Rare tumours
of cancer, cancer types in children

It’s devastating to hear that your child has cancer, and at times it can feel overwhelming, but there are many healthcare professionals and support organisations to help you through this difficult time.

Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information, and if you have any questions it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.


Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information, and if you have any questions it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.

Causes

The causes of most rare childhood cancers are unknown. But if other family members have had particular types of cancer, this may sometimes suggest that there is an inherited faulty gene in the family. If this is a possibility, your child’s specialist will talk to you about it.

Treatments

Rare cancers are treated with the same treatments used for other childhood cancers. This includes surgery, radiotherapy and chemotherapy. Your child may need a combination of these treatments.

Surgery

Usually an operation is done to remove all or as much of the cancer as possible. Other treatments, such as radiotherapy or chemotherapy, may be given after or sometimes before surgery. They may also be used if an operation is not possible.

Radiotherapy

Radiotherapy uses high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. It can be used to treat any cancer cells that may be left behind after surgery, or to shrink a cancer.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is usually given as injections and drips (infusions) into a vein. Chemotherapy may be used to lower the risk of the cancer coming back or to treat cancer that has spread to other parts of the body.

Raynaud’s phenomenon
of heart and blood vessels, conditions

Raynaud’s phenomenon is a common condition that affects the blood supply to certain parts of the body – usually the fingers and toes.

It’s often referred to as Raynaud’s syndrome, Raynaud’s disease or just Raynaud’s.

Causes

Raynaud’s is usually triggered by cold temperatures, anxiety or stress. The condition occurs because your blood vessels go into a temporary spasm, which blocks the flow of blood.

This causes the affected area to change colour to white, then blue and then red, as the bloodflow returns. You may also experience numbness, pain, and pins and needles.

Symptoms of Raynaud’s can last from a few minutes to several hours.

IIt’s not a serious threat to your health, but can be painful and difficult to live with. If can affect your ability to move your fingers and hands. People with Raynaud’s often go for long periods without any symptoms, and sometimes the condition goes away altogether.

Other parts of the body that can be affected by Raynaud’s include the ears, nose, nipples and lips.


Raynaud’s phenomenon is the result of over-sensitive blood vessels in the body’s extremities. In many cases, no cause is identified, although it’s sometimes linked to other health conditions.

When your body is exposed to cold temperatures, the extremities, such as your fingers and toes, lose heat. This is because the small blood vessels under the skin spasm, slowing down the blood supply that is helping to preserve your body’s core temperature.

In people with Raynaud’s, the sensitive blood vessels overreact to cold temperatures and become narrower than usual, significantly restricting the blood flow.

Symptoms can be triggered by mildly cool weather, getting something out of the freezer, or running your hands under a cold tap. Strong emotions such as stress or anxiety may also trigger symptoms.

Diagnoses

Raynaud’s phenomenon can usually be diagnosed after an examination of your symptoms and some blood tests.

Your GP may place your hands in cold water or cool air to see if you show symptoms of Raynaud’s.

Further testing is usually recommended to find out whether you have primary or secondary Raynaud’s.

Secondary Raynaud’s may require more treatment and, in some cases, referral to a specialist.

Secondary Raynaud’s may be suspected if:

your symptoms only started when you were over 30 years of age – most cases of primary Raynaud’s begin between the ages of 20 to 30 you’re experiencing severe pain during an attack of Raynaud’s only one side of your body is affected

Your GP may also check the tiny blood vessels, known as capillaries, found where your nail meets the finger. These capillaries are often larger in people with secondary Raynaud’s, and look like red pen marks.


Your GP may also refer you for blood tests to check for other health conditions that could be causing your symptoms. These tests may include:

a full blood count – to check for infection or, much less commonly, a cancer of the blood, such as leukaemia an antinuclear antibodies (ANA) test – to check for an overactive immune system, which is common in people with autoimmune conditions such as scleroderma and lupus erythrocyte sedimentation rate – to check for an autoimmune disorder

Treatments

In many cases, it may be possible to control the symptoms of Raynaud’s yourself by avoiding the cold, wearing gloves and using relaxation techniques when feeling stressed.

Stopping smoking can also improve symptoms, as smoking can affect your circulation.

If you’re unable to control your symptoms yourself, then a medication called nifedipine may be recommended.

Read more about treating Raynaud’s.


You can usually treat Raynaud’s phenomenon yourself, although medication is sometimes necessary.

If you’ve been diagnosed with secondary Raynaud’s, you may be referred to a specialist in the treatment of the underlying condition.

If your secondary Raynaud’s may be a side effect of a medication, you may be asked to stop taking it, to see if your symptoms improve.

Complications

Secondary Raynaud’s can severely restrict the blood supply, so it carries a higher risk of complications, such as ulcers, scarring and even tissue death (gangrene) in the most serious cases. However, severe complications are rare.

Read more about the complications of Raynaud’s.


People with Raynaud’s phenomenon have an increased risk of developing other problems, such as scleroderma.

Reactive arthritis
of muscle bone and joints, conditions

Reactive arthritis, formerly known as Reiter’s syndrome, is a condition that causes inflammation (redness and swelling) in various places in the body.

It usually develops following an infection, and in most cases clears up in a few months without causing long-term problems.

The three most common places affected by reactive arthritis are:

the joints (arthritis), which can cause pain, stiffness and swelling the eyes (conjunctivitis), which can cause eye pain and redness the urethra (non-gonococcal urethritis), which can cause pain when urinating (the urethra is the tube that carries urine out of the body) 

However, most people will not experience all of these problems. 

Read more about the symptoms of reactive arthritis.

Symptoms

The symptoms of reactive arthritis usually develop within four weeks of an infection.

In most cases, reactive arthritis follows a sexually transmitted infection (STI) such as chlamydia, or a bowel infection such as food poisoning.

The three parts of the body most commonly affected by reactive arthritis are the:

joints and tendons urinary system eyes

However, most people won’t experience problems in all of these areas.


Reactive arthritis can also cause symptoms, including:

feeling unusually tired a high temperature (fever) weight loss mouth ulcers painless white patches inside your mouth a rash thick and crumbly nails abdominal (tummy) pain bouts of diarrhoea

Causes

Reactive arthritis usually develops within four weeks of an infection, typically after a sexually transmitted infection (STI) such as chlamydia, or an infection of the bowel.

For reasons that are still unclear, the immune system (the body’s defence against infection) appears to malfunction in response to the infection and starts attacking healthy tissue, causing it to become inflamed.

Read more about the causes of reactive arthritis.


It’s not known exactly what causes reactive arthritis, but it’s thought to be the result of the immune system reacting to an infection.

