Impetigo
of infections and poisoning

Impetigo is a common and highly contagious skin infection that causes sores and blisters. It’s not usually serious and often improves within a week of treatment or within a few weeks without treatment.

Impetigo is the most common skin infection in young children in the UK, but it can affect people of all ages.

Symptoms

There are 2 types of impetigo:

non-bullous impetigo – the most common type bullous impetigo

Non-bullous impetigo

The symptoms of non-bullous impetigo begin with the appearance of red sores – usually around the nose and mouth but other areas of the face and the limbs can also be affected.

The sores quickly burst leaving behind thick, golden crusts typically around 2cm across. The appearance of these crusts is sometimes likened to cornflakes stuck to the skin.

After the crusts dry, they leave a red mark that usually fades without scarring. The time it takes for the redness to disappear can vary between a few days and a few weeks.

The sores aren’t painful, but they may be itchy. It’s important not to touch or scratch the sores because this can spread the infection to other parts of the body, and to other people.

Other symptoms, such as a high temperature (fever) and swollen glands, are rare but can occur in more severe cases.

Bullous impetigo

The symptoms of bullous impetigo begin with the appearance of fluid-filled blisters (bullae) which usually occur on the central part of the body between the waist and neck, or on the arms and legs. The blisters are usually about 1cm to 2cm across.

The blisters may quickly spread, before bursting after several days to leave a yellow crust that usually heals without leaving any scarring.

The blisters may be painful and the area of skin surrounding them may be itchy. As with non-bullous impetigo, it’s important not to touch or scratch the affected areas of the skin.

Symptoms of fever and swollen glands are more common in cases of bullous impetigo.


Impetigo does not cause any symptoms until 4 to 10 days after you first become infected. This means that people can easily pass the infection on to others without realising it.

There are 2 main types of impetigo, known as non-bullous and bullous impetigo, which have different symptoms. Most people with impetigo have the non-bullous type.

Causes

Impetigo occurs when the skin becomes infected with bacteria, usually either Staphylococcus aureus or Streptococcus pyogenes.

The bacteria can infect the skin in 2 main ways:

through a break in otherwise healthy skin – such as a cut, insect bite or other injury – this is known as primary impetigo through skin damaged by another underlying skin condition, such as head lice, scabies or eczema – this is known as secondary impetigo

The bacteria can be spread easily through close contact with someone who has the infection, such as through direct physical contact, or by sharing towels or flannels.

As the condition doesn’t cause any symptoms until 4 to 10 days after initial exposure to the bacteria, it’s often easily spread to others unintentionally.

Children and people with diabetes or a weakened immune system – either due to a condition such as HIV or a treatment such as chemotherapy – are most at risk of developing impetigo.


Impetigo occurs when the skin becomes infected with bacteria, usually either Staphylococcus aureus or Streptococcus pyogenes.

These bacteria can infect the skin in 2 ways:

through a break in otherwise healthy skin, such as a cut, insect bite or other injury – this is known as primary impetigo through skin damaged by another underlying skin condition, such as head lice, scabies or eczema – this is known as secondary impetigo

The bacteria can be spread easily through close contact with someone who has the infection, such as through direct physical contact, or by sharing towels or flannels.

As the condition does not cause any symptoms until 4 to 10 days after initial exposure to the bacteria, it is often easily spread to others unintentionally.

Impetigo stops being infectious after 48 hours of treatment starting or after the sores have stopped blistering or crusting.

Diagnoses

Further tests are usually only required in cases where the infection is severe or widespread, doesn’t respond to treatment, or keeps recurring.

In these circumstances, your GP may refer you to a dermatologist (skin specialist) for further tests or they may take a swab of the affected skin themselves for testing.

This can help to rule out or confirm other skin conditions that may be responsible for your symptoms and can detect whether you carry one of the types of bacteria responsible for the infection inside your nose.

If your doctor thinks you may keep getting impetigo because you naturally have these bacteria inside your nose, they may prescribe you an antiseptic nasal cream to try to clear the bacteria.

Treatments

Pharmacy First Scotland: Impetigo treatment from your local pharmacyAdults and children over 2 years with impetigo can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotland’s Service directory.Search for a pharmacy near you

Impetigo isn’t usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required.


Impetigo usually gets better without treatment in around 2 to 3 weeks.

However, treatment is often recommended because it can reduce the length of the illness to around seven to 10 days and can lower the risk of the infection being spread to others.

The main treatments prescribed are antibiotic creams or antibiotic tablets. These usually have to be used for around a week.

Read about treating impetigo.


Impetigo isn’t usually serious and often clears up without treatment after 2 to 3 weeks.

Treatment is often recommended as it can help clear up the infection in around 7 to 10 days and reduce the risk of the infection being passed on to others.

If impetigo is confirmed, it can usually be effectively treated with antibiotics.

If the infection is being caused by an underlying skin condition, such as eczema, this may also need to be treated.


Further tests are usually only required in cases where the infection is severe or widespread, doesn’t respond to treatment, or keeps recurring.

In these circumstances, your GP may refer you to a dermatologist (skin specialist) for further tests or they may take a swab of the affected skin themselves for testing.

This can help to rule out or confirm other skin conditions that may be responsible for your symptoms and can detect whether you carry one of the types of bacteria responsible for the infection inside your nose.

If your doctor thinks you may keep getting impetigo because you naturally have these bacteria inside your nose, they may prescribe you an antiseptic nasal cream to try to clear the bacteria.

Preventions

During treatment, it’s important to take precautions to minimise the risk of impetigo spreading to other people or to other areas of the body.

Most people are no longer contagious after 48 hours of treatment or once their sores have dried and healed. It’s important to stay away from work, school, nursery or playgroup until this point.

The advice below can also help to prevent the spread of the infection:

do not share flannels, sheets or towels with anyone who has impetigo – wash them at a high temperature after use wash the sores with soap and water and cover them loosely with a gauze bandage or clothing avoid touching or scratching the sores, or letting others touch them – it may help to ensure your nails are kept clean and short avoid contact with newborn babies, preparing food, playing contact sports, or going to the gym – until the risk of infection has passed wash your hands frequently – particularly after touching infected skin washable toys should also be washed – wipe non-washable soft toys thoroughly with a cloth that has been wrung out in detergent and warm water and allowed to dry completely

If you think that the infection has spread to someone else, make sure they’re seen by a pharmacist as soon as possible.


