen gets in their eyes it may cause an allergic reaction and this will show as conjunctivitis.

For treatment of allergic conjunctivis see the hayfever section.

 

Infective conjunctivitis is an infection of the eye by either a virus or more commonly b bacteria. The treatment of this condition involves the use of antibacterial preparations for use in the eye. These preparations will kill the bacteria, the cause of the condition, allowing the eyes to recover. The preparations are available from the Pharmacy as drops or ointments and they are equally effective. The drops usually require four times daily administration whereas the ointment is usually applied twice daily. This is because the ointment, being of a thicker consistency, stays in the eye for longer.

If there is no improvement within a few days of using these preparations you should consult your doctor.

  • Tired Eyes

Tired eyes are often experienced after prolonged use of the eyes, for example after using a computer or driving. In this case eye drops or lotions can be used to refresh the eyes. They usually contain witch hazel which acts to revive the surface of the eye.

 

 

HOW TO USE EYE DROPS

  1. Wash your hands.
  2. Sit down in front of a mirror so that you can see what you are doing.
  3. Remove the top from the bottle.
  4. Avoid touching the dropper tip against your eye, eyelashes, or any other surface.
  5. Tilt your head back and look upwards. Gently pull your lower eyelid down.
  6. Hold the dropper above your eye and squeeze one drop inside your lower eyelid.
  7. Release the lower eyelid and blink a few times to make sure the whole of the eye is covered by the liquid.
  8. Wipe away any excess with a clean tissue.
  9. If you need to put in more than one drop, or if you are using another type of eye drop, then you should wait for a few minutes before putting the next drop in. If you do not wait then the first drop may be washed out by the second before it has had time to work.

 

Your eye-drops have been tested to make sure that they are free from germs when you receive them. In order to keep them in good condition, follow these simple rules:

  • When not in use, keep the bottle tightly closed in a cool, dark place.
  • If the dropper is separate, DO NOT put it down on any surface.
  • DO NOT allow the dropper or dropper nozzle to touch your eye or your fingers.
  • NEVER lend your eye-drops to anyone else.
  • Eye drops should not be used for longer than four weeks. This is because they can become dirty and infected. Write the date that you open the bottle on the label so that you will know when to throw them away.

 

  • DO NOT wear contact lenses until your course of eye-drops is finished, unless you have been told otherwise.

 

© National Pharmaceutical Association

 

 

 

FOOT CARE

 

WARNING: Diabetics should not self treat any conditions of the feet, it is important to bring any problems you have with your feet to the attention of your doctor or chiropodist.

We often neglect our feet, after all they are the part of our body that we hide in shoes and socks and they are the furthest point from our faces however the problems that do arise are easily treated to bring rapid relief and a quick return of comfort.

The common conditions that affect our feet are:

  • Athlete’s Foot
  • Verrucae
  • Corns
  • Calluses
  • Bunions

 

Verrucae

Verrucas are hard, raised areas of skin usually on the base of the foot. They are caused by a virus which enters the skin when it is moist or damaged. Since they are caused by a virus they are usually located on areas of the sole of the foot that contact the floor, and they are often caught in changing rooms of leisure centers. There is often a number of visible black spots in the center of verrucae. This is blood that is collecting in the verrucae which is fighting the viral infection. They can be painful because of the pressure the growing areas of hard skin puts of the nerves under the skin. This can be aggravated by the fact that the body weight will often be placed on the area of the foot bearing the verrucae. Treatment is the same as for corns and is very simple.

 

Corns

Corns are almost identical to verrucas except that there is no viral involvement. Corns are caused by friction between the foot and

either other areas of the foot or footwear. Treatment is the same as for verrucas and is very simple.

 

Calluses

These are areas of hardened skin on areas of the feet that would rub on footwear. The cause is similar to corns however the outcome is a larger area of hard skin without the obvious center which corns possess.

Treatment is similar to that for bunions, however more can be done for calluses than bunions.

 

Bunions

A bunion is caused by continuous use of ill fitting footwear and slowly produces a displaced joint in the foot. This usually affects

the big toe due to pointed shoes. The constant pressure on the joint in the foot pushes it out of position and causes the body to produce a sack of fluid over the joint to protect it from further damage. However, this defense mechanism only makes matters worse as further pressure on this fluid causes pain when it becomes inflamed. Treatment is used to provide relief from the pain involved and is similar to some treatments for calluses. There is no treatment which cures bunions apart from surgery.