Treatments

There is currently no cure for reactive arthritis, but most people get better in around six months. Meanwhile, treatment can help to relieve symptoms such as pain and stiffness.

Symptoms can often be controlled using non-steroidal anti-inflammatory drugs (NSAIDs) and painkillers such as ibuprofen.

Severe symptoms may require more powerful steroid medication (corticosteroids) or disease-modifying anti-rheumatic drugs (DMARDs).

Read more about treating reactive arthritis.


There’s no cure for reactive arthritis, but the condition is usually temporary and treatment can help to relieve your symptoms.

Most people will make a full recovery in about six months, although around one in five cases lasts a year or more, and a small number of people experience long-term joint problems.

There is also a risk you could develop the condition again after another infection.

Preventions

The most effective way to reduce your risk of reactive arthritis is to avoid the STIs and bowel infections that most commonly cause the condition.

The most effective way of preventing STIs is to always use a barrier method of contraception, such as a condom, during sex with a new partner. 

Read advice on contraception and sexual health.

Restless legs syndrome
of brain nerves and spinal cord

Restless legs syndrome, also known as Willis-Ekbom disease, is a common condition of the nervous system that causes an overwhelming, irresistible urge to move the legs.

It can also cause an unpleasant crawling or creeping sensation in the feet, calves and thighs. The sensation is often worse in the evening or at night. Occasionally, the arms are affected too.

Restless legs syndrome is also associated with involuntary jerking of the legs and arms, known as periodic limb movements in sleep (PLMS).

Some people have the symptoms of restless legs syndrome occasionally, while others have them every day. The symptoms can vary from mild to severe. In severe cases, restless legs syndrome can be very distressing and disrupt a person’s daily activities.

Symptoms

Restless legs syndrome typically causes an overwhelming urge to move your legs and an uncomfortable sensation in your legs.

The sensation may also affect your arms, chest and face, too. It has been described as:

tingling, burning, itching or throbbing a “creepy-crawly” feeling feeling like fizzy water is inside the blood vessels in the legs a painful, cramping sensation in the legs, particularly in the calves 

These unpleasant sensations can range from mild to unbearable, and are usually worse in the evening and during the night. They can often be relieved by moving or rubbing your legs.

Some people experience symptoms occasionally, while others have them every day. You may find it difficult to sit for long periods of time – for example, on a long train journey.

Just over half of people with restless legs syndrome also experience episodes of lowerback pain.


Your GP or specialist will ask you about the pattern of your symptoms to help assess their severity. For example, they may ask you:

how often you have symptoms how unpleasant you find your symptoms whether your symptoms cause significant distress whether your sleep is disrupted, making you tired during the day

Keeping a sleep diary may help your doctor assess your symptoms. You can use the diary to record your daily sleeping habits, such as the time you go to bed, how long it takes you to fall asleep, how often you wake during the night, and episodes of tiredness during the day.

Mild symptoms of restless legs syndrome can usually be treated by making lifestyle changes – for example, establishing a regular sleeping pattern and avoiding stimulants, such as caffeine, alcohol or tobacco, in the evening.

If your symptoms are more severe, you may need medication to bring them under control.

Read more about treating restless leg syndrome

Causes

In the majority of cases, there’s no obvious cause of restless legs syndrome. This known as idiopathic or primary restless legs syndrome, and it can run in families.

Some neurologists (specialists in treating conditions that affect the nervous system) believe the symptoms of restless legs syndrome may have something to do with how the body handles a chemical called dopamine. Dopamine is involved in controlling muscle movement and may be responsible for the involuntary leg movements associated with restless legs syndrome.

In some cases, restless legs syndrome is caused by an underlying health condition, such as iron deficiency anaemia or kidney failure. This is known as secondary restless legs syndrome.

There’s also a link between restless legs syndrome and pregnancy. About 1 in 5 pregnant women will experience symptoms in the last three months of their pregnancy, although it’s not clear exactly why this is. In such cases, restless legs syndrome usually disappears after the woman has given birth.

Read more about the causes of restless legs syndrome


In many cases, the exact cause of restless legs syndrome is unknown.

When no cause can be found, it’s known as “idiopathic” or primary restless legs syndrome.

Research has identified specific genes related to restless legs syndrome, and it can run in families. In these cases, symptoms usually occur before the age of 40.

Diagnoses

There’s no single test for diagnosing restless legs syndrome.

A diagnosis will be based on your symptoms, your medical and family history, a physical examination, and your test results.

Your GP should be able to diagnose restless legs syndrome, but they may refer you to a neurologist if there’s any uncertainty.

There are four main criteria your GP or specialist will look for to confirm a diagnosis. These are:

an overwhelming urge to move your legs, usually with an uncomfortable sensation such as itching or tingling your symptoms occur or get worse when you’re resting or inactive your symptoms are relieved by moving your legs or rubbing them your symptoms are worse during the evening or at night


Your GP may refer you for blood tests to confirm or rule out possible underlying causes of restless legs syndrome. For example, you may have blood tests to rule out conditions such as anaemia, diabetes and kidney function problems.

It’s particularly important to find out the levels of iron in your blood because low iron levels can sometimes cause secondary restless legs syndrome. Low iron levels can be treated with iron tablets.


If you have restless legs syndrome and your sleep is being severely disrupted, sleep tests – such as a suggested immobilisation test – may be recommended. The test involves lying on a bed for a set period of time without moving your legs while any involuntary leg movements are monitored.

Occasionally, polysomnography may be recommended. This is a test that measures your breathing rate, brain waves and heartbeat throughout the course of a night. The results will confirm whether you have periodic limb movements in sleep (PLMS).

Treatments

Mild cases of restless legs syndrome that aren’t linked to an underlying health condition may not require any treatment, other than making a few lifestyle changes, such as:

adopting good sleep habits – for example, following a regular bedtime ritual, sleeping regular hours, and avoiding alcohol and caffeine late at night quitting smoking if you smoke exercising regularly during the daytime

If your symptoms are more severe, you may need medication to regulate the levels of dopamine and iron in your body.

If restless legs syndrome is caused by iron deficiency anaemia, iron supplements may be all that’s needed to treat the symptoms.

Read more about treating restless legs syndrome


Mild restless legs syndrome that isn’t linked to an underlying health condition can be managed with just a few lifestyle changes.

If symptoms are more severe, medication may be needed.

Restless legs syndrome caused by an underlying health condition can often be cured by treating that condition. For example, iron deficiency anaemia can be treated by taking iron supplements.

If it’s associated with pregnancy, it usually disappears on its own within four weeks of the birth.

