Scarlet fever
of infections and poisoning

The illness is caused by Streptococcus pyogenes bacteria, also known as Group A Streptococcus, which are found on the skin and in the throat.



The symptoms of scarlet fever usually develop 2 to 5 days after infection. However, the incubation period (the period between exposure to the infection and symptoms appearing) can be as short as one day or as long as 7 days.

Speak to your GP if: You or your child: have symptoms of scarlet fever do not get better in a week (after seeing a GP) have scarlet fever and chickenpox at the same time are ill again weeks after scarlet fever got better – this can be a sign of a complication like rheumatic fever are feeling unwell and have been in contact with someone who has scarlet fever 

Rash

The distinctive rough pink-red rash caused by scarlet fever.https://dermnetnz.org/

The distinctive pink-red rash caused by scarlet fever develops 12 to 48 hours after symptoms like a sore throat or headache.

Red blotches are the first sign of the rash. These turn into a fine pink-red rash that feels like sandpaper to touch and looks like sunburn. It may also be itchy.

On darker skin the rash may be more difficult to see although its rough texture should be apparent.

The rash usually starts on the chest and stomach, but soon spreads to other parts of the body, like the:

ears neck elbows inner thighs groin

The rash doesn’t usually spread to the face. However, the cheeks become flushed and the area just around the mouth stays quite pale. The rash will turn white if you press a glass on it.

The rash usually fades after about a week, but the outer layers of skin, usually on the hands and feet, may peel for several weeks afterwards.

In milder cases, sometimes called scarlatina, the rash may be the only symptom.

Other symptoms of scarlet fever

Other symptoms of scarlet fever may include:

swollen neck glands loss of appetite nausea or vomiting red lines in the folds of the body, such as the armpit, which may last a couple of days after the rash has gone a white coating on the tongue, which peels a few days later leaving the tongue red and swollen (this is known as strawberry tongue) a general feeling of being unwell

Symptoms

Scarlet fever usually follows a sore throat or a skin infection, like impetigo, caused by particular strains of Streptococcus bacteria.

The symptoms of scarlet fever usually develop 2 to 5 days after infection. However, the incubation period (the period between exposure to the infection and symptoms appearing) can be as short as one day or as long as 7 days.

Speak to your GP if: You or your child: have symptoms of scarlet fever do not get better in a week (after seeing a GP) have scarlet fever and chickenpox at the same time are ill again weeks after scarlet fever got better – this can be a sign of a complication like rheumatic fever are feeling unwell and have been in contact with someone who has scarlet fever 

Rash

The distinctive rough pink-red rash caused by scarlet fever.https://dermnetnz.org/

The distinctive pink-red rash caused by scarlet fever develops 12 to 48 hours after symptoms like a sore throat or headache.

Red blotches are the first sign of the rash. These turn into a fine pink-red rash that feels like sandpaper to touch and looks like sunburn. It may also be itchy.

On darker skin the rash may be more difficult to see although its rough texture should be apparent.

The rash usually starts on the chest and stomach, but soon spreads to other parts of the body, like the:

ears neck elbows inner thighs groin

The rash doesn’t usually spread to the face. However, the cheeks become flushed and the area just around the mouth stays quite pale. The rash will turn white if you press a glass on it.

The rash usually fades after about a week, but the outer layers of skin, usually on the hands and feet, may peel for several weeks afterwards.

In milder cases, sometimes called scarlatina, the rash may be the only symptom.

Other symptoms of scarlet fever

Other symptoms of scarlet fever may include:

swollen neck glands loss of appetite nausea or vomiting red lines in the folds of the body, such as the armpit, which may last a couple of days after the rash has gone a white coating on the tongue, which peels a few days later leaving the tongue red and swollen (this is known as strawberry tongue) a general feeling of being unwell

Treatments

If you think you or your child may have scarlet fever, see your GP for a proper diagnosis and appropriate treatment. It usually clears up after about a week

Your GP should be able to diagnose scarlet fever by examining the distinctive rash and asking about other symptoms. They may also decide to take a sample of saliva from the back of the throat so it can be tested in a laboratory to confirm the diagnosis.