 

Verrucae and Corn Treatment

The aim of these treatments is to remove the area of hard skin from the foot by applying a corrosive material only to the affected area. This is often Salicylic Acid. There are several products on the market which contain this acid as the active ingredient, they should be applied only to the corn or verrucae, and if required the surrounding skin should be protected with vaseline for example. Some of these products will require the use of plasters to keep the Salicylic Acid in place while the newer products come in a self-sealing gel. The latter are easier to use but are of course more expensive.

 

It is also helpful to use abrasive items like foot files or pumice stones which help remove the hardened outer layers of skin. This allows the corrosive products to work more quickly as they can penetrate further.

 

Callus and Bunion Treatment

The primary goal of the treatment of these conditions is to remove the aggravating factors by changing footwear or adding padding to existing footwear to reduce or remove the pressure and friction that cause these conditions.

This is all that can be done for bunions apart from undergoing an operation to correct the joint problem.

Calluses can be further treated to remove the hard skin by application of Salicylic Acid. This acts by removing the outer layers of hardened skin from the foot. This can also be accomplished by use of foot files and other abrasive products.

 

GASTRO-INTESTINAL PROBLEMS

 

There are many minor problems that can affect the gastro-intestinal tract, and even though they are usually short lived, they are often very inconvenient and can be quite distressing.

  • Many of the problems that affect the gastro-intestinal tract can be remedied by improvements in lifestyle. The following simple measures can help prevent Gastro-Intestinal Problems occurring:try not to eat too quickly
  • eat a well balanced diet
  • have a good posture while eating
  • drink plenty of fluids throughout the day as well as at meal times

 

Indigestion

The stomach is the most common part of the gastro-intestinal tract that patients report problems with, and a wide range of problems are often referred to as indigestion. Indigestion is a term with a very personal meaning as symptoms differ between individuals. Symptoms of indigestion associated with excess stomach acid that can follow a spicy or greasy meal or large intakes of alcohol include bloating, flatulence, and heartburn.

Bloating is a feeling of fullness after a meal that actually feels uncomfortable and may be quite long lived.

Flatulence is the passing on wind after it collects in the stomach, it is caused by excess stomach acid reacting with the contents of the stomach to produce gasses, mainly carbon dioxide.

Heartburn is a burning or heavy sensation down the centre of the chest ONLY. It does not spread to other areas as do the pain symptoms associated with certain heart conditions. Heartburn is caused by the reflux of stomach acid up into the esophagus, which acts on the top layers of the mucosal membranes and produces a burning sensation.

 

Treatment

The choice of treatment for indigestion varies on the symptoms present. The main aim of all treatments though is to remove the excess acid, this can be done in several ways.

Antacids are usually tablets or sometimes liquids that contain ingredients that neutralize the acids in the stomach. Examples are Sodium Bicarbonate, Magnesium Carbonate and Aluminium Hydroxide. These work by reacting with the acid to form weaker acids that are not as damaging to the stomach. Antacids can be used for all types of indigestion but they should not be used regularly as your body can become used to them leading to almost permanent problems with indigestion. They should also be used in caution by people on a low salt diet e.g. people with heart conditions.

  • Alginates are again available in tablet and liquid form. These are derived from seaweed and work by forming a raft of tiny bubbles when they react with acid. This effect is called rafting as the alginate containing the tiny bubbles floats on top of the stomach contents and stops the reflux that causes heartburn. Again, those people on a low salt diet should use these products with caution.
  • H2-Antagonists are a fairly recent addition to the products available to combat indigestion. These have long term effects on stomach acid since they slow the production of stomach acid rather than neutralizing it once it has been made. Due to the stronger nature of these medicines though they are more restricted in their uses. They should not be used for more than a week without a medical consultation and they are not recommended for use by people who have used the prescription only version of these medicines within the past year especially if it was for the treatment of an ulcer of the stomach or duodenum.
  • The latest addition to the range of indigestion products on the market is a pro-kinetic called domperidone. This agent works by encouraging the muscles around the stomach and small intestine to contract and therefore moves the contents of the bowel down and away from the stomach. This product is therefore recommended for indigestion associated with bloating. As it is a new product you should speak to your Pharmacist before you use it to ensure it is suitable.