To reduce the risk of impetigo returning, make sure any cuts, scratches or bites are kept clean. Ensure any condition that causes broken skin, such as eczema, is treated promptly.

If you develop impetigo frequently, your doctor may suggest taking a swab from around your nose to see if you carry staphylococcal bacteria. These bacteria can live in the noses of some people without causing problems, although they can lead to impetigo if they infect broken skin nearby.

If you’re found to carry these bacteria, you may be prescribed an antiseptic nasal cream to apply several times a day for 5 to 10 days in an attempt to clear the bacteria and reduce the chances of impetigo recurring.


As impetigo is a highly contagious condition, it is important to take precautions to reduce the risk of the infection spreading.


To reduce the risk of impetigo returning, make sure any cuts, scratches or bites are kept clean, and ensure any condition that causes broken skin, such as eczema, is treated promptly.

If you develop impetigo frequently, your doctor may suggest taking a swab from around your nose to see if you carry staphylococcal bacteria inside your nose. These bacteria can live in the noses of some people without causing problems, although they can lead to impetigo if they infected broken skin nearby.

If you are found to carry these bacteria, you may be prescribed an antiseptic nasal cream to apply several times a day for 5 to 10 days in an attempt to clear the bacteria and reduce the chances of impetigo recurring.

Complications

Complications of impetigo are rare, but they can sometimes occur and can be serious. Tell your pharmacist if you have impetigo and your symptoms change or get worse.

Some complications associated with impetigo include:

cellulitis – an infection of the deeper layers of the skin and underlying tissue scarlet fever – a rare bacterial infection that causes a fine, pink rash across the body guttate psoriasis – a non-infectious skin condition that can develop in children and teenagers after a bacterial infection septicaemia (a type of sepsis) – a bacterial infection of the blood Staphylococcal scalded skin syndrome (SSSS) – a serious skin condition that looks like the skin has been scalded with boiling water post-streptococcal glomerulonephritis – an infection of the small blood vessels in the kidneys

In very rare cases, impetigo may lead to some scarring, particularly if you scratch at the blisters, crusts or sores


Complications of impetigo are rare, but they can sometimes occur and can be serious. Tell your pharmacist if you have impetigo and your symptoms change or get worse.

Indigestion
of stomach liver and gastrointestinal tract

Indigestion can be pain or discomfort in your upper abdomen (dyspepsia) or burning pain behind the breastbone (heartburn).

Dyspepsia and heartburn may occur together or on their own. Symptoms usually appear soon after eating or drinking.

Common associated symptoms include:

feeling full or bloated feeling sick (nausea) belching bringing up (regurgitating) fluid or food into the gullet (oesophagus)

Indigestion is a common problem that affects many people, but in most cases it’s mild and only occurs occasionally.

Read more about the symptoms of indigestion.

Symptoms

The main symptom of indigestion is pain or a feeling of discomfort in your upper abdomen (dyspepsia). People often experience the associated feeling of burning behind the breastbone (heartburn), but this may occur on its own.

These symptoms usually come on soon after eating or drinking, although there can sometimes be a delay between eating a meal and experiencing indigestion.

Heartburn is caused by acid that passes from your stomach into your gullet (oesophagus).

If you have indigestion, you may also have symptoms such as:

feeling uncomfortably full or heavy belching or flatulence(passing wind) bringing food or fluid back up from your stomach (reflux) bloating feeling sick (nausea) vomiting

Causes

Indigestion may be caused by stomach acid coming into contact with the sensitive, protective lining of the digestive system (mucosa). The stomach acid breaks down the lining, leading to irritation and inflammation, which can be painful.

The majority of people with indigestion don’t have inflammation in their digestive system. Therefore, their symptoms are thought to be caused by increased sensitivity of the mucosa (to acidity or stretching).

In most cases indigestion is related to eating, although it can be triggered by other factors such as smoking, drinking, alcohol, pregnancy, stress or taking certain medications.

Read more about the causes of indigestion.


Indigestion has a number of different causes, but it’s rarely due to a serious, underlying condition.

It’s normal for your stomach to produce acid, but sometimes this acid can irritate the lining of your stomach, the top part of your bowel (duodenum) or your gullet (oesophagus).

This irritation can be painful and often causes a burning sensation. Indigestion may also be due to the lining of your digestive system being overly sensitive to acid, or the ‘stretching’ caused by eating.

Indigestion can also be triggered or made worse by other factors.

Diagnoses

For most people, indigestion (dyspepsia) is mild and infrequent, and does not require treatment from a healthcare professional.

However, if you have indigestion regularly, or if it causes you severe pain or discomfort, see your pharmacist. 

They will ask about your indigestion symptoms, as well as:

any other symptoms you have – which may indicate an underlying health condition any medication you are taking – as some medications can cause indigestion your lifestyle – as some lifestyle factors, such as smoking, drinking alcohol or being overweight, can cause indigestion 

Depending on the type of indigestion symptoms you have, your pharmacist may recommend you see your GP to investigate your condition further. This is because indigestion can sometimes be a symptom of an underlying condition or health problem, such as a Helicobacter pylori (H pylori) bacterial infection.

Treatments

Most people are able to treat indigestion with simple changes to their diet and lifestyle, or with a number of different medications, such as antacids.

Read more about the treatment of indigestion.

Very rarely, a serious underlying health condition is the cause of indigestion. If this is suspected, then further investigation such as an endoscopy will be required.


Pharmacy First Scotland: Indigestion treatment from your pharmacyIf you have symptoms of indigestion you can get treatment directly from a pharmacy. Find your local pharmacy on Scotland’s Service Directory.Search for a pharmacy near you

Most people will not need to seek medical advice for their indigestion. However, your pharmacist may advise you see your GP if you have recurring indigestion and any of the following apply:

you are 55 years old or over you have lost a lot of weight without meaning to you have increasing difficulty swallowing (dysphagia) you have persistent vomiting you have iron deficiency anaemia you have a lump in your stomach you have blood in your vomit or blood in your stools

This is because these symptoms may be a sign of an underlying health condition, such as a stomach ulcer or stomach cancer. You may need to be referred for an endoscopy to rule out any serious cause.