Retinoblastoma: Children
of cancer, cancer types in children

More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past.

It’s devastating to hear that your child has cancer, and at times it can feel overwhelming. There are many healthcare professionals and support organisations to help you through this difficult time.

Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information and if you have any questions it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.

Retinoblastoma develops in the light-sensitive lining of the eye (called the retina).

There are 2 forms of retinoblastoma:

a heritable form – this is genetic or inherited; there are often tumours in both eyes (bilateral) or sometimes only in 1 eye a non-heritable form – this is not passed on in the family; there’s 1 tumour in only 1 eye (unilateral)


It’s devastating to hear that your child has cancer, and at times it can feel overwhelming. There are many healthcare professionals and support organisations to help you through this difficult time.

Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information and if you have any questions it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.

Retinoblastoma develops in the light-sensitive lining of the eye (called the retina).

There are 2 forms of retinoblastoma:

a heritable form – this is genetic or inherited; there are often tumours in both eyes (bilateral) or sometimes only in 1 eye a non-heritable form – this is not passed on in the family; there’s 1 tumour in only 1 eye (unilateral)


Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information and if you have any questions it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.

Retinoblastoma develops in the light-sensitive lining of the eye (called the retina).

There are 2 forms of retinoblastoma:

a heritable form – this is genetic or inherited; there are often tumours in both eyes (bilateral) or sometimes only in 1 eye a non-heritable form – this is not passed on in the family; there’s 1 tumour in only 1 eye (unilateral)

Symptoms

Some children with a family history of retinoblastoma are picked up by screening before they have any symptoms.

If there’s no family history of retinoblastoma, the first sign of the condition is often a white pupil that does not reflect light (leukocoria). This may be picked up when a picture of your child is taken using flash photography. The pupil of the affected eye may look white in the photograph.

Some children may have a squint or, if the tumour is large, they may have a painful red eye.

Causes

The heritable form of retinoblastoma, which accounts for about 2 in every 5 cases, is caused by a genetic abnormality. This means that an abnormal gene allows the tumour to develop. This abnormal gene may either be inherited from a parent or happen for the first time at an early stage of development in the womb.

Genetic counselling and support is available for families in which a member has retinoblastoma. Not all children of a parent with retinoblastoma will inherit this gene, but children born into families with a history of retinoblastoma are offered blood testing. They are also usually checked (screened) soon after birth for signs of retinoblastoma. This means that treatment can be started early if a tumour does develop.

Screening usually starts shortly after birth and is repeated every few months for 5 years. An eye specialist examines the eye, while shining a light into it with an ophthalmoscope. In younger children, this may need to be done under a general anaesthetic.

The genetic abnormality in the heritable form of retinoblastoma is now well-understood. But we don’t know what causes non-heritable retinoblastoma.

Diagnoses

Tests are likely to involve an examination under anaesthetic (EUA) where an eye specialist (ophthalmologist) examines your child’s eye while they’re asleep. Unlike nearly all other types of cancer, retinoblastomas can be diagnosed just by their appearance. So it’s not usually necessary to take a sample of tissue (a biopsy). Your child will have several more EUAs to check how treatment is progressing.

When retinoblastoma is diagnosed, your child may have some other tests to check the exact position and size of the tumour, and whether it has begun to spread into surrounding structures. This is known as staging.

They may have some of the following tests:

an ultrasound scan – this is a painless scan that uses sound waves to examine the eye and the surrounding area an MRI (magnetic resonance imaging) scan – this uses magnetism to build up a detailed picture of the eye and the head a lumbar puncture – the doctor inserts a fine needle between the bones in the lower spine to remove a sample of the fluid from around the brain and spinal cord (cerebrospinal fluid) then the fluid is examined under a microscope to check whether there are any cancer cells present a bone marrow sample – this may be taken to check whether there are any cancer cells in the bone marrow (where our blood cells are made); the doctor inserts a needle into the hip bone and draws some of the bone marrow out with a syringe so that it can be checked for any cancer cells a bone scan – this involves taking a series of X-rays to check for signs of any spread to the bones a blood test – this may be taken for genetic testing for the Rb gene; the results of this test can take some months

The doctor or a specialist nurse will explain more about the tests that your child needs.

Staging

The stage of a cancer is a term used to describe its size and whether it has spread from where it first started. Knowing the stage of your child’s retinoblastoma helps the doctors to decide on the most appropriate treatment.

The following staging system is commonly used for retinoblastoma.

Intraocular retinoblastoma

There is cancer in 1 or both eyes, but it has not spread to other parts of the eye or the tissues surrounding the eye. This stage may be sub-divided into 5 grades (A–E), depending on the size and position of the cancer and on whether there’s any damage to the eye.

Extraocular retinoblastoma

The cancer has spread outside the eye into surrounding tissue, or to other parts of the body.

Treatments

Treatment depends on the number, position and size of the tumours in the eye. The aim of treatment is to first get rid of the cancer, and secondly to try to keep the sight in the eye. Some treatments may cause changes to the vision in the affected eye. Your child’s specialist will talk to you about the possible risks as well as the advantages of the treatment.

Smaller tumours

For smaller tumours, treatment is given to the eye itself (called local therapy), while your child is asleep and under anaesthetic.

Cryotherapy

This is used to freeze the tumours. More than 1 session may be necessary, in which case they are usually done at monthly intervals.

Laser therapy

A laser is used to heat the tumour. Your child may need a number of sessions at intervals of 3 to 4 weeks.

Plaque

A small radioactive disc is stitched over the tumour on the outside of the eye. The disc needs to stay in place for up to 4 days while the radiation destroys the cancer cells. This is done for slightly larger tumours, or tumours that have not been successfully treated with other methods.

Thermotherapy

This process uses heat to destroy the cancer cells and may be combined with chemotherapy or radiotherapy, as heat can improve the effectiveness of these treatments. The heat is produced by a laser, which is directed at the tumour.

Larger tumours

Chemotherapy

This is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It may be given before the local treatments mentioned above, to help shrink the tumour and make treatment more successful. Chemotherapy can also be used if the cancer has spread to other parts of the body, or if there’s a risk that it may spread. The chemotherapy drugs most commonly used to treat retinoblastoma are carboplatin, etoposide, and vincristine.

Newer techniques include giving chemotherapy directly into the artery (the blood vessel) that supplies the eye (intra-arterial chemotherapy) or injecting chemotherapy into the central gelatinous part of the eye (intra-vitreal chemotherapy).