 

Constipation

Constipation is described as a decrease in the frequency and volume of bowel motions. In practice this is often accompanied by discomfort on passing a motion or sometimes permanent discomfort in the lower abdomen. There are many causes of constipation and most of these can be remedied by changes to lifestyle. Constipation can be caused by a poor diet, insufficient fluid intake

and too little exercise.

 

Treatment

The main aim of treatment is to improve bowel movement, this can be done with the use of Laxatives. There are actually four main types of laxative.

  • Stimulant Laxatives (e.g. Senna, Bisacodyl)

These medicines work by irritating the lining of the bowel to cause contractions of the bowel muscles. This will directly lead to the passing of a motion and therefore some relief from constipation. However, because of the way in which they work they may cause cramping and gripping pains in the stomach which can make symptoms seem worse. Also, your bowel can become reliant on this type of product and as such they should only be used occasionally. It has also come to light recently that some of the most popular laxatives may have been causing bowel problems following long term and regular usage, this has caused regulatory bodies to withdraw many laxatives from the market.

  • Osmotic Laxatives (e.g. Lactulose, Magnesium Hydroxide)

These medicines work by drawing water into the bowel, this action softens the contents of the bowel and reduces the likeliness of constipation. Lactulose is an altered sugar that is not absorbed into the body and water is attracted to the sugar molecules via an effect called osmosis. Magnesium Hydroxide works in the same way but is also used in indigestion. This type of laxative will not treat constipation as rapidly as a stimulant laxative but they are much safer for use in the long term perhaps following surgery or where other medication is vital but cause constipation as a side effect.

  • Bulking Agents (e.g. Isphagula Husk)

These medicines work by adding bulk to the contents of the bowel usually in the form of fiber. This causes an outward pressure

on the lining of the bowel which causes the muscles around the bowel to contract more strongly. These medicines are also slow

acting when compared to stimulant laxatives but are again safer for long term use.

  • Lubricating Agents (e.g. Glycerin Suppositories, Liquid Paraffin)

This type of laxative works by lining the bowel with a lubricant so that the passing of a motion is eased. Glycerin Suppositories are by far the fastest working laxatives but are not particularly popular due to the route of administration. Liquid Paraffin works in the same way as glycerin suppositories but is taken by mouth, this would seem ideal but it does have problems of its own. As with stimulant laxative the bowel can become over reliant on this medicine. There are problems associated with fat soluble vitamin absorption and pneumonia following aspiration of the Liquid Paraffin into the lungs.

 

Diarrhoea

Diarrhoea is the opposite of Constipation. There is an increase in the frequency and volume of bowel motions. This can be accompanied by many other symptoms such as nausea, vomiting and gripping pain. There are several possible causes of diarrhea ranging from viral infections to international travel. Where an upset stomach accompanies the diarrhea it is possible that food poisoning is the cause of the symptoms, however this is extremely difficult to prove. This is because bacteria may be the cause and tracing the bacteria to the source is almost impossible.

 

Treatment

The aim of treatment here is to ensure that dehydration does not occur and to try and slow the rate of movement of food through the bowel so that more fluid can be absorbed.

  • Oral Rehydration Sachets

This should be the mainstay of treatment of diarrhea. Most cases of diarrhea are short lived and intervention other than regular fluids to prevent dehydration is a waste of time. Oral Rehydration Sachets replenish the body’s salts that are lost along with water during diarrhoea. This protects against dehydration due to salt loss as well as fluid loss.

  • Kaolin and Morphine

This is a popular remedy because of its reputation, however it has now been vastly improved upon by medicines like Loperamide. It is available in liquid and tablet form. The kaolin absorbs anything in the bowel that may be the cause of the diarrhea while the morphine relaxes the bowel muscles and slows down bowel movements.

If you use this product remember to keep drinking plenty of fluids. Also, if you use the mixture shake the bottle well.

  • Loperamide

Loperamide is similar in its action to Morphine but is much more effective, two capsules taken as one dose are usually sufficient to treat an episode of diarrhoea.

If you use this product remember to drink plenty of fluids.