An endoscopy is a procedure where the inside of the body is examined using an endoscope (a thin, flexible tube that has a light and camera on one end).

Severe indigestion can cause long-term problems with parts of your digestive tract, such as scarring of the oesophagus or the passage from your stomach. Read more about the possible complications of severe indigestion.


Treatment for indigestion (dyspepsia) will vary, depending on what is causing it and how severe your symptoms are.

If you have been diagnosed with an underlying health condition, you may want to read our information on:

treating gastro-oesophageal reflux disease (GORD) treating a stomach ulcer


If you have indigestion that is persistent or recurring, treatment with antacids and alginates may not be effective enough to control your symptoms. Your pharmacist may recommend a different type of medication, which will be prescribed at the lowest possible dose to control your symptoms. Possible medications include:

proton pump inhibitors (PPIs) H2-receptor antagonists

Your pharmacist may advise you to see your GP who may also test you for the Helicobacter pylori (H pylori) bacteria (see Indigestion – diagnosis) and prescribe treatment for this if necessary.

Proton pump inhibitors (PPIs)

PPIs restrict the acid produced in your stomach.

The medication is taken as tablets and if you are over 18, you can buy some types of PPIs over the counter in pharmacies, but these should only be used for short-term treatment. PPIs may enhance the effect of certain medicines. If you are prescribed a PPI, your progress will be monitored if you are also taking other medicines, such as:

warfarin – a medicine that stops the blood clotting phenytoin – a medicine to treat epilepsy

If your ingestion is persistent, your pharmacist might advise you to see your GP.

If your GP refers you for an endoscopy (a procedure that allows a surgeon to see inside your abdomen), you will need to stop taking a PPI at least 14 days before the procedure. This is because PPIs can hide some of the problems that would otherwise be spotted during the endoscopy.

PPIs can sometimes cause side effects. However, they are usually mild and reversible. These side effects may include:

headaches diarrhoea constipation feeling sick (nausea) vomiting flatulence stomach pain dizziness skin rashes

H2-receptor antagonists

H2-receptor antagonists are another type of medication that your pharmacist or GP may suggest if antacids, alginates and PPIs have not been effective in controlling your indigestion. There are four H2-receptor antagonists:

cimetidine  famotidine  nizatidine  ranitidine 

These medicines work by lowering the acidity level in your stomach.

Your GP may prescribe any one of these four H2-receptor antagonists, although ranitidine is available from pharmacies under the Pharmacy First Scotland service. H2-receptor antagonists are usually taken in tablet form.

As with PPIs, you will need to stop taking H2-receptor antagonists at least 14 days before having an endoscopy if this has been arranged through your GP. This is because they can hide some of the problems that could otherwise be spotted during the endoscopy.

Helicobacter pylori (H pylori) infection

If your indigestion symptoms are caused by an infection with H pylori bacteria, you will need to have treatment to clear the infection from your stomach. This should help relieve your indigestion, because the H pylori bacteria will no longer be increasing the amount of acid in your stomach.

H pylori infection is usually treated using triple therapy (treatment with three different medications). Your GP will prescribe a course of treatment containing:

two different antibiotics (medicines to treat infections that are caused by bacteria) a PPI

You will need to take these medicines twice a day for seven days. You must follow the dosage instructions closely to ensure that the triple therapy is effective.

In up to 85% of cases, one course of triple therapy is effective in clearing an H pylori infection. However, you may need to have more than one course of treatment if it does not clear the infection the first time.

Complications

In most cases, indigestion (dyspepsia) is mild and only occurs occasionally. However, severe indigestion can cause complications, some of which are outlined below.

Ingrown toenail
of skin hair and nails

The big toe is often affected, either on one or both sides. The nail curls and pierces the skin, which becomes red, swollen and tender.

Other possible symptoms include:

pain if pressure is placed on the toe inflammation of the skin at the end of the toe a build-up of fluid (oedema) in the area surrounding the toe an overgrowth of skin around the affected toe (hypertrophy) bleeding white or yellow pus coming from the affected area


Other possible symptoms include:

pain if pressure is placed on the toe inflammation of the skin at the end of the toe a build-up of fluid (oedema) in the area surrounding the toe an overgrowth of skin around the affected toe (hypertrophy) bleeding white or yellow pus coming from the affected area


pain if pressure is placed on the toe inflammation of the skin at the end of the toe a build-up of fluid (oedema) in the area surrounding the toe an overgrowth of skin around the affected toe (hypertrophy) bleeding white or yellow pus coming from the affected area

Symptoms

pain if pressure is placed on the toe inflammation of the skin at the end of the toe a build-up of fluid (oedema) in the area surrounding the toe an overgrowth of skin around the affected toe (hypertrophy) bleeding white or yellow pus coming from the affected area


Partial nail avulsion

Partial nail avulsion removes part of your toenail and is the most commonly used operation for treating ingrown toenails. It’s about 98% effective.

A local anaesthetic is used to numb your toe and the edges of your toenail are cut away. A chemical called phenol is applied to the affected area to prevent the nail growing back and becoming ingrown in the future.

A course of antibiotics may be prescribed if your nail is infected, and any pus will be drained away.

Total nail avulsion

Total nail avulsion completely removes your toenail. This may be necessary if your nail is thick and pressing into the skin surrounding your toe. After your toenail has been removed, you’ll have an indentation where your nail used to be. However, it’s perfectly safe for you not to have a toenail.

After surgery

After toenail surgery, your toe will be wrapped in a sterile bandage. This will help stem any bleeding and prevent infection. Rest your foot and keep it raised for 1 to 2 days after the operation.

To help reduce the pain, you may need to take a painkiller, such as paracetamol, and wear soft or open-toed shoes for the first few days after surgery.