There’s no evidence to suggest that catching scarlet fever when pregnant will put your baby at risk. However, if you’re heavily pregnant, tell the doctors and midwives in charge of your care if you’ve been in contact with someone who has scarlet fever.


Most cases of scarlet fever clear up after about a week without treatment. However, your GP may recommend treatment as it:

reduces the length of time you’re infectious speeds up recovery lowers the risk of complications of scarlet fever

With treatment, most people recover in about 4 to 5 days and can return to nursery, school or work 24 hours after starting antibiotic treatment.

Without treatment, you’ll be infectious for 1 to 2 weeks after symptoms appear.

Antibiotics

Scarlet fever is usually treated with a 10-day course of antibiotics. This is often in the form of penicillin or amoxicillin tablets, although liquid may be used for young children.

For people who are allergic to penicillin, alternative antibiotics like erythromycin can be used instead.

The symptoms usually improve within 24 hours of starting antibiotics, with the other symptoms disappearing within a few days. However, it’s important that the whole course of treatment is completed to ensure the infection is fully cleared and reduce the potential for antibiotic resistance.

Keep your child away from nursery or school for at least 24 hours after starting antibiotic treatment. Adults with scarlet fever should also stay off work for at least 24 hours after starting treatment.

Self care

Many of the symptoms of scarlet fever can be relieved using some simple self care measures.

Do drink plenty of cool fluidseat soft foods (if your throat is painful)take paracetamol to bring down a high temperatureuse calamine lotion or antihistamines to relieve itching

Preventions

There’s currently no vaccine for scarlet fever.

If your child has scarlet fever, keep them away from nursery or school for at least 24 hours after starting treatment with antibiotics. Adults with the illness should also stay off work for at least 24 hours after starting treatment.

GPs, schools and nurseries should be aware of the current high levels of scarlet fever and inform local health protection teams if they become aware of cases, particularly if more than one child is affected.

Do cover your mouth and nose with a tissue when coughing or sneezing wash your hands with soap and water after using or disposing of tissues.

Don’t do not share contaminated utensils, cups and glasses, clothes, baths, bed linen or towels

Complications

Most cases of scarlet fever don’t cause complications, particularly if the condition is properly treated.

However, there’s a small risk of the infection spreading to other parts of the body and causing more serious infections, like:

an ear infection a throat abscess (painful collection of pus) sinusitis (inflammation of the sinuses) pneumonia (inflammation of the lungs)

Very rare complications that can occur at a later stage include:

bacteraemia (an infection of the bloodstream) septic arthritis meningitis necrotising fasciitis (a severe infection involving death of areas of soft tissue below the skin) Streptococcal toxic shock syndrome (rapidly progressive symptoms with low blood pressure and multi-organ failure)

Speak to your GP immediately if: You or child develop any of these symptoms in the first few weeks after the main infection has cleared up: feeling very unwell severe pain severe headaches vomiting diarrhoea If your GP is closed, phone the 111 service.

Schizophrenia
of mental health

Schizophrenia is a long-term mental health condition that causes a range of different psychological symptoms, including:

hallucinations – hearing or seeing things that do not exist delusions – unusual beliefs not based on reality that often contradict the evidence muddled thoughts based on hallucinations or delusions changes in behaviour

Doctors often describe schizophrenia as a psychotic illness. This means sometimes a person may not be able to distinguish their own thoughts and ideas from reality.

Read more about the symptoms of schizophrenia.

Symptoms

Changes in thinking and behaviour are the most obvious signs of schizophrenia, but people can experience symptoms in different ways.

The symptoms of schizophrenia are usually classified into one of two categories – positive or negative.

positive symptoms – represent a change in behaviour or thoughts, such as hallucinations or delusions negative symptoms – represent a withdrawal or lack of function that you would usually expect to see in a healthy person; for example, people with schizophrenia often appear emotionless, flat and apathetic

The condition may develop slowly. The first signs of schizophrenia, such as becoming socially withdrawn and unresponsive or experiencing changes in sleeping patterns, can be hard to identify. This is because the first symptoms often develop during adolescence and changes can be mistaken for an adolescent “phase”.