 

 

 

HAYFEVER

 

  • Hayfever is a very common ailment affecting many people, fortunately it is usually only problematic during the spring and summer months. Hayfever is caused when the body’s defenses over react to pollen released into the air by plants. The pollen causes release of a substance called Histamine from cells in the skin. It is this Histamine that is the cause of many of the symptoms; a blocked nose, itchy runny eyes and sneezing. There are a great many products on the market for this annoying condition, ranging from tablets and nasal sprays to eye drops and within each of these groups there are many possibilities. We will consider each of these in turn:Tablets
  • Sprays
  • Eye Drops

 

Tablets

All of the tablets available for hayfever contain Antihistamines. They work by blocking the effects of histamine inside the body.

These antihistamines can be divided again into two broad groups, the 1st Generation and the 2nd Generation. The 1st Generation

are the older type of antihistamines which are very effective but have the disadvantage of causing drowsiness in most people who

use them, the 2nd Generation antihistamines are newer and tend to avoid causing this drowsiness, although it is not guaranteed in

all users.

These are many antihistamines, some examples are Chlorpheniramnie, Terfenadine, Loratidine and Cetirizine.

 

Sprays

These sprays are for use in the nose and they can be divided into three further groups.

Steroids - these sprays act to reduce the inflammation in the nasal lining and therefore reduce the discomfort arising from the

nasal cavity.

It is important to note that the use of nasal sprays avoids many of the associated side effects of steroids.

Some examples of sprays in this category are Beclomethasone and Flunisolide.

Decongestants - these act by reducing the blood flow in the nose, this will reduce the amount of mucus produced in the nose and

also reduce the inflammation.

Some examples of sprays in this category are Phenylephrine and Xylometazoline.

Cromoglycate - this substance has an action that is not completely understood, however it is believed that it reduces the amount

of histamine released upon contact with pollen.

 

Eye Drops

These are products aimed at the treatment of the itchiness caused in the eyes by the pollen. They contain similar ingredients to

the nasal sprays, but they are specially formulated for use in the eyes.

Take care using these drops if you are a contact lens wearer.

 

MIGRAINE

 

Migraine is used to describe a particular type of headache. It is a medical condition that can only be confirmed by a doctor. An attack of migraine is often accompanied, although not always, by the following:

  • blurred vision
  • flashing and/or colored lights before the eyes
  • nausea and vomiting
  • tingling or numbness of the extremities i.e. the hands or feet

The usual course of treatment is the same as for a headache, that is analgesics (pain killers). However, there are also specialist products available that assist with the added symptoms of a migraine. These products usually contain an anti-emetic. These

agents act to suppress the symptoms of nausea and vomiting.

 

Analgesics

There is a huge range of analgesics available on the market today, some contain one pain killer some contain combination of two

 

or more.

There is no preferred analgesic, individuals respond differently to different analgesics. The best way to find out which pain killer is

best for you is to try several over a period of time and base your decision on personal experience.

Always follow the instructions given with any analgesic. Always read any labeling to ensure the medication is suitable for your

use. Never give prescription analgesics to, or accept them from, another person.

The main analgesics in use are:

  • Paracetamol

This is an extremely safe analgesic if used correctly. This agent also acts to lower temperatures in fever - Antipyretic.

  • Aspirin

This agent is similar to paracetamol but also has an anti-inflammatory property. It is quite useful but can cause irritation to the

stomach. Since its market introduction under the trademark Aspirin® in the year 1899, acetylsalicylic acid has attained a leading

position world-wide in the prescription-free therapy of painful, inflammatory and feverish states. The substance’s tolerability and

special pharmacological traits allow for an easy controlling of therapy.

Do not use Aspirin if you have an allergy to it.

  • Codeine

This agent is used in preparations with other analgesics, i.e. aspirin and paracetamol. It is and opiate an when combined with

other analgesics has and additive effect. The two agents together work better then each ingredient alone.

  • Ibuprofen

This agent is based on aspirin but is more gentle on the stomach. Again it is also available in combination with Codeine.

 

Anti-Emetics

These agents act centrally to combat the feelings of nausea that migraine sufferers may experience.

The following agents are contained in preparations combined with analgesics:

  • Cyclizine

This agent is an antihistamine that has a central action that reduces feelings of nausea.