Surgery

If the tumour is very large and the vision in the eye is lost, your child is likely to need an operation to remove the eye. The specialist will only do this if it is absolutely necessary. An artificial eye is then fitted.

Radiotherapy

Radiotherapy treats cancer by using high energy rays from a machine to destroy the cancer cells, while doing as little harm as possible to normal cells. It can be given to the whole eye but does have some effect on the surrounding tissue. Radiotherapy for retinoblastoma is normally only used when other treatments have not worked well.

Side effects of treatment

The side effects will depend on the treatment your child is having. The immediate side effects will usually improve when treatment finishes. But unfortunately, some treatments may cause side effects that develop many years later. The specialist will explain all of this to you before treatment starts. Your child’s follow-up will include checking for any long-term effects of treatment.

Clinical trials

Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for children’s cancers.

If appropriate, your child’s medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information is provided to help explain things.

Taking part in a research trial is completely voluntary, and you’ll be given plenty of time to decide whether it’s right for your child.

Treatment guidelines

Sometimes, clinical trials are not available for your child’s tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines.

Follow-up care

At least 9 out of every 10 children with retinoblastoma are cured. Following treatment, the eye specialist will frequently examine your child’s eye under anaesthetic to check that the retina is healthy, the cancer has not come back, and no new tumours have developed. Follow-up is usually in a clinic for childhood cancers, called a paediatric oncology clinic.

Children with heritable retinoblastoma will be given genetic counselling when they are old enough to understand it.

Having the heritable form of retinoblastoma means an increased risk of developing other types of cancer later in life. Your child will be followed up closely into adulthood. They will be encouraged to get any new symptoms, such as a lump, checked early, and to have a healthy lifestyle to help to reduce cancer risk.

Rhabdomyosarcoma
of cancer, cancer types in children

More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past.

It’s devastating to hear that your child has cancer, and at times it can feel overwhelming. There are many healthcare professionals and support organisations to help you through this difficult time.

Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information and if you have any questions it is important to ask the specialist doctor or nurse who knows your child’s individual situation.

Sarcomas are rare types of tumour that develop in the supporting tissues of the body, such as bone, muscle or cartilage. There are 2 main types of sarcomas:

soft tissue sarcomas can develop in muscle, fat, blood vessels, or in any of the other tissues that support, surround and protect the organs of the body bone sarcomas can develop in any of the bones of the skeleton

Rhabdomyosarcoma is the most common of soft tissue sarcomas in children. These tumours develop from muscle or fibrous tissue and can grow in any part of the body.

The most common areas of the body to be affected are around the head and neck, bladder, testes, womb, or vagina.

Sometimes tumours are also found in a muscle or a limb, in the chest or in the abdominal wall. If the tumour is in the head or neck area, it can occasionally spread into the brain or the fluid around the spinal cord.


It’s devastating to hear that your child has cancer, and at times it can feel overwhelming. There are many healthcare professionals and support organisations to help you through this difficult time.

Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information and if you have any questions it is important to ask the specialist doctor or nurse who knows your child’s individual situation.

Sarcomas are rare types of tumour that develop in the supporting tissues of the body, such as bone, muscle or cartilage. There are 2 main types of sarcomas:

soft tissue sarcomas can develop in muscle, fat, blood vessels, or in any of the other tissues that support, surround and protect the organs of the body bone sarcomas can develop in any of the bones of the skeleton

Rhabdomyosarcoma is the most common of soft tissue sarcomas in children. These tumours develop from muscle or fibrous tissue and can grow in any part of the body.

The most common areas of the body to be affected are around the head and neck, bladder, testes, womb, or vagina.

Sometimes tumours are also found in a muscle or a limb, in the chest or in the abdominal wall. If the tumour is in the head or neck area, it can occasionally spread into the brain or the fluid around the spinal cord.


Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information and if you have any questions it is important to ask the specialist doctor or nurse who knows your child’s individual situation.

Sarcomas are rare types of tumour that develop in the supporting tissues of the body, such as bone, muscle or cartilage. There are 2 main types of sarcomas:

soft tissue sarcomas can develop in muscle, fat, blood vessels, or in any of the other tissues that support, surround and protect the organs of the body bone sarcomas can develop in any of the bones of the skeleton

Rhabdomyosarcoma is the most common of soft tissue sarcomas in children. These tumours develop from muscle or fibrous tissue and can grow in any part of the body.

The most common areas of the body to be affected are around the head and neck, bladder, testes, womb, or vagina.

Sometimes tumours are also found in a muscle or a limb, in the chest or in the abdominal wall. If the tumour is in the head or neck area, it can occasionally spread into the brain or the fluid around the spinal cord.

Symptoms

The most common symptom is a lump or swelling. Other symptoms will depend on the part of the body that’s affected by the rhabdomyosarcoma:

a tumour in the head or neck area can sometimes cause a blockage (obstruction) and discharge from the nose or throat; occasionally, an eye may appear swollen and protruding a tumour in the abdomen (tummy) can cause pain or discomfort in the abdomen and difficulty going to the toilet (constipation) a tumour in the bladder may cause symptoms such as blood in the urine and difficulty passing urine (peeing)

Causes

The causes of rhabdomyosarcoma are unknown but research is going on all the time. Children with certain rare genetic disorders, such as Li-Fraumeni syndrome, have a higher risk of developing rhabdomyosarcoma.

Diagnoses

Different tests are usually needed to diagnose a rhabdomyosarcoma. Your child may need a small operation to remove a sample from the tumour (a biopsy) so that it can be examined under a microscope. This is usually done under a general anaesthetic.

Tests may be done to check the exact size of the tumour and to find out if it has spread to any other part of the body. These may include:

a chest X-ray to check the lungs an ultrasound CT or MRI scans blood tests and bone marrow

Any tests and investigations that your child needs will be explained to you

Staging

The ‘stage’ of a cancer is a term used to describe its size and whether it has spread from where it first started. Knowing the stage helps the doctors decide on the most effective treatment for your child.

The staging system for rhabdomyosarcoma is based on:

where in the body the tumour started if it is in only one part of the body (localised disease), or if it has spread to another part of the body (metastatic disease).

There are different ways of staging rhabdomyosarcoma, and your child’s specialist doctor will explain more about the system they are using.

Treatments

Rhabdomyosarcomas are rare tumours and should be treated at specialist centres. Treatment will depend on the size of the tumour, its position in the body and whether it has spread.

The 3 main types of treatment for soft tissue sarcomas are chemotherapy, surgery and radiotherapy. Your child may have a combination of treatments.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It can be given:

to shrink the tumour before surgery after surgery to reduce the risk of rhabdomyosarcoma coming back

The drugs used and the length of treatment depends on the type and stage of the rhabdomyosarcoma.