People often have episodes of schizophrenia, during which their symptoms are particularly severe, followed by periods where they experience few or no positive symptoms. This is known as acute schizophrenia.

If you are experiencing symptoms of schizophrenia, see your GP as soon as possible. The earlier schizophrenia is treated, the more successful the outcome tends to be.

Read more information about how schizophrenia is diagnosed.


Hallucinations

A hallucination is when a person experiences a sensation but there is nothing or nobody there to account for it. It can involve any of the senses, but the most common is hearing voices.

Hallucinations are very real to the person experiencing them, even though people around them cannot hear the voices or experience the sensations.

Research using brain-scanning equipment shows changes in the speech area in the brains of people with schizophrenia when they hear voices. These studies show the experience of hearing voices as a real one, as if the brain mistakes thoughts for real voices.

Some people describe the voices they hear as friendly and pleasant, but more often they are rude, critical, abusive or annoying. The voices might describe activities taking place, discuss the hearer’s thoughts and behaviour, give instructions, or talk directly to the person. Voices may come from different places or one place in particular, such as the television.

Delusions

A delusion is a belief held with complete conviction, even though it is based on a mistaken, strange or unrealistic view. It may affect the way people behave. Delusions can begin suddenly, or may develop over weeks or months.

Some people develop a delusional idea to explain a hallucination they are having. For example, if they have heard voices describing their actions, they may have a delusion that someone is monitoring their actions.

Someone experiencing a paranoid delusion may believe they are being harassed or persecuted. They may believe they are being chased, followed, watched, plotted against or poisoned, often by a family member or friend.

Some people who experience delusions find different meanings in everyday events or occurrences. They may believe people on TV or in newspaper articles are communicating messages to them alone, or that there are hidden messages in the colours of cars passing on the street.

Confused thoughts (thought disorder)

People experiencing psychosis often have trouble keeping track of their thoughts and conversations. Some people find it hard to concentrate and will drift from one idea to another. They may have trouble reading newspaper articles or watching a TV programme.

People sometimes describe their thoughts as “misty” or “hazy” when this is happening to them. Thoughts and speech may become jumbled or confused, making conversation difficult and hard for other people to understand.

Changes in behaviour and thoughts

A person’s behaviour may become more disorganised and unpredictable, and their appearance or dress may seem unusual to others. People with schizophrenia may behave inappropriately or become extremely agitated and shout or swear for no reason.

Some people describe their thoughts as being controlled by someone else, that their thoughts are not their own, or that thoughts have been planted in their mind by someone else.

Another recognised feeling is that thoughts are disappearing, as though someone is removing them from their mind. Some people feel their body is being taken over and someone else is directing their movements and actions.


The negative symptoms of schizophrenia can often appear several years before somebody experiences their first acute schizophrenic episode. These initial negative symptoms are often referred to as the prodromal period of schizophrenia.

Symptoms during the prodromal period usually appear gradually and slowly get worse. They include becoming more socially withdrawn and experiencing an increasing lack of care about your appearance and personal hygiene.

It can be difficult to tell whether the symptoms are part of the development of schizophrenia or caused by something else. Negative symptoms experienced by people living with schizophrenia include:

losing interest and motivation in life and activities, including relationships and sex  lack of concentration, not wanting to leave the house, and changes in sleeping patterns  being less likely to initiate conversations and feeling uncomfortable with people, or feeling there is nothing to say

The negative symptoms of schizophrenia can often lead to relationship problems with friends and family because they can sometimes be mistaken for deliberate laziness or rudeness.

Causes

The exact cause of schizophrenia is unknown. However, most experts believe the condition is caused by a combination of genetic and environmental factors.

It is thought certain things make you more vulnerable to developing schizophrenia, and certain situations can trigger the condition.

Read more about the causes of schizophrenia.


The exact causes of schizophrenia are unknown, but research suggests that a combination of physical, genetic, psychological and environmental factors can make people more likely to develop the condition.

Current thinking is that some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode. However, it’s not known why some people develop symptoms while others don’t.

Diagnoses

There is no single test for schizophrenia. The condition is usually diagnosed after assessment by a specialist in mental health.