  • Buclizine

This agent belongs to the same family of drugs as cyclizine and works in the same way.

  • Isomethaptene

This drug belongs to another class of drugs called the sympathomimetics, these agents act by mimicking the bodies own natural

chemicals that usually act to stop nausea.

 

General Advice

If you suffer from migraine here are a few tips to help you through an attack:

  • Use soluble analgesics

These get into the body more quickly than normal tablets and especially so with migraine as during an attack the stomach empties more slowly.

  • Lie in a darkened room

This will help reduce the nauseating effect of the visual disturbances, also the relaxation may help.

 

MOUTH ULCERS

 

Despite the common occurrence of mouth ulcers and vast amounts of research, the cause of these irritating sores is still not completely understood. However, by far and away the most common cause is the infection of an injury in the mouth. These injuries can be cuts, abrasions or burns.

A mouth ulcer affects the softer areas of the mouth, for example the tongue and cheeks. The surface layer of the skin is removed leading to the formation of the ulcer which usually appears circular with a yellow or white center and a raised red rim. It is because of the removal of the skin layer that nerve cells are exposed causing the associated pain.

You should not attempt to treat a mouth ulcer yourself if:

  • you are pregnant
  • you are diabetic
  • the ulcer has an uneven coloration
  • the ulcer is causing you no discomfort or pain
  • it is your first mouth ulcer
  • it has been present for more than 14 days
  • it is larger than 1cm in diameter
  • you take any other medication

 

Treatment

There are many types of treatment available. These can be placed into three main categories:

  • Pain Relief
  • Antibacterials
  • Anti-inflammatories

 

Pain Relief

These products contain ingredients which act to prevent the sensation of pain. They usually contain an anesthetic which is

applied directly to the ulcer. After some initial stinging while the an aesthetic starts to work the area will become numb.

Care should be taken with hot food and drinks as further damage can be caused to the ulcer while it is numb.

Some examples of the anesthetics used are benzocaine and lidocaine.

Also available is an ingredient called choline salicylate which is related to aspirin. This pain killer works at the site of the ulcer in

the same way as the analgesics or pain killers. This means that they are generally longer acting than the anesthetics.

Choline salicylate should not be used by people allergic to aspirin.

 

Antibacterials

These treatments are used to kill any bacteria that may be infecting the ulcer or more generally the entire mouth. They are usually mouth washes if the antibacterial is the only active ingredient although they are often incorporated into the other treatments, for example, pain relief treatments.

 

Anti-inflammatories

These are the newest treatments available for mouth ulcers, they are based on corticosteroids which act to reduce the inflammation at the site of the ulcer and as such aid healing.

It is important to note that the use of these locally acting products avoids many of the associated side effects of oral corticosteroids.

 

General Advice

There are some simple things you can do to reduce the discomfort felt while you have a mouth ulcer.

Firstly, do not expose the ulcer to foods which cause pain and aggravate the symptoms. These types of food are acidic, spicy, salty, coarse or hot and cold. However it may be of some benefit to gargle with salt water as this is mildly antibacterial.

You can also use mouth washes regularly to prevent mouth ulcers if you find that you are getting mouth ulcers regularly.

You should consult your doctor if the problem persists.

 

VAGINAL THRUSH - CANDIDIASIS

 

Vaginal Thrush is one of the most common infections affecting the genitals. A yeast called Candida albicans is responsible for the infection and discomfort caused in most cases.

Thrush displays the classical symptoms of a vaginal itch and a discharge. The itch may also sometimes be described as a burning sensation. The discharge varies between individuals and may be of a watery consistency or thicker perhaps similar to yoghurt. So what treatment is available for this condition?

WARNING: It is very important that if any of the following apply, the assistance of a doctor is sought.

  • If you are a first time sufferer.
  • If you are pregnant or likely to be pregnant.
  • If there is any abnormal or irregular vaginal bleeding.
  • If you are under 16 or over 60 years of age.
  • If there is any associated pain with the above symptoms.
  • If you have had more than 2 previous attacks in the past 6 months.
  • If you have a history or have recently been exposed to any other sexually transmitted diseases.
  • If there is any pain on urination (going to the toilet).
  • If there are any sores blisters or ulcers in the vaginal area.