Surgery

If it is possible, your child will have an operation to remove all or as much as possible of the tumour, without damaging surrounding tissue or organs. The operation will depend on the size of the tumour and where it is in your body. The surgeon will explain what is involved. Chemotherapy is usually given before surgery to shrink the tumour and make it easier to remove with surgery. If an operation isn’t possible, both chemotherapy and radiotherapy are given.

Radiotherapy

Radiotherapy treats cancer by using high energy rays, which destroy the cancer cells while doing as little harm as possible to normal cells. It may be given after surgery to the area where the rhabdomyosarcoma started.

Side effects of treatment

The side effects will depend on the treatment being given and the part of the body that is being treated. Your child’s doctor will discuss this with you before treatment starts. Most side effects are short-term (temporary) and gradually disappear once treatment stops.

Chemotherapy may cause side effects such as feeling sick, hair loss, tiredness, and an increased risk of infection. But it can also make your child feel better by relieving any symptoms the tumour is causing.

Radiotherapy can make your child feel tired, and the skin in the area that’s being treated may go red or get darker. Other side effects will depend on the area of the body that is being treated. Your child’s specialist doctor or nurse will explain this.

Late side effects

A small number of children may develop long-term side effects many years after treatment for rhabdomyosarcoma. This depends on the type of treatment your child had. Your child’s doctor or nurse will talk to you about any possible risk of late side effects. Follow-up for children who’ve had cancer includes close monitoring for any signs of any late effects.

Late effects may include a possible reduction in bone growth, infertility, a change in the way the heart and the kidneys work, and a slight increase in the risk of developing another cancer in later life.

Clinical trials

Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for children’s cancer. If appropriate, your child’s medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information is provided to help explain things.

Taking part in a research trial is completely voluntary, and you’ll be given plenty of time to decide if it’s right for your child.

Before any trial is allowed to take place, it must be approved by an ethics committee, which protects the interests of the patients taking part. If you decide to take part in a trial, your doctor or a research nurse must discuss the treatment with you so that you understand the trial and what it means for your child to take part. You may decide not to take part, or you can withdraw from a trial at any stage. You will then receive the best standard treatment available.

Treatment guidelines

Sometimes, clinical trials are not available for your child’s tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines.

Follow-up care

After treatment, the doctors will regularly check your child to be sure that the cancer has not come back and there are no complications. After a while, you will not need to visit the clinic so often.

If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows their situation in detail.

Rheumatoid arthritis
of muscle bone and joints, conditions

Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints.

The hands, feet and wrists are commonly affected, but it can also cause problems in other parts of the body.

There may be periods where your symptoms become worse, known as a flare-up or flare. A flare can be difficult to predict, but with treatment it is possible to decrease the number of flares and minimise or prevent long-term damage to the joints.

Read more about the symptoms of rheumatoid arthritis and living with rheumatoid arthritis.

Symptoms

Rheumatoid arthritis mainly affects the joints, although it can cause problems in other parts of the body too.

The symptoms of rheumatoid arthritis often develop gradually over several weeks, but some cases can progress quickly over a number of days.

The symptoms vary from person to person. They can come and go, and may change over time. You may occasionally experience flares when your condition deteriorates and your symptoms become more severe.


Rheumatoid arthritis is primarily a condition that affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected.

Rheumatoid arthritis typically affects the joints symmetrically (both sides of the body at the same time and to the same extent), but this is not always the case.

The main symptoms of rheumatoid arthritis affecting the joints are outlined below.

Pain

The joint pain associated with rheumatoid arthritis is usually a throbbing and aching pain. It is often worse in the mornings and after a period of inactivity.

Stiffness

Joints affected by rheumatoid arthritis can feel stiff. For example, if your hands are affected, you may not be able to fully bend your fingers or form a fist.

Like joint pain, the stiffness is often more severe in the morning or after a period of inactivity. Morning stiffness associated with another type of arthritis called osteoarthritis usually wears off within 30 minutes of getting up, but rheumatoid arthritis morning stiffness often lasts longer than this.

Swelling, warmth and redness

The lining of joints affected by rheumatoid arthritis become inflamed, which can cause the joints to swell, and become hot and tender to touch.

In some people, firm swellings called rheumatoid nodules can also develop under the skin around affected joints.


As well as problems affecting the joints, some people with rheumatoid arthritis experience a range of more general symptoms, such as:

tiredness and a lack of energy a high temperature (fever) sweating a poor appetite weight loss

The inflammation associated with rheumatoid arthritis can also sometimes cause problems affecting other areas of the body, including dry eyes if the eyes are affected and chest pain if the heart or lungs are affected. Read more about the complications of rheumatoid arthritis.

Causes

Rheumatoid arthritis is an autoimmune disease. This means that your immune system – which usually fights infection – attacks the cells that line your joints by mistake, making them swollen, stiff and painful.

Over time, this can damage the joint itself, the cartilage and nearby bone.

It’s not clear what triggers this problem with the immune system, although you are at an increased risk if you are a woman, you have a family history of rheumatoid arthritis, or you smoke.

Read more about the causes of rheumatoid arthritis.


Rheumatoid arthritis is an autoimmune condition, which means it is caused by the body’s immune system attacking itself. However, it is not yet known what triggers this.

Normally, your immune system makes antibodies that attack bacteria and viruses, helping fight infection. But if you have rheumatoid arthritis, your immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint.

This causes the thin layer of cells (synovium) covering your joints to become sore and inflamed.

This inflammation in turn causes chemicals to be released that thicken the synovium and damage nearby:

bones cartilage – the stretchy connective tissue between bones tendons – the tissue that connects bone to muscle ligaments – the tissue that connects bone and cartilage

If the condition is not treated, these chemicals gradually cause the joint to lose its shape and alignment and, eventually, can destroy the joint completely.

Various theories of why the immune system starts to attack the joints have been suggested, including that an infection or virus may trigger this, but none of these theories has been proven.

Diagnoses

Rheumatoid arthritis can be difficult to diagnose because many conditions cause joint stiffness and inflammation and there is no definitive test for the condition.

You should see your GP if you have these symptoms so they can try to determine the cause.


No blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but a number of tests can show possible indications of the condition. Some of the main tests used are outlined below.

Erythrocyte sedimentation rate (ESR)

In an ESR test, a sample of your red blood cells is placed into a test tube of liquid. The cells are then timed to see how fast they fall to the bottom of the tube (measured in millimetres per hour). If they are sinking faster than usual, you may have an inflammatory condition, such as rheumatoid arthritis.