Causes

A number of things can cause an ingrown toenail to develop, including:

badly cut toenails – cutting your toenails too short, or cutting the edges, will encourage the skin to fold over your nail and the nail to grow into the skin wearing tight-fitting shoes, socks or tights – this places pressure on the skin around your toenail; the skin may be pierced if it’s pressed on to your toenail sweaty feet – if the skin around your toenails is soft, it’s easier for your nail to pierce it and embed itself within it injury – for example, stubbing your toe can sometimes cause an ingrown toenail to develop natural shape of the nail – the sides of curved or fan-shaped toenails are more likely to press into the skin surrounding the nail

A fungal nail infection can cause your toenail to thicken or widen.

Treatments

Pharmacy First Scotland: Infected ingrown toenail treatment from your pharmacy Adults 18 years and over with an infected ingrown toenail can get advice and treatment directly from a pharmacy in certain instances. If the pharmacist cannot treat you they may recommend you see your podiatrist or GP. Find your local pharmacy on Scotland’s Service directory.


Left untreated, an ingrown toenail can become infected, so it’s important that you:

keep your feet clean by washing them regularly with soap and water change your socks regularly cut your toenails straight across to stop them digging into the surrounding skin gently push the skin away from the nail using a cotton bud (this may be easier after using a small amount of olive oil to soften the skin) wear comfortable shoes that fit properly

Surgery may be recommended if your toenail doesn’t improve. Depending on the severity of your symptoms, this may involve removing part or all of your toenail.

Partial nail avulsion

Partial nail avulsion removes part of your toenail and is the most commonly used operation for treating ingrown toenails. It’s about 98% effective.

A local anaesthetic is used to numb your toe and the edges of your toenail are cut away. A chemical called phenol is applied to the affected area to prevent the nail growing back and becoming ingrown in the future.

A course of antibiotics may be prescribed if your nail is infected, and any pus will be drained away.

Total nail avulsion

Total nail avulsion completely removes your toenail. This may be necessary if your nail is thick and pressing into the skin surrounding your toe. After your toenail has been removed, you’ll have an indentation where your nail used to be. However, it’s perfectly safe for you not to have a toenail.

After surgery

After toenail surgery, your toe will be wrapped in a sterile bandage. This will help stem any bleeding and prevent infection. Rest your foot and keep it raised for 1 to 2 days after the operation.

To help reduce the pain, you may need to take a painkiller, such as paracetamol, and wear soft or open-toed shoes for the first few days after surgery.

Preventions

Taking care of your feet will help prevent foot problems such as ingrown toenails. It’s important to cut your toenails properly (straight across, not at an angle or down the edges).

Wash your feet every day, dry them thoroughly and use foot moisturiser. You can also use a foot file or pumice stone to remove hard or dead skin.

Wearing shoes that fit properly will help to ensure your feet remain healthy. You should also change your socks (or tights) every day.

Visit your GP or a podiatrist as soon as possible if you develop problems with your feet.

Inherited heart conditions
of heart and blood vessels, conditions

Inherited cardiac conditions (ICC) is an umbrella term covering a wide variety of relatively rare diseases of the heart. They are also referred to as genetic cardiac conditions.

ICCs are caused by a fault – also known as a mutation – in one or more of our genes. If someone has a faulty gene, there’s a 50/50 chance it can be passed on to your children.

The effects of these conditions on you and your family can be enormous. These conditions can – in some cases – become life-threatening. Around 500 young people die every year in the UK as a result of a genetic heart disorder.

These conditions do not always have symptoms, so you can be unaware you have the conditions. Sadly, this can sometimes mean that the first time a family is aware of being affected is after a sudden cardiac death (SCD).

However, great improvements are being made in the detection of ICCs and also how you can live with your condition. There are effective treatments which allow you to lead a normal life.


ICCs are caused by a fault – also known as a mutation – in one or more of our genes. If someone has a faulty gene, there’s a 50/50 chance it can be passed on to your children.

The effects of these conditions on you and your family can be enormous. These conditions can – in some cases – become life-threatening. Around 500 young people die every year in the UK as a result of a genetic heart disorder.

These conditions do not always have symptoms, so you can be unaware you have the conditions. Sadly, this can sometimes mean that the first time a family is aware of being affected is after a sudden cardiac death (SCD).

However, great improvements are being made in the detection of ICCs and also how you can live with your condition. There are effective treatments which allow you to lead a normal life.


The effects of these conditions on you and your family can be enormous. These conditions can – in some cases – become life-threatening. Around 500 young people die every year in the UK as a result of a genetic heart disorder.

These conditions do not always have symptoms, so you can be unaware you have the conditions. Sadly, this can sometimes mean that the first time a family is aware of being affected is after a sudden cardiac death (SCD).

However, great improvements are being made in the detection of ICCs and also how you can live with your condition. There are effective treatments which allow you to lead a normal life.

Symptoms

Sometimes people don’t experience many signs and symptoms, but the main symptoms of familial arrhythmia are:

palpitations fainting or blackouts (also known as syncope or “near” faint)

The majority of children and young adults with syncope have a normal heart disease and no major heart rhythm problem.

However, it’s really important to speak to your GP or health professional if you – or a member of your family – have suffered unexplained fainting, especially if it’s happened more than once.

Treatments

Different conditions require different treatments or interventions, which include:

changes to your lifestyle medication  implantable cardioverter defibrillators (ICDs) – see heart surgery  heart transplantation (in rare cases) – see heart surgery 

See our section on Treatments

Insomnia
of mental health

Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning.

It’s a common problem thought to regularly affect around one in every three people in the UK, and is particularly common in elderly people.

If you have insomnia, you may:

find it difficult to fall asleep lie awake for long periods at night wake up several times during the night wake up early in the morning and not be able to get back to sleep not feel refreshed when you get up find it hard to nap during the day, despite feeling tired feel tired and irritable during the day and have difficulty concentrating

Occasional episodes of insomnia may come and go without causing any serious problems, but for some people it can last for months or even years at a time.

Persistent insomnia can have a significant impact on your quality of life. It can limit what you’re able to do during the day, affect your mood, and lead to relationship problems with friends, family and colleagues.