 

Treatment

There are currently two possibilities for the treatment of Thrush available at your local chemist for you to purchase. One is called Clotrimazole (Canesten) and the other called Fluconazole.

When using either of these preparations make sure you follow any printed directions and consult a medical professional if there is no improvement within 7 days. You should expect to notice some improvement in the condition within 3 days following a single dose treatment although this is not always the case.

Clotrimazole

Clotrimazole (CANESTEN)is available in two forms, a pessary (vaginal tablet) and a cream. The choice of dosage form is important

and should be carefully considered. If the infection is deep inside the vagina then the pessary is the better choice, however if it is

mainly towards the outside of the body then the cream may be the better choice.

The use of either of the items should be discussed fully with a pharmacist before purchasing.

 

Fluconazole

Fluconazole is a preparation which is swallowed orally rather than being applied to the site of the infection. This product acts in a central manner rather than at the site of action. Fluconazole may interfere with other medicines you may be taking and its use should be discussed with a pharmacist.

Overview

 

 

ATHLETE’S FOOT

 

Athlete’s foot is a common fungal infection that affects many people at some time in their lives. The condition easily spreads in public places such as communal showers, locker rooms and fitness centers.

Usually this condition affects the spaces between your toes, but it can spread to your toenails and the soles and sides of your feet. The infection can also involve your palms and fingers. Although it occurs primarily in adults, athlete’s foot can affect children.

Changing socks, keeping your feet dry and alternating shoes can help you prevent athlete’s foot. Often, athlete’s foot responds well to over-the-counter treatments you can apply to your skin. More severe cases may require oral medications.

 

Signs and symptoms

The signs and symptoms of athlete’s foot can be numerous, although you probably won’t have all of them:

*Itching, stinging and burning between your toes, especially the last two toes

*Itching, stinging and burning on the soles of your feet

*Itchy blisters

*Cracking and peeling skin, especially between your toes and on the soles of your feet

 

*Excessive dryness of the skin on the bottoms or sides of the feet

*Nails that are thick, crumbly, ragged, discolored or pulling away from the nail bed

 

Causes

A group of fungi called dermatophytes causes athlete’s foot. These organisms sprout tendril-like extensions that infect the superficial layer of the skin. In response to this fungal growth, the basal layer of the skin produces more skin cells than usual. As these

cells push to the surface, the skin becomes thick and scaly. Most often, the more the fungi spread, the more scales your skin produces, causing the ring of advancing infection to form.

Also called tinea pedis, ringworm of the foot and dermatophytosis, athlete’s foot is closely related to other fungal skin conditions, most with similar names. Tinea is a type of fungus, and pedis is the Latin word for “foot.” Other common tinea infections include:

*Ringworm of the body (tinea corporis). This form causes a red, scaly ring or circle of rash on the top layer of your skin.

*Jock itch (tinea cruris). This form affects your genitals, inner thighs and buttocks.

*Ringworm of the scalp (tinea capitis). This form is most common in children and involves red, itchy patches on the scalp, leaving bald patches.

 

Risk factors

The organisms that cause athlete’s foot thrive in damp, close environments created by thick, tight shoes that can pinch the toes together and create warm, moist areas in between them. Damp socks and shoes increase the risk. Warm, humid conditions that promote heavy sweating favor its spread. The fungus is carried on fragments of skin or other particles that contaminate floors, mats, rugs, bed linens, clothes, shoes and other surfaces. Plastic shoes in particular provide a welcoming environment for fungal growth and infection. Person-to-person contact is another means of transmission. Even household pets can pass along fungal infections. Although transmission can occur within a household, the infection is more commonly passed along in public areas such as locker rooms, saunas, swimming pools, communal baths and showers. Not everyone who carries the fungus develops signs and symptoms of athlete’s foot. Vulnerability probably involves a genetic component, but those who are known to be more vulnerable include people with weakened immune systems, for example, people with diabetes or HIV/AIDS. Men are more likely than women to develop athlete’s foot.

 

When to seek medical advice

If you have a rash on your foot that doesn’t improve or worsens after you’ve taken self-care steps, see your doctor. See someone sooner if you notice excessive redness, swelling, drainage or fever.