C-reactive protein (CRP)

A CRP test can indicate if there is inflammation anywhere in the body by checking how much CRP is present in your blood. CRP is produced by the liver. If there is more CRP than usual, there is inflammation in your body.

Full blood count

The full blood count will measure your red cells to rule out anaemia. Anaemia is a condition where the blood is unable to carry enough oxygen, due to a lack of blood cells.

Anaemia is common in people with rheumatoid arthritis, although the problem can have many causes, so having anaemia does not prove that you have rheumatoid arthritis.

Rheumatoid factor and anti-CCP antibodies

Specific blood tests can help to diagnosis rheumatoid arthritis, but are not accurate in every person. About half of all people with rheumatoid arthritis have a positive rheumatoid factor present in their blood when the disease starts, but about one in every 20 people without rheumatoid arthritis also tests positive for this.

Another antibody test known as anti-CCP (anti-cyclic citrullinated peptide) is also available. People who test positive for anti-CCP are very likely to develop rheumatoid arthritis, but not everybody found to have rheumatoid arthritis has this antibody.

Those who test positive for both rheumatoid factor and anti-CCP may be more likely to have severe rheumatoid arthritis requiring higher levels of treatment.

Treatments

You should see your GP if you think you have symptoms of rheumatoid arthritis, so your GP can try to identify the underlying cause.

Diagnosing rheumatoid arthritis quickly is important because early treatment can help stop the condition getting worse and reduce the risk of further problems such as joint damage.

Read more about diagnosing rheumatoid arthritis.


There is no cure for rheumatoid arthritis, but early diagnosis and appropriate treatment enables many people with rheumatoid arthritis to have periods of months or even years between flares and to be able to lead full lives and continue regular employment.

The main treatment options include:

medication that is taken in the long-term to relieve symptoms and slow the progress of the condition supportive treatments, such as physiotherapy and occupational therapy, to help keep you mobile and find ways around any problems you have with daily activities surgery to correct any joint problems that develop 

Read more about treating rheumatoid arthritis.


You should see your GP if you think you have symptoms of rheumatoid arthritis.

There are a number of conditions that can cause problems such as joint pain and stiffness, so it’s important to get a proper diagnosis.

Diagnosing rheumatoid arthritis as soon as possible is particularly important because early treatment can help stop the condition getting worse and reduce the risk of further problems such as joint damage.

Read more about diagnosing rheumatoid arthritis.



Biological treatments are a newer form of treatment for rheumatoid arthritis. They include etanercept, infliximab, adalimumab, certolizumab, golimumab, rituximab, abatacept and tocilizumab.

They are usually taken in combination with methotrexate or another DMARD and are normally only used if these medications alone have not been effective.

Biological medications are given by injection and they work by stopping particular chemicals in the blood from activating your immune system to attack your joints.

Side effects from biological treatments are usually mild and include skin reactions at the site of the injections, infections, feeling sick, a high temperature (fever) and headaches.

Some people may also be at risk of getting more serious problems, including the reactivation of infections such as tuberculosis (TB) in people who have had them in the past.


Your doctor may also refer you to other services that might be able to help you with your rheumatoid arthritis symptoms.

Complications

Having rheumatoid arthritis can lead to several other conditions that may cause additional symptoms and can sometimes be life-threatening.

Possible complications include carpal tunnel syndrome, inflammation of other areas of the body (such as the lungs, heart and eyes), and an increased risk of heart attacks and strokes.

Ensuring that rheumatoid arthritis is well controlled helps reduce your risk of complications such as these.

Read more about the complications of rheumatoid arthritis.


Having rheumatoid arthritis can put you at a higher risk of developing other conditions, particularly if it isn’t well controlled.

Ringworm and other fungal infections
of infections and poisoning

Ringworm is a common fungal infection that can cause a red or silvery ring-like rash on the skin. Ringworm commonly affects arms and legs, but it can appear almost anywhere on the body. Despite its name, ringworm doesn’t have anything to do with worms.

Other similar fungal infections can affect the scalp, feet, groin and nails. These fungal infections, medically known as ‘tinea’, are not serious and are usually easily treated. However, they are contagious and easily spread.

Symptoms

The symptoms of a tinea fungal infection depend on where the infection is.

Causes

Fungal spores are passed between people through direct skin contact and by sharing objects such as towels, hairbrushes and bedding. Athlete’s foot is commonly spread in gym and swimming pool changing rooms.

Pets, such as dogs and cats, can have ringworm, and you can catch it by stroking them.

Read more about the causes of ringworm.


Tinea fungal infections are caused by a particular type of fungi, called dermatophytes, which live off keratin. Keratin is a tough, waterproof tissue found in many parts of your body, including your skin, hair and nails. This explains why fungal infections mostly affect your skin, scalp or nails.

Diagnoses

Ringworm and other tinea fungal infections are usually easy to diagnose from their appearance and location.

Treatments

See your GP if you or your child has a fungal scalp infection, as it’s treated with antifungal tablets, which are only available on prescription. Symptoms of a fungal scalp infection include small patches of scaly scalp skin (which may be sore), patchy hair loss and itchiness. Other types of fungal infections (including ringworm) are generally treated with antifungal cream from the pharmacy, and you don’t need to see a doctor unless it persists. However, pharmacists often prefer children to see a GP to confirm a diagnosis.


Most ringworm infections are mild and can be treated using a pharmacy antifungal cream. Scalp infections can be treated with antifungal tablets, sometimes combined with antifungal shampoo. If the skin is irritated or broken, it can lead to other bacterial infections, which may need treatment with antibiotics. Read more about how to treat fungal infections.


Make an appointment to see your GP if you:

or your child develop the symptoms of a fungal scalp infection have ringworm that has not improved after two weeks of treatment with antifungal cream have another medical condition, or you’re having medical treatment that is known to weaken your immune system, such as chemotherapy or steroid tablets

Read more about how fungal infections are diagnosed.


Most tinea fungal infections, including ringworm, are easily treated by using antifungal creams, tablets or shampoo. You can also help to get rid of fungal infections and stop them from spreading by:

washing areas of affected skin daily and drying thoroughly, paying particular attention to skin folds and between your toes in the case of a groin or foot infection, changing your underwear or socks daily, because fungi can persist in flakes of skin with a scalp infection, not sharing combs, hairbrushes or hats washing clothes, towels and bed linen frequently wearing loose-fitting clothes, preferably made of cotton or other natural materials

Read more about preventing ringworm.


Groin infections can sometimes occur at the same time as athlete’s foot. It’s vital to treat both infections at the same time to avoid being re-infected with either condition.