If you are concerned you may be developing symptoms of schizophrenia, see your GP as soon as possible. The earlier schizophrenia is treated, the more successful the outcome tends to be.

Your GP will ask about your symptoms and check they are not the result of other causes, such as recreational drug use.


If you or a friend or relative are diagnosed with schizophrenia, you may feel anxious about what will happen. You may be worried about the stigma attached to the condition, or feel frightened and withdrawn.

It is important to remember that a diagnosis can be a positive step towards getting good, straightforward information about the illness and the kinds of treatment and services available.

Treatments

Schizophrenia is usually treated with a combination of medication and therapy appropriate to each individual. In most cases, this will be antipsychotic medicines and cognitive behavioural therapy (CBT).

People with schizophrenia will usually receive help from a community mental health team (CMHT), which will offer day-to-day support and treatment.

Many people recover from schizophrenia, although they may have periods when symptoms return (relapses). Support and treatment can help reduce the impact the condition has on your life.

Read more about treating schizophrenia.



Psychological treatment can help people with schizophrenia cope with the symptoms of hallucinations or delusions better. They can also help treat some of the negative symptoms of schizophrenia, such as apathy or a lack of enjoyment.

Psychological treatments for schizophrenia work best when they are combined with antipsychotic medication. Common psychological treatments include:

Scoliosis
of muscle bone and joints, conditions

Scoliosis is the abnormal twisting and curvature of the spine.

It is usually first noticed by a change in appearance of the back.

Typical signs include:

a visibly curved spine one shoulder being higher than the other one shoulder or hip being more prominent than the other clothes not hanging properly a prominent ribcage a difference in leg lengths

Back pain is common in adults with scoliosis. Young people with scoliosis may also experience some discomfort but it’s less likely to be severe.

Causes

In around eight out of every 10 cases, a cause for scoliosis is not found. This is known as idiopathic scoliosis.

A small number of cases are caused by other medical conditions, including:

cerebral palsy – a condition  associated with brain damage muscular dystrophy – a genetic condition that causes muscle weakness  Marfan syndrome – a disorder of the connective tissues

Rarely, babies can be born with scoliosis, as a result of a problem with the development of the spine in the womb.

In adults, age related changes in the discs and joints of the spine and a reduction in bone density may cause scoliosis. Adults can also experience worsening over time of previously undiagnosed or untreated scoliosis.

Read more about the causes of scoliosis.


In most cases, the cause of scoliosis is unknown and it cannot usually be prevented.

It is not thought to be linked with things such as bad posture, exercise or diet.

If the cause of scoliosis is unknown, it is called idiopathic scoliosis. About eight out of every 10 cases of scoliosis are idiopathic.

However, researchers have found there is a family history of the condition in some idiopathic cases, which suggests a possible genetic link.

Idiopathic scoliosis can affect adults and children. Some cases may only become noticable in later life.


In a small number of cases, a cause is identified.

Other health conditions

Some cases of scoliosis are caused by conditions that affect the nerves and muscles (neuromuscular conditions), such as:

cerebral palsy – a condition that affects the brain and nerves and occurs during or shortly after birth muscular dystrophy – a genetic condition that causes muscle weakness neurofibromatosis – a genetic condition that causes benign tumours to grow along your nerves

Scoliosis can also develop as part of a pattern of symptoms called a syndrome. This is known as syndromic scoliosis. Conditions that can cause syndromic scoliosis include:

Marfan syndrome – a disorder of the connective tissues inherited by a child from their parents Rett syndrome – a genetic disorder, usually affecting females, which causes severe physical and mental disability

These conditions are usually diagnosed at a young age and children with them are often monitored for problems such as scoliosis.

Birth defects

In rare cases, babies can be born with scoliosis. This is known as congenital scoliosis. Congenital scoliosis is caused by the bones in the spine developing abnormally in the womb.

Long-term damage

In adults, scoliosis can sometimes be caused by gradual deterioration to the parts of the spine. This is known as degenerative scoliosis.

This can occur because some parts of the spine become narrower and weaker (osteoporosis) with age.