Screening and diagnosis

Your doctor will want to determine if your symptoms are caused by athlete’s foot or by another skin disorder, such as dermatitis or psoriasis. You’ll probably be asked about exposure to contaminated areas or contacts with people who have athlete’s foot. Your doctor may take skin scrapings or fluid samples from your foot to view them under a microscope to identify a fungus within minutes. If the sample shows fungus, an antifungal medication is the usual treatment. If the test is negative but your doctor still suspects that you have athlete’s foot, a sample may be sent to a laboratory to determine whether it will grow fungus under the right conditions. This test is known as a culture, and it may take weeks to get results. Your doctor may also order a culture if your condition doesn’t respond to treatment.

 

Complications

The fungal infection can create an environment that invites a secondary bacterial infection. By producing an antibiotic substance, the fungus can kill off vulnerable bacteria and favor the overgrowth of hardier, resistant types. In turn, the bacteria release substances that can cause tissue breakdown - soggy skin and painful eroded areas between the toes.

After an episode of athlete’s foot, proteins might enter your bloodstream, leading to an allergic reaction that may cause an eruption of blisters on your fingers, toes or hands (dermatophytid reaction).

 

Treatment

For mild conditions, your doctor may advise you to apply a prescription or over-the-counter antifungal ointment, lotion, powder or spray. Most infections respond well to these topical agents, as for example clotrimazole (Canesten). Clotrimazole inhibits the synthesis of ergosterol, an essential component of fungal cell membranes. By inhibiting the enzyme 24-methylenhydroanosterol, the cell is unable to build up desmethylsterol out of lanosterol, and therefore also unable to build up ergosterol. When this important building block is missing, the cell membrane is damaged, cell contents leak and thus lead to the destruction of the fungus. As they are all dependent on ergosterol, clotrimazole thus has a perfect point of attack with all fungi that are able to cause skin infections in humans.

Clotrimazole’s mode of action depends on the level of concentration. At low concentration it is fungistatic. Fungal growth is inhibited and fungi are thus unable to spread further. At higher concentrations ranging from 10-20 mg/l, as are applied for local treatment of the epidermis, it even has a fungicidal effect leading to a direct destruction of fungi. Furthermore, clotrimazole is said to reduce the risk of infestation of the host tissue with yeast cells, which would, at a later point in time, multiply there. Clotrimazole may also stimulate the immune system, which would be supportive of treatment. If your fungal infection is severe or doesn’t respond to topical medicine, your doctor may give you a prescription oral medication. Your doctor may prescribe an oral antibiotic if you have an accompanying bacterial infection. In addition, your doctor may recommend wet dressings, steroid ointments, compresses or vinegar soaks to help clear up blisters or soggy skin.

 

Prevention

These tips can help you avoid athlete’s foot or ease the symptoms if infection occurs:

*Keep your feet dry, especially between your toes. Go barefoot to let your feet air out as much as possible when you’re home.

*Go with natural materials. Wear socks that are made of natural material, such as cotton or wool, or a synthetic fiber designed to draw moisture away from your feet.

*Change socks and stockings regularly. If your feet sweat a lot, change your socks twice a day.

*Wear light, well-ventilated shoes. Avoid shoes made of synthetic material, such as vinyl or rubber.

*Alternate pairs of shoes. This allows time for your shoes to dry.

 

*Protect your feet in public places. Wear waterproof sandals or shower shoes in communal showers, pools, fitness centers and other public areas.

*Treat your feet. Use an antifungal powder daily.

*Don’t borrow shoes. Borrowing risks spreading a fungal infection.

References

Athlete’s foot by Mayo Clinic staff accessed at: www.mayoclinic.com

Fungali infections accessed at:http://www.fungal-infections.info/

 

Overview

DIAPER RASH

 

You start to change your baby’s diaper, and there it is a patchwork of bright red skin on your baby’s bottom. Don’t panic. What you’re seeing is most likely diaper rash, a common form of inflamed skin (dermatitis). Most infants develop a diaper rash at some time or another; some even arrive home from the hospital with a slight rash. Diaper rash may be more common after solid foods are added to your baby’s diet or when your baby is taking antibiotics. Other factors that can lead to diaper rash include continuously wet or infrequently changed diapers, diarrhea and the use of plastic pants to cover a diaper. Diaper rashes can occur intermittently, anytime while your child is in diapers, but they’re more common in babies during the first 12 months. Diaper rash can alarm parents and annoy babies, but fortunately most cases disappear after a few days with simple home treatments.