Preventions

The following advice will help to stop fungal infections from spreading. The fungi that cause tinea infections can survive on items such as furniture, hairbrushes, clothing and towels, and can be spread through contact with these items. Therefore, if someone in your household has a fungal infection, you should:

avoid sharing personal items – such as combs, hairbrushes, towels, clothing and bed linen avoid scratching the affected areas of your skin or scalp, because it could spread the infection to other parts of your body

It’s important that other household members check themselves for signs of infection and get treatment if necessary. If you suspect that your pet is the source of the infection, take them to your vet for treatment. Patches of missing fur is a sign that an animal has ringworm. Always wash your hands after touching a pet with the infection. If someone in your family has a fungal infection, there is no need for them to stay off work or school. However, treatment should be started as soon as possible. Good personal hygiene should also be followed to stop it spreading to other children. Wearing something on your feet in gym and swimming pool changing rooms will reduce your chances of getting athlete’s foot. Find out how to treat fungal infections.

Rosacea
of skin hair and nails

Rosacea is a common but poorly understood long-term skin condition that mainly affects the face.

It can be controlled to some degree with long-term treatment, but sometimes the changes in physical appearance can have a significant psychological impact.

Symptoms

Symptoms often begin with episodes of flushing, where the skin turns red for a short period, but other symptoms can develop as the condition progresses, such as:

burning and stinging sensations permanent redness spots (papules and pustules) small blood vessels in the skin becoming visible

Rosacea is a relapsing condition, which means there are periods when symptoms are particularly bad, but less severe at others.

Read about the symptoms of rosacea

Rosacea symptoms include redness and flushing, as well as stinging and spots.Source: https://dermnetnz.org/


Rosacea causes a range of symptoms, although not everyone will experience them all.

Most people with rosacea have periods when their symptoms are particularly troublesome, followed by periods when their symptoms are less so.

The main symptoms of rosacea include:

flushing persistent facial redness visible blood vessels papules and pustules thickened skin

These are discussed in more detail below.

Other symptoms associated with rosacea include:

sensitive skin – burning, itching, stinging and pain dry, rough skin raised red patches (plaques) on your skin facial swelling (lymphoedema)

Rosacea can cause different symptoms, including facial redness and flushing.Source: https://dermnetnz.org/

Permanent damage to the face (scarring) almost never occurs in rosacea.

Causes

The exact cause of rosacea is unknown, although a number of possible factors have been suggested, including abnormalities in the blood vessels of the face and a reaction to microscopic mites commonly found on the face.

Although they’re not thought to be direct causes of the condition, several triggers have been identified that may make rosacea worse.

These include:

exposure to sunlight stress strenuous exercise hot or cold weather hot drinks alcohol and caffeine certain foods, such as spicy foods

Read about causes of rosacea


The exact cause of rosacea is unknown, although a number of potential factors have been suggested.

It’s possible a combination of these factors may be responsible for the condition, although there isn’t enough evidence to say this for certain.

Some of the main factors that have been suggested are outlined below.

Treatments

See your GP if you have persistent symptoms that could be caused by rosacea. Early diagnosis and treatment can help stop the condition getting worse.

There’s no specific test for rosacea, but your GP will often be able to diagnose the condition by:

examining your skin asking about your symptoms asking about possible triggers you may have

In some circumstances your GP may arrange further tests to rule out other conditions with similar symptoms, such as lupus or the menopause. For example, these could be a blood test or skin biopsy, where a small scraping of skin is removed and examined.


There’s currently no cure for rosacea, but treatment can help control the symptoms.

Long-term treatment is usually necessary, although there may be periods when your symptoms improve and you can stop treatment temporarily.

For most people, treatment involves a combination of self-help measures and medication, such as:

avoiding known triggers – for example, avoiding drinks containing alcohol or caffeine creams and gels – medications applied directly to the skin to reduce spots and redness oral medications – tablets or capsules that can help clear up more severe spots, such as oral antibiotics

In some cases procedures such as laser and intense pulsed light (IPL) treatment may be helpful. These involve beams of light being aimed at the visible blood vessels in the skin to shrink them and make them less visible.

Read about more about treating rosacea and self-help measures for rosacea


Although rosacea can’t be cured, treatment can help keep the symptoms under control.

Long-term treatment is usually necessary, although there may be periods where your symptoms improve and you can stop treatment temporarily.

Treatment choices depend on which type of symptom is most troublesome, but usually involves a combination of self-help measures and medication, and are outlined below. 


If you have round red bumps that rise from your skin (papules) and pus-filled swellings (pustules) caused by rosacea, there are a number of different medications that can be effective.

These can be divided into topical treatments that are applied to the skin, or oral treatments, which are taken by mouth.

Topical treatments

Topical medications are usually prescribed first. These include:

metronidazole cream or gel azelaic acid cream or gel ivermectin cream

Ivermectin is a relatively new medicine. There’s some evidence to suggest it may be more effective and perhaps less irritating to the skin than metronidazole, although it’s not currently available on the NHS everywhere and may only be recommended if the other treatments don’t work.

You’ll usually need to apply these topical treatments once or twice a day, taking care not to get them in your eyes or mouth. It may be several weeks before you notice any significant improvement in your symptoms.

Side effects of these treatments can include a burning or stinging sensation, itchiness and dry skin.

Oral antibiotics

If your symptoms are more severe, an oral antibiotic medication may be recommended as these can help reduce inflammation of the skin.

Antibiotics often used to treat rosacea include tetracycline, oxytetracycline, doxycycline and erythromycin. 

These medications are usually taken for 4 to 6 weeks, but longer courses may be necessary if the spots are persistent.

For example, a low-dose doxycycline capsule is available if oral antibiotics need to be taken long term.

Common side effects of these medications include:

feeling and being sick diarrhoea bloating and indigestion tummy (abdominal) pain loss of appetite

Some of the medications used can also make your skin sensitive to sunlight and artificial sources of light, such as sun lamps and sunbeds.

As with the topical treatments mentioned above, these medications usually need to be taken once or twice a day and you may not notice a significant improvement in your symptoms for several weeks.


Treating facial redness and flushing caused by rosacea is generally more difficult than treating papules and pustules caused by the condition. 

But as well as the self-help measures mentioned above, there are some medications that can help.

Brimonidine tartrate

Brimonidine tartrate is a relatively new medication for facial redness caused by rosacea. It comes in the form of a gel that’s applied to the face once a day.

The medication works by restricting the widening (dilation) of the blood vessels in your face. Research has shown it can start to have an effect about 30 minutes after it’s first used, and this can last for around 12 hours.