Diagnoses

Scoliosis can usually be diagnosed after a physical examination of the spine, ribs, hips and shoulders.

You may be asked to bend forward to see if any areas are particularly prominent. For example, one of your shoulders may be higher than the other or there may be a bulge in your back.

Initial examinations are usually carried out by a GP. If scoliosis is suspected, you should be referred to an orthopaedic specialist (a specialist in conditions that affect the skeleton) for further tests and to discuss treatment.

Treatments

If you or your child have signs of scoliosis, make an appointment to see your GP. They can examine your back and can refer you for an X-ray for confirmation.

If you or your child are diagnosed with scoliosis, it’s important to see a scoliosis specialist to talk about treatment options.

Read more about diagnosing scoliosis.

Rarely scoliosis can cause a condition called cauda equina syndrome to develop. Cauda equina syndrome is a rare but serious back condition which can lead to permanent damage or disability. If you develop this condition you’ll need to be seen by an emergency specialist spinal team.

Phone 111 if: there has been a new, significant trauma within the last 7 days, for example a fall from height or direct blow to the back Or you have experienced a new onset of the following symptoms: loss of feeling/pins and needles between your inner thighs or genitals numbness in or around your back passage or buttocks altered feeling when using toilet paper to wipe yourself increasing difficulty when you try to urinate increasing difficulty when you try to stop or control your flow of urine loss of sensation when you pass urine leaking urine or recent need to use pads not knowing when your bladder is either full or empty inability to stop a bowel movement or leaking loss of sensation when you pass a bowel motion change in ability to achieve an erection or ejaculate loss of sensation in genitals during sexual intercourse


Treatment for scoliosis depends on your age, how severe it is, and whether it’s thought it will worsen with time.

In very young children, treatment is not always necessary because the curvature of the spine may improve naturally as they get older. If treatment is necessary, bracing or casting may be used to attempt to halt the curve’s progression.

If the infant or younger child’s curve continues to progress despite bracing or casting, an operation may be necessary. This will usually involve inserting metal rods into the back to stabilise the spine, which are lengthened at regular intervals as your child grows.

In older children and adults, it is unlikely that scoliosis will improve with time, and in some it may progressively worsen.

The main treatments for older children are:

a back brace worn until they stop growing, to prevent the spine from curving further surgery to correct the curvature – where the spine is straightened using rods attached to the spine by screws, hooks and/or wires

In adults, treatment primarily aims to relieve any pain. Non-surgical options, such as painkillers and exercises are often tried first, with correctional surgery seen as a last resort.

Read more about treating scoliosis in children and treating scoliosis in adults.


If your child has scoliosis, their treatment will depend on their age and how severe it is.

The main treatment options are:

observation casting bracing surgery

These are described below.

There is a separate page about treating scoliosis in adults.


Back pain is one of the main problems caused by scoliosis in adults, so treatment is mainly aimed at pain relief.

In some cases, surgery may be carried out to improve the shape of the spine as a way of helping with back and leg pains.


Rarely scoliosis can cause a condition called cauda equina syndrome to develop. Cauda equina syndrome is a rare but serious back condition which can lead to permanent damage or disability. If you develop this condition you’ll need to be seen by an emergency specialist spinal team.

Phone 111 if: there has been a new, significant trauma within the last 7 days, for example a fall from height or direct blow to the back Or you have experienced a new onset of the following symptoms: loss of feeling/pins and needles between your inner thighs or genitals numbness in or around your back passage or buttocks altered feeling when using toilet paper to wipe yourself increasing difficulty when you try to urinate increasing difficulty when you try to stop or control your flow of urine loss of sensation when you pass urine leaking urine or recent need to use pads not knowing when your bladder is either full or empty inability to stop a bowel movement or leaking loss of sensation when you pass a bowel motion change in ability to achieve an erection or ejaculate loss of sensation in genitals during sexual intercourse

Complications

Physical complications of scoliosis are rare, although serious problems can develop if it’s left untreated.

Septic shock
of blood and lymph

Any type of bacteria can cause the infection. Fungi such as candida and viruses can also be a cause, although this is rare.