 

Signs and symptoms

Diaper rash is characterized by reddish, puffy and perhaps slightly warmer skin in the diaper region buttocks, thighs and genitals. You may notice your baby seems more uncomfortable than usual, especially during diaper changes. A baby with a diaper rash often fusses or cries when the diaper area is washed or touched.

 

Causes

Diaper rash can be traced to a number of causes, including:

  • Irritation from stool and urine. Prolonged exposure to urine or feces can irritate a baby’s sensitive skin. Your baby may be more prone to diaper rash if he or she is experiencing frequent bowel movements, because feces are more irritating than urine.

Introduction of new foods. As babies start to eat solid foods, generally when they’re between 4 and 12 months old, the content of their stool changes, increasing the likelihood of diaper rash. Changes in your baby’s diet can also increase the frequency of stools, which can lead to diaper rashes. If you’re breast-feeding, your baby may develop diaper rash in response to something you’ve eaten, such as tomato-based foods.

*Irritation from a new product. Disposable wipes, a new brand of disposable diaper, or a detergent, bleach or fabric softener used to launder cloth diapers can all irritate your baby’s delicate bottom. Other substances that can add to the problem include ingredients found in some baby lotions, powders and oils.

Bacterial or yeast (fungi) infection. What begins as a simple skin infection may spread to the surrounding region. The area covered by a diaper buttocks, thighs and genitals is especially vulnerable to this tendency because it’s warm and moist, making a perfect breeding ground for bacteria and yeast. These rashes generally start within the creases of the skin and there may be red dots scattered around the creases.

* Sensitive skin. Babies with skin conditions such as atopic dermatitis or eczema may be more likely to develop diaper rashes. However, the irritated skin of atopic dermatitis and eczema commonly affects more than just the diaper area.

  • Chafing or rubbing. Tightfitting diapers or clothing that rubs against the skin can lead to a rash.

Use of antibiotics. Antibiotics kill bacteria both bad and good. Without the right balance of good bacteria, however, yeast infections can occur. This can happen when babies take antibiotics or when mothers who are breast-feeding their infants are taking

antibiotics.

 

When to seek medical advice

Diaper rash is usually easily treated and improves within several days after starting home treatment. If your baby’s skin doesn’t improve after a few days of home treatment with over-the-counter ointment and more frequent diaper changes, talk to your doctor. Sometimes, diaper rash leads to secondary infections that may require prescription medications. Have your child examined if the rash is severe, worsens despite home treatment or occurs along with any of the following:

  • Fever
  • Blisters or boils
  • A rash that extends beyond the diaper area
  • Pus or weeping discharge
  • Rashes that don’t respond to home treatment

 

Treatment

The best treatment for diaper rash is to keep your baby’s skin as clean and dry as possible. If your baby’s diaper rash persists during home treatment, your doctor may prescribe an antifungal cream as Canesten and possibly a mild hydrocortisone cream. Diaper rashes usually require several days to improve and can continue for weeks. If the rash persists despite prescription treatment, your doctor may recommend that your baby see a dermatologist. Use creams with steroids only if your baby’s pediatrician or dermatologist recommends them strong steroids or frequent use can lead to additional problems.

 

Prevention

A few simple strategies can help decrease the likelihood of diaper rash developing on your baby’s skin:

  • Change diapers often. Remove dirty diapers promptly. If your child is in child care, ask staff members to do the same.

 

  • Rinse your baby’s bottom with water as part of each diaper change. You can use a sink, tub or water bottle for this purpose. Moist washcloths and cotton balls also can aid in cleaning the skin. Don’t use wipes that contain alcohol or fragrance.
  • Pat your baby dry with a clean towel. Don’t scrub your baby’s bottom. Scrubbing can further irritate the skin.

* Don’t over-tighten diapers or use diapers with elastic edges. Both prevent airflow into the diaper region, setting up a moist environment favorable to diaper rashes. Tightfitting diapers can also cause chafing at the waist or thighs.

Give your baby’s bottom a little breathing room. When possible, let your baby go without a diaper. Exposing skin to air is a natural and gentle way to let it dry. To avoid messy accidents, try laying your baby on a large towel and engage in some

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