Causes

It’s not always clear what triggers insomnia, but it’s often associated with:

stress and anxiety a poor sleeping environment – such as an uncomfortable bed, or a bedroom that’s too light, noisy, hot or cold lifestyle factors – such as jet lag, shift work, or drinking alcohol or caffeine before going to bed mental health conditions – such as depression and schizophrenia physical health conditions – such as heart problems, other sleep disorders and long-term pain certain medicines – such as some antidepressants, epilepsy medicines and steroid medication

Read more about the causes of insomnia


Insomnia can be triggered by a number of possible factors, including worry and stress, underlying health conditions, and alcohol or drug use.

Sometimes it’s not possible to identify a clear cause.

Treatments

Make an appointment to see your GP if you’re finding it difficult to get to sleep or stay asleep and it’s affecting your daily life – particularly if it has been a problem for a month or more and the above measures have not helped.

Your GP may ask you about your sleeping routines, your daily alcohol and caffeine consumption, and your general lifestyle habits, such as diet and exercise.

They will also check your medical history for any illness or medication that may be contributing to your insomnia.

Your GP may suggest keeping a sleep diary for a couple of weeks to help them gain a better understanding of your sleep patterns.

Each day, make a note of things such as the time you went to bed and woke up, how long it took you to fall asleep, and the number of times you woke up during the night.


Your GP will first try to identify and treat any underlying health condition, such as anxiety, that may be causing your sleep problems.

They’ll probably also discuss things you can do at home that may help to improve your sleep.

In some cases, a special type of cognitive behavioural therapy (CBT) designed for people with insomnia (CBT-I) may be recommended.

This is a type of talking therapy that aims to help you avoid the thoughts and behaviours affecting your sleep. It’s usually the first treatment recommended and can help lead to long-term improvement of your sleep.

Prescription sleeping tablets are usually only considered as a last resort and should be used for only a few days or weeks at a time.

This is because they don’t treat the cause of your insomnia and are associated with a number of side effects. They can also become less effective over time.

Read more about treating insomnia


Insomnia will often improve by making changes to your bedtime habits. If these don’t help, your GP may be able to recommend other treatments.

If you’ve had insomnia for more than four weeks, your GP may recommend cognitive and behavioural treatments or suggest a short course of prescription sleeping tablets as a temporary measure.

If it’s possible to identify an underlying cause of your sleeping difficulties, treating this may be enough to return your sleep to normal.

The various treatments for insomnia are outlined below. 


If changing your sleeping habits doesn’t help, your GP may be able to refer you for a type of cognitive behavioural therapy (CBT) that’s specifically designed for people with insomnia (CBT-I).

The aim of CBT-I is to change unhelpful thoughts and behaviours that may be contributing to your insomnia. It’s an effective treatment for many people and can have long-lasting results.

CBT-I may include:

stimulus-control therapy – which aims to help you associate the bedroom with sleep and establish a consistent sleep/wake pattern sleep restriction therapy – limiting the amount of time spent in bed to the actual amount of time spent asleep, creating mild sleep deprivation; sleep time is then increased as your sleeping improves relaxation training – aims to reduce tension or minimise intrusive thoughts that may be interfering with sleep paradoxical intention – you try to stay awake and avoid any intention of falling asleep; it’s used if you have trouble getting to sleep, but not maintaining sleep biofeedback – sensors connected to a machine are placed on your body to measure your body’s functions, such as muscle tension and heart rate; the machine produces pictures or sounds to help you recognise when you’re not relaxed 

CBT-I is sometimes carried out by a specially trained GP. Alternatively, you may be referred to a clinical psychologist.

The therapy may be carried out in a small group with other people who have similar sleep problems, or one-to-one with a therapist. Self-help books and online courses may also be used.


The following treatments aren’t normally recommended for insomnia, because it’s not clear how effective they are and they can sometimes cause side effects:

antidepressants (unless you also have depression) chloral hydrate clomethiazole barbiturates herbal remedies, such as valerian extract complementary and alternative therapies, such as acupuncture, hypnotherapy and reflexology

Iron deficiency anaemia
of nutritional

Iron deficiency anaemia is a condition where a lack of iron in the body leads to a reduction in the number of red blood cells.

Iron is used to produce red blood cells, which help store and carry oxygen in the blood. If you have fewer red blood cells than is normal, your organs and tissues won’t get as much oxygen as they usually would.

There are several different types of anaemia, and each one has a different cause. Iron deficiency anaemia is the most common type.

Other types of anaemia can be caused by a lack of vitamin B12 or folate in the body – read more about vitamin B12 and folate deficiency anaemia.

Symptoms

Many people with iron deficiency anaemia only have a few symptoms. The severity of the symptoms largely depends on how quickly anaemia develops.

You may notice symptoms immediately, or they may develop gradually if your anaemia is caused by a long-term problem, such as a stomach ulcer.

The most common symptoms include:

tiredness and lack of energy (lethargy) shortness of breath noticeable heartbeats (heart palpitations) a pale complexion

Less common symptoms include:

headache  hearing sounds that come from inside the body, rather than from an outside source (tinnitus) an altered sense of taste feeling itchy a sore or abnormally smooth tongue hair loss a desire to eat non-food items, such as ice, paper or clay (pica) difficulty swallowing (dysphagia) painful open sores (ulcers) on the corners of your mouth spoon-shaped nails

When to see your GP

See your GP if you experience symptoms of iron deficiency anaemia. They should be able to diagnose the condition using a simple blood test.

Read more about diagnosing iron deficiency anaemia

Causes

There are many things that can lead to a lack of iron in the body. In men and post-menopausal women, the most common cause is bleeding in the stomach and intestines.

This can be caused by a stomach ulcer, stomach cancer, bowel cancer, or by taking non-steroidal anti-inflammatory drugs (NSAIDs).

In women of reproductive age, heavy periods and pregnancy are the most common causes of iron deficiency anaemia as your body needs extra iron for your baby during pregnancy.

Unless you’re pregnant, it’s rare for iron deficiency anaemia to be caused just by a lack of iron in your diet. However, if you do lack dietary iron, it may mean you’re more likely to develop anaemia than if you have one of the problems mentioned above.