At first the infection can lead to a reaction called sepsis. This begins with:

weakness chills a rapid heart and breathing rate

Left untreated, toxins produced by bacteria can damage the small blood vessels, causing them to leak fluid into the surrounding tissues.

This can affect your heart’s ability to pump blood to your organs, which lowers your blood pressure and means blood doesn’t reach vital organs, such as the brain and liver.

Phone 999 immediately if: You think that you or someone in your care has symptoms of septic shock like: low blood pressure (hypotension) that makes you feel dizzy when you stand up a change in your mental state, like confusion or disorientation diarrhoea nausea and vomiting cold, clammy and pale skin


At first the infection can lead to a reaction called sepsis. This begins with:

weakness chills a rapid heart and breathing rate

Left untreated, toxins produced by bacteria can damage the small blood vessels, causing them to leak fluid into the surrounding tissues.

This can affect your heart’s ability to pump blood to your organs, which lowers your blood pressure and means blood doesn’t reach vital organs, such as the brain and liver.

Phone 999 immediately if: You think that you or someone in your care has symptoms of septic shock like: low blood pressure (hypotension) that makes you feel dizzy when you stand up a change in your mental state, like confusion or disorientation diarrhoea nausea and vomiting cold, clammy and pale skin


weakness chills a rapid heart and breathing rate

Left untreated, toxins produced by bacteria can damage the small blood vessels, causing them to leak fluid into the surrounding tissues.

This can affect your heart’s ability to pump blood to your organs, which lowers your blood pressure and means blood doesn’t reach vital organs, such as the brain and liver.

Phone 999 immediately if: You think that you or someone in your care has symptoms of septic shock like: low blood pressure (hypotension) that makes you feel dizzy when you stand up a change in your mental state, like confusion or disorientation diarrhoea nausea and vomiting cold, clammy and pale skin

Treatments

You’ll usually be admitted to an intensive care unit (ICU) so your body’s functions and organs can be supported while the infection is treated. In some cases treatment may start in the emergency department.

Treatment may include:

oxygen therapy fluids given directly through a vein (intravenously) medication to increase your blood flow antibiotics surgery (in some cases)

Oxygen therapy

To help you breathe more easily, you’ll be given oxygen through a face mask, a tube inserted into your nose, or an endotracheal tube inserted into your mouth. If you have severe shortness of breath, a mechanical ventilator may be used.

Increasing blood flow

You’ll probably be given fluids directly into a vein. This will help raise your blood pressure by increasing the amount of fluid in your blood.

To increase the blood flow to your vital organs, such as your brain, liver, kidneys and heart, you may be prescribed inotropic medicines or vasopressors.

Inotropic medicines

Inotropic medicines (inotropes), such as dobutamine, stimulate your heart. They increase the strength of your heartbeat, which helps get oxygen-rich blood to your tissues and organs, where it’s needed.

Vasopressors

Vasopressors include:

dopamine adrenaline noradrenaline

These medicines will cause your blood vessels to narrow, increasing your blood pressure and the flow of blood around your body. This will allow your vital organs to start functioning properly.

Antibiotics

Antibiotics are often used to treat the associated bacterial infection. The type of antibiotic used depends on the type of bacterial infection and where in the body the infection started.

You may be started on antibiotics immediately to increase your chances of survival. Initially, two or three types of antibiotics may be used. The most effective type of antibiotic can be used once the bacterium responsible for the infection is identified.

Surgery

In severe cases of sepsis or septic shock, the large decrease in blood pressure and blood flow can kill organ tissue. If this happens, surgery may be required to remove the dead tissue.

Complications

The chances of surviving septic shock will depend on:

the cause of infection the number of organs that have failed how soon treatment is started

Complications of septic shock can include:

inability of the lungs to take in enough oxygen (respiratory failure) the heart not being able to pump enough blood around the body (heart failure) kidney failure or injury abnormal blood clotting

These are serious health conditions that will need to be treated urgently. Septic shock can be fatal because of complications like these.