Common side effects of brimonidine tartrate include itchiness and a burning sensation where the gel is applied.

Less common side effects can include:

a dry mouth headaches pins and needles dry skin

A rebound effect, where flushing becomes worse, has also been reported with this medication.

Oral treatments

Alternatively, there are a number of oral medications that may help improve redness caused by rosacea.

These include:

clonidine – a medication that relaxes the blood vessels beta-blockers – medications that decrease the activity of the heart anxiety medications – medications sometimes used to help calm the person and reduce blushing 

It’s not clear how effective these medications are at treating redness caused by rosacea, but they may sometimes be prescribed under the supervision of a dermatologist.

Laser and intense pulsed light (IPL) treatment

Redness and visible blood vessels (telangiectasia) can also sometimes be successfully improved with vascular laser or intense pulsed light (IPL) treatment. These treatments may also improve flushing.

A referral to a dermatologist is usually required before having these treatments and they’re not usually available on the NHS, so you may need to pay for them privately. Around 2 to 4 treatments may be needed, so the overall cost may be significant.

Laser and IPL machines produce narrow beams of light that are aimed at the visible blood vessels in the skin. The heat from the lasers damages the dilated veins and causes them to shrink so they’re no longer visible, with minimal scarring or damage to the surrounding area.

Laser treatment can cause pain, but most people don’t need an anaesthetic. Side effects of laser treatment are usually mild and can include:

bruising crusting of the skin swelling and redness of the skin blisters (in rare cases) infection (in very rare cases)

These side effects usually only last a few days and are rarely permanent.


In some people with rosacea the skin of the nose can become thickened. This is known as rhinophyma.

If you have severe rhinophyma, your GP may refer you to a dermatologist or plastic surgeon to discuss ways the appearance of your skin can be improved.

A number of surgical treatments are available to remove any excess tissue and remodel the nose into a more pleasing shape.

This may be done with a laser, a scalpel or specially designed abrasive instruments using a technique called dermabrasion.


If rosacea is affecting your eyes (ocular rosacea), you may require further treatment. 

For example, you may need to use lubricating eye drops or ointment if you have dry eyes, or oral antibiotics if you have blepharitis.

If initial treatment isn’t effective or you develop any further problems with your eyes, you’ll need to be referred to an eye specialist called an ophthalmologist for further assessment and treatment.

Preventions

If you have rosacea, there are a number of things you can do to help keep the condition under control.

Scabies
of skin hair and nails

Scabies is a contagious skin condition caused by tiny mites that burrow into the skin.

The main symptom of scabies is intense itching that’s worse at night. It also causes a skin rash on areas where the mites have burrowed.

Read more about the symptoms of scabies.

Symptoms

The main symptoms of scabies are intense itching and a rash in areas of the body where the mites have burrowed.

The itching is often worse at night, when your skin is warmer. It may take 4 to 6 weeks before the itching starts because this is how long it takes for the body to react to mite droppings.

Symptoms will start within 1 to 2 days if you’ve had a scabies infection in the past. This is because your immune system will have learned to respond to a scabies infection.

Causes

Scabies is a skin condition caused by the parasite Sarcoptes scabiei.

The intense itching associated with scabies is thought to be caused by the immune system reacting to the mites and their saliva, eggs and faeces.

Diagnoses

Your GP should be able to diagnose scabies from the appearance of your skin, and by looking for the burrow marks of the Sarcoptes scabiei mite.

However, as scabies is spread very easily, it’s often possible to make a confident diagnosis if more than one family member has the same symptoms.

Your GP will also want to rule out other skin conditions that may be causing your symptoms, such as eczema or impetigo (a highly contagious bacterial skin infection).

Read more about the symptoms of scabies.


The burrows of scabies mites can be identified by using an ink test. Ink is rubbed around an area of itchy skin before being wiped off with an alcohol pad.

If scabies burrows are present, some of the ink will remain and will have tracked into the burrows, showing up as a dark line.

To confirm the diagnosis, a skin sample may be gently scraped from the affected area so it can be examined under a microscope for evidence of scabies mites, their eggs and faeces (poo).

Treatments

Visit your GP if you think you have scabies. It’s not usually a serious condition, but it does need to be treated.

The 2 most widely used treatments for scabies are permethrin cream and malathion lotion (brand name Derbac M). Both medications contain insecticides that kill the scabies mite.

Permethrin 5% cream is usually recommended as the first treatment. Malathion 0.5% lotion is used if permethrin is ineffective.

If your partner has been diagnosed with genital scabies, to avoid reinfection you should visit your nearest sexual health clinic so you can be checked and, if necessary, treated.

Avoid having sex and other forms of close bodily contact until both you and your partner have completed the full course of treatment.

Read more about diagnosing scabies and treating scabies.


See your GP immediately if you have scabies and you haven’t had a previous infection. Delaying treatment places other people at risk.

As other more serious skin conditions can sometimes cause similar symptoms to the symptoms of scabies, your GP will need to rule these out.

If you have scabies, your partner will also need to be treated regardless of whether or not they have any symptoms. This is because it’s highly likely that scabies will have been transmitted through close bodily contact, such as during sex.

To reduce the risk of reinfection, avoid having sex and other forms of prolonged close bodily contact, such as holding hands, until both you and your partner have completed the full course of treatment.

If you’ve been diagnosed with scabies, you may be advised to visit your nearest sexual health clinic to be checked and, if necessary, treated for other sexually transmitted infections (STIs).


Your GP should be able to prescribe treatments, such as a mild steroid cream, to reduce the itchiness. Menthol cream or gel, available from pharmacies without a prescription, may also help relieve itchy skin.

Oral sedative antihistamines are also available from your local pharmacy and can be used to control itching and help you get a better night’s sleep.

As this type of antihistamine can cause drowsiness, you should avoid driving or operating heavy machinery if you’re affected in this way.

Non-sedating antihistamines don’t help relieve the itching of scabies. Check with your GP or pharmacist if you’re unsure.

You may continue to experience itchiness for a couple of weeks after your treatment has been completed. This is because your immune system will still be reacting to the presence of dead mites and their droppings.

Visit your GP if you’re still experiencing itchiness 6 weeks after completing your treatment.

Complications

Scabies can sometimes lead to a secondary skin infection if your skin becomes irritated and inflamed through excessive itching.

Crusted scabies is a rare but more severe form of scabies, where a large number of mites are in the skin. This can develop in older people and those with a lowered immunity.

Read more about complications of scabies.


A secondary infection and crusted scabies are 2 possible complications of scabies.