Read more about the causes of iron deficiency anaemia


Iron deficiency anaemia occurs when the body doesn’t have enough iron, leading to the decreased production of red blood cells. Red blood cells carry oxygen around the body.

A lack of iron can be caused by several factors. Some of the most common causes of iron deficiency anaemia are outlined below.


Other conditions or actions that cause blood loss and may lead to iron deficiency anaemia include:

inflammatory bowel disease – a condition that causes redness and swelling (inflammation) in the digestive system, such as Crohn’s disease and ulcerative colitis  oesophagitis – inflammation of the gullet (oesophagus) caused by stomach acid leaking through it schistosomiasis – an infection caused by parasites, mainly found in sub-Saharan Africa blood donation – donating a large amount of blood may lead to anaemia trauma – a serious accident, such as a car crash, may cause you to lose a large amount of blood  nosebleeds – having regular nosebleeds may lead to anaemia, although this is rare haematuria (blood in your urine) – but this rarely causes anaemia and may be a symptom of another condition

Malabsorption

Malabsorption is when your body can’t absorb iron from food, and is another possible cause of iron deficiency anaemia.

This may happen if you have coeliac disease, a common digestive condition where a person has an adverse reaction to gluten, or surgery to remove all or part of your stomach (gastrectomy).

Lack of iron in your diet

Unless you’re pregnant, it’s rare for iron deficiency anaemia to be caused solely by a lack of iron in your diet.

However, a lack of dietary iron can increase your risk of developing anaemia if you also have any of the conditions mentioned above.

Some studies suggest vegetarians or vegans are more at risk of iron deficiency anaemia because of the lack of meat in their diet.

If you are vegetarian or vegan, it is possible to gain enough iron by eating other types of food, such as:

beans nuts dried fruit, such as dried apricots wholegrains, such as brown rice fortified breakfast cereals soybean flour most dark-green leafy vegetables, such as watercress and curly kale

If you’re pregnant, you may need to increase the amount of iron-rich food you consume during pregnancy to help prevent iron deficiency anaemia.

Read more about vegetarian and vegan diets


To determine the underlying cause of your anaemia, your GP may ask questions about your lifestyle and medical history. For example, they may ask you about:

your diet – to see what you typically eat and whether this includes any iron-rich foods any medicines you take – to see if you’ve been regularly taking a type of medicine that can cause bleeding from the stomach and intestines (gastrointestinal bleeding), such as ibuprofen or aspirin your menstrual pattern – if you’re a woman, your GP may ask if you’ve been experiencing particularly heavy periods your family history – you’ll be asked if your immediate family has anaemia or a history of gastrointestinal bleeding or blood disorders

Iron deficiency anaemia is common during pregnancy. If you’re pregnant, your GP will usually only look for an alternative cause if a blood test has identified a particularly low haemoglobin level, or if your symptoms or medical history suggest your anaemia may be caused by something else.


Your GP will also need to ensure the underlying cause of your anaemia is treated so it doesn’t happen again.

For example, if non-steroidal anti-inflammatory drugs (NSAIDs) are causing bleeding in your stomach, your GP may prescribe a different medicine to help minimise the risk of stomach bleeding.

Heavy periods can be treated with medication or – in particularly severe cases – surgery.

Diagnoses

The gastrointestinal tract is the part of the body responsible for digesting food. It contains the stomach and intestines.

Bleeding in the gastrointestinal tract is the most common cause of iron deficiency anaemia in men, as well as women who’ve experienced the menopause (when monthly periods stop).

Most people with gastrointestinal bleeding don’t notice any obvious blood in their stools and don’t experience any changes in their bowel habits.

Some causes of gastrointestinal bleeding are described below.


See your GP if you experience symptoms of iron deficiency anaemia, such as tiredness, shortness of breath and heart palpitations.

A simple blood test can usually confirm the diagnosis.

Your GP may also carry out a physical examination and ask you a number of questions to help determine the cause of your anaemia.


To diagnose iron deficiency anaemia, a blood sample is taken from a vein in your arm and a full blood count is made. This means all the different types of blood cells in the sample will be measured.

If you have anaemia:

your levels of haemoglobin – a substance that transports oxygen – will be lower than normal you’ll have fewer red blood cells, which contain haemoglobin, than normal your red blood cells may be smaller and paler than usual

Your GP may also test for a substance called ferritin, a protein that stores iron. If your ferritin levels are low, it means there isn’t much iron stored in your body and you may have iron deficiency anaemia.

Read more about blood tests 

Vitamin B12 and folate deficiency

If your GP thinks your anaemia may be the result of a vitamin B12 and folate deficiency, the levels of these substances may be tested. Folate works with vitamin B12 to help your body produce red blood cells.

Vitamin B12 and folate deficiency anaemia is more common in people who are over the age of 75.

Treatments

Treatment for iron deficiency anaemia involves taking iron supplements to boost the low levels of iron in your body. This is usually effective, and the condition rarely causes long-term problems.

You’ll need to be monitored every few months to check the treatment is working and your iron levels have returned to normal.

The underlying cause will need to be treated so you don’t get anaemia again. Increasing the amount of iron in your diet may also be recommended.

Good sources of iron include:

dark-green leafy vegetables, such as watercress and curly kale iron-fortified cereals or bread brown rice  pulses and beans nuts and seeds meat, fish and tofu eggs dried fruit, such as dried apricots, prunes and raisins

Read more about treating iron deficiency anaemia


Treatment for iron deficiency anaemia usually involves taking iron supplements and changing your diet to increase your iron levels, as well as treating the underlying cause.


Your GP will also need to ensure the underlying cause of your anaemia is treated so it doesn’t happen again.

For example, if non-steroidal anti-inflammatory drugs (NSAIDs) are causing bleeding in your stomach, your GP may prescribe a different medicine to help minimise the risk of stomach bleeding.

Heavy periods can be treated with medication or – in particularly severe cases – surgery.

Complications

Iron deficiency anaemia rarely causes serious or long-term complications, although some people with the condition find it affects their daily life.

Some common complications are outlined below.


Pregnant women with severe anaemia have an increased risk of developing complications, particularly during and after birth.

They may also develop postnatal depression, which some women experience after having a baby.

Research suggests babies born to mothers who have untreated anaemia are more likely to:

be born prematurely – before the 37th week of pregnancy have a low birth weight have problems with iron levels themselves do less well in mental ability tests

Irritable bowel syndrome (IBS)
of stomach liver and gastrointestinal tract

Itchy skin
of skin hair and nails

Itchy bottom
of skin hair and nails

The anus is the opening at the lower end of the digestive system, where solid waste leaves your body.



It’s rare for an itchy bottom on it’s own to be a sign of something more serious.

If an itchy bottom lasts longer, you may be able to get an idea of the cause from other symptoms you have. But, you should not self-diagnose. Speak to your GP if you’re worried.

An itchy bottom that’s worse at night can be caused by threadworms. This is often the case for children. You can’t take medicine for threadworms if you’re: pregnant breastfeeding a child under 2 This means you should speak to a GP, midwife or health visitor instead.

Conditions with itchy bottom

Sometimes an itchy bottom can be a symptom of another problem or condition. This includes:

skin conditions like eczema or psoriasis – if you have itching elsewhere on the body too threadworms (especially in children) – symptoms will get worse at night and there will be worms in poo (they look like bits of thread) haemorrhoids (piles) – swellings in and around the anus, as well as pain and blood when pooing bowel incontinence or diarrhoea – can cause poo leaking or pooing you can not control sexually transmitted infection (STI) like genital warts – can cause sores, swelling and irritation ringworm – can cause sores, swelling and irritation

Some long-term medications can also cause an itchy bottom. For example, steroid creams or peppermint oil.

Symptoms

An itchy bottom that’s worse at night can be caused by threadworms. This is often the case for children. You can’t take medicine for threadworms if you’re: pregnant breastfeeding a child under 2 This means you should speak to a GP, midwife or health visitor instead.

Conditions with itchy bottom

Sometimes an itchy bottom can be a symptom of another problem or condition. This includes:

skin conditions like eczema or psoriasis – if you have itching elsewhere on the body too threadworms (especially in children) – symptoms will get worse at night and there will be worms in poo (they look like bits of thread) haemorrhoids (piles) – swellings in and around the anus, as well as pain and blood when pooing bowel incontinence or diarrhoea – can cause poo leaking or pooing you can not control sexually transmitted infection (STI) like genital warts – can cause sores, swelling and irritation ringworm – can cause sores, swelling and irritation

Some long-term medications can also cause an itchy bottom. For example, steroid creams or peppermint oil.


skin conditions like eczema or psoriasis – if you have itching elsewhere on the body too threadworms (especially in children) – symptoms will get worse at night and there will be worms in poo (they look like bits of thread) haemorrhoids (piles) – swellings in and around the anus, as well as pain and blood when pooing bowel incontinence or diarrhoea – can cause poo leaking or pooing you can not control sexually transmitted infection (STI) like genital warts – can cause sores, swelling and irritation ringworm – can cause sores, swelling and irritation

Some long-term medications can also cause an itchy bottom. For example, steroid creams or peppermint oil.


They can suggest treatments like:

creams and ointments to relieve itching medication if the symptoms are caused by threadworms

Find your nearest pharmacy

Speak to your GP if: You have an itchy bottom that: doesn’t get better after 3 to 4 days keeps coming back makes you anxious or depressed affects your sleep is painful is accompanied by other symptoms, like itching elsewhere on your body You should also speak to a GP if your itchy bottom is caused by an underlying condition like piles.

What to expect at your GP appointment Your GP might need to check your bottom (a rectal examination) to help find out what’s causing your itching. You may feel awkward, but this is nothing to be embarrassed or worried about. It’s one of the most common examinations GPs carry out. At your appointment, your GP may ask: whether you use creams, powders or soaps around your bottom how long you have had the itching whether the itching gets worse at night or after eating certain foods if you have any other symptoms Your GP will decide on the best treatment for you depending on what’s causing your symptoms. They may suggest: things you can do yourself to ease an itchy bottom a stronger medication, cream or ointment

Causes

The cause of itchy bottom isn’t always known. If it gets better quickly without treatment, it may be the result of a short term issue. For example, sweating more in hot weather.

It’s rare for an itchy bottom on it’s own to be a sign of something more serious.

If an itchy bottom lasts longer, you may be able to get an idea of the cause from other symptoms you have. But, you should not self-diagnose. Speak to your GP if you’re worried.

An itchy bottom that’s worse at night can be caused by threadworms. This is often the case for children. You can’t take medicine for threadworms if you’re: pregnant breastfeeding a child under 2 This means you should speak to a GP, midwife or health visitor instead.

Conditions with itchy bottom

Sometimes an itchy bottom can be a symptom of another problem or condition. This includes:

skin conditions like eczema or psoriasis – if you have itching elsewhere on the body too threadworms (especially in children) – symptoms will get worse at night and there will be worms in poo (they look like bits of thread) haemorrhoids (piles) – swellings in and around the anus, as well as pain and blood when pooing bowel incontinence or diarrhoea – can cause poo leaking or pooing you can not control sexually transmitted infection (STI) like genital warts – can cause sores, swelling and irritation ringworm – can cause sores, swelling and irritation

Some long-term medications can also cause an itchy bottom. For example, steroid creams or peppermint oil.

Treatments

A pharmacist can often help to treat an itchy bottom. You can ask if they have a private area to discuss your symptoms.

They can suggest treatments like:

creams and ointments to relieve itching medication if the symptoms are caused by threadworms

Find your nearest pharmacy

Speak to your GP if: You have an itchy bottom that: doesn’t get better after 3 to 4 days keeps coming back makes you anxious or depressed affects your sleep is painful is accompanied by other symptoms, like itching elsewhere on your body You should also speak to a GP if your itchy bottom is caused by an underlying condition like piles.

What to expect at your GP appointment Your GP might need to check your bottom (a rectal examination) to help find out what’s causing your itching. You may feel awkward, but this is nothing to be embarrassed or worried about. It’s one of the most common examinations GPs carry out. At your appointment, your GP may ask: whether you use creams, powders or soaps around your bottom how long you have had the itching whether the itching gets worse at night or after eating certain foods if you have any other symptoms Your GP will decide on the best treatment for you depending on what’s causing your symptoms. They may suggest: things you can do yourself to ease an itchy bottom a stronger medication, cream or ointment

Kaposi’s sarcoma
of cancer, cancer types in adults

It’s mainly seen in people with a poorly controlled or severe HIV infection. It can also affect some people who have a weakened immune system for another reason, as well as people who have a genetic vulnerability to the virus.



Over time, the patches may grow into lumps known as nodules and may merge into each other.

Internal organs can also be affected, including the lymph nodes, lungs and the digestive system, which can cause symptoms such as:

uncomfortable swelling in the arms or legs (lymphoedema) breathlessness, coughing up blood and chest pain nausea, vomiting, stomach pain and diarrhoea

The rate at which symptoms progress depends on the type of Kaposi’s sarcoma you have. Most types get worse quickly in a matter of weeks or months without treatment, but some progress very slowly over many years.

Symptoms

The most common initial symptom is the appearance of small, painless, flat and discoloured patches on the skin or inside the mouth. They’re usually red or purple and look similar to bruises.

Over time, the patches may grow into lumps known as nodules and may merge into each other.

Internal organs can also be affected, including the lymph nodes, lungs and the digestive system, which can cause symptoms such as:

uncomfortable swelling in the arms or legs (lymphoedema) breathlessness, coughing up blood and chest pain nausea, vomiting, stomach pain and diarrhoea

The rate at which symptoms progress depends on the type of Kaposi’s sarcoma you have. Most types get worse quickly in a matter of weeks or months without treatment, but some progress very slowly over many years.

Causes

Kaposi’s sarcoma is caused by a virus called the human herpesvirus 8 (HHV-8), also known as the Kaposi’s sarcoma-associated herpesvirus (KSHV). This virus is thought to be spread during sex, through saliva, or from a mother to her baby during birth.

HHV-8 is a relatively common virus and the vast majority of people who have it will not develop Kaposi’s sarcoma. It only seems to cause cancer in some people with a weakened immune system and in some people who have a genetic vulnerability to the virus.

A weakened immune system allows the HHV-8 virus to multiply to high levels in the blood, which increases the chance it will cause Kaposi’s sarcoma.

The virus appears to alter the genetic instructions that control cell growth. This means some cells reproduce uncontrollably and form lumps of tissue known as tumours.

Treatments

You should speak to your GP if you have any worrying symptoms you think could be caused by Kaposi’s sarcoma. If you have HIV, you can also contact your local HIV clinic if you have any concerns.

Your doctor will ask about your symptoms and examine your skin to look for the characteristic discoloured patches. If they suspect Kaposi’s sarcoma, they will refer you for further tests to confirm the diagnosis.

These tests may include:

an HIV test – a blood test to confirm whether or not you have HIV (if you haven’t already been diagnosed with the condition) a skin biopsy – where a small sample of cells is removed from an affected area of skin and checked for Kaposi’s sarcoma cells an endoscopy – where a thin, flexible tube called an endoscope is passed down your throat to see if your lungs or digestive system are affected a computerised tomography (CT) scan to see if your lymph nodes or other parts of your body are affected


There are 4 main types of Kaposi’s sarcoma. These types affect different groups of people and are treated in different ways.

HIV-related Kaposi’s sarcoma

Although it’s not as common as it used to be, Kaposi’s sarcoma is still one of the main types of cancer to affect people with HIV. 

HIV-related Kaposi’s sarcoma can progress very quickly if not treated. However, it can usually be controlled by taking HIV medication – known as combination antiretroviral therapy (cART) – to prevent HIV multiplying and allow the immune system to recover. The immune system can then reduce the levels of HHV-8 in the body.

Read more about treating HIV.

Some people may also require treatment with radiotherapy (where high-energy rays are used to destroy cancer cells) or chemotherapy (where powerful medications are used to destroy cancer cells), depending on the site and extent of the cancer and what symptoms it’s causing.

Classic Kaposi’s sarcoma

Classic Kaposi’s sarcoma mainly affects middle-aged and elderly men of Mediterranean or Ashkenazi Jewish descent. Ashkenazi Jews are descended from Jewish communities that lived in central and eastern Europe. Most Jewish people in the UK are Ashkenazi Jews.

It’s thought people who develop classic Kaposi’s sarcoma were born with a genetic vulnerability to the HHV-8 virus.

Unlike the other types of Kaposi’s sarcoma, the symptoms of classic Kaposi’s sarcoma progress very slowly over many years and are usually limited to the skin.

Immediate treatment isn’t usually required because, in many cases, the condition doesn’t affect life expectancy. You’ll usually be monitored carefully and only treated if the symptoms get significantly worse.

Radiotherapy is often used if treatment is required, although small skin patches or nodules may be removed using minor surgery or cryotherapy (freezing).

Transplant-related Kaposi’s sarcoma

Transplant-related Kaposi’s sarcoma is a rare complication of an organ transplant. It occurs because the immunosuppressant medication used to weaken the immune system and help prevent the body rejecting the new organ can allow a previous HHV-8 infection to reactivate, which means levels of the virus increase as it starts multiplying again.

Transplant-related Kaposi’s sarcoma can be aggressive and usually needs to be treated quickly. It’s normally treated by reducing or stopping the immunosuppressants, if this is possible. If this is unsuccessful, radiotherapy or chemotherapy may be used.

Endemic African Kaposi’s sarcoma

Endemic African Kaposi’s sarcoma is common in parts of Africa and is one of the most widespread types of cancer in that region.

Although this type of Kaposi’s sarcoma is classified separately from HIV-related Kaposi’s sarcoma, many cases may actually result from an undiagnosed HIV infection. All suspected cases therefore must have an HIV test, as the most effective treatment in these cases is HIV medication.

In cases not caused by HIV infection, this type of Kaposi’s sarcoma may be the result of a genetic vulnerability to HHV-8. These cases are usually treated with chemotherapy, although sometimes radiotherapy may be used.