Shingles
of infections and poisoning

Sometimes shingles causes symptoms that develop a few days before the painful rash. This includes symptoms like:

a headache burning, tingling, numbness or itchiness of the skin in the affected area a feeling of being generally unwell a high temperature (fever)

Shingles rash

The shingles rash usually appears on one side of your body. It develops on the area of skin related to the affected nerve.

New blisters can appear for up to a week. A few days after appearing they become yellowish in colour, flatten and dry out.

Scabs then form where the blisters were, which may leave some slight scarring.

Examples of the shingles rash Shingles on the back Shingles on the chest Shingles on the face Shingles on back of neck

Shingles pain

Most people with shingles experience a localised band of pain in the affected area.

The pain may be a constant, dull or burning sensation and its intensity can vary from mild to severe. You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender.


a headache burning, tingling, numbness or itchiness of the skin in the affected area a feeling of being generally unwell a high temperature (fever)

Shingles rash

The shingles rash usually appears on one side of your body. It develops on the area of skin related to the affected nerve.

New blisters can appear for up to a week. A few days after appearing they become yellowish in colour, flatten and dry out.

Scabs then form where the blisters were, which may leave some slight scarring.

Examples of the shingles rash Shingles on the back Shingles on the chest Shingles on the face Shingles on back of neck

Shingles pain

Most people with shingles experience a localised band of pain in the affected area.

The pain may be a constant, dull or burning sensation and its intensity can vary from mild to severe. You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender.

Symptoms

The main symptom of shingles is pain, followed by a rash that develops into itchy blisters. These look like chickenpox.

Sometimes shingles causes symptoms that develop a few days before the painful rash. This includes symptoms like:

a headache burning, tingling, numbness or itchiness of the skin in the affected area a feeling of being generally unwell a high temperature (fever)

Shingles rash

The shingles rash usually appears on one side of your body. It develops on the area of skin related to the affected nerve.

New blisters can appear for up to a week. A few days after appearing they become yellowish in colour, flatten and dry out.

Scabs then form where the blisters were, which may leave some slight scarring.

Examples of the shingles rash Shingles on the back Shingles on the chest Shingles on the face Shingles on back of neck

Shingles pain

Most people with shingles experience a localised band of pain in the affected area.

The pain may be a constant, dull or burning sensation and its intensity can vary from mild to severe. You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender.

Causes

When you catch chickenpox the virus stays in your body. It can become active again later on if your immune system is lowered and cause shingles.

Your immune system can be lowered by things like:

stress other illnesses or conditions treatments like chemotherapy

It’s possible to have shingles more than once, but it’s very rare to get it more than twice.

Treatments

There’s no cure for shingles. But, there are ways to ease your symptoms until the condition improves.

Shingles symptoms usually get better in 2 to 4 weeks.

Speak to your GP or pharmacist as soon as you get symptoms of shingles. Early treatment may help to reduce the severity of the condition and complications.

Treating symptoms at home

Do keep the rash as clean and dry as possible wear loose-fitting clothing use a cool damp cloth to soothe the skin and keep blisters clean try calamine lotion to help relieve itching

Don’t do not let dressings or plasters stick to the rash do not use antibiotic cream – this slows healing

Other treatments for shingles

Your GP or pharmacist may recommend painkillers to ease discomfort caused by shingles. This includes:

paracetamol non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen opioids – used for more severe pain antidepressants – used for severe pain anticonvulsants – used for severe pain

Some people with shingles may also be prescribed antiviral tablets.

Preventions

You can’t give shingles to other people. But, other people can catch chickenpox from you if they haven’t had it before.

If you have shingles, you’re contagious until the last blister has dried and scabbed over.

To help prevent the virus being passed on:

Don’t do not share towels or flannels do not go swimming do not play contact sports do not go work or school if your rash is weeping (oozing fluid) and can’t be covered

Chickenpox

Chickenpox can be particularly dangerous for certain groups of people. If you have shingles, avoid:

pregnant women who haven’t had chickenpox before people with a weak immune system, for example someone with HIV or AIDS babies less than 1 month old (unless it’s your own baby)

Complications

Complications can sometimes occur as a result of shingles. They are more likely if your immune system is low, (the body’s natural defence system), or are elderly.

Shingles is rarely life threatening. Complications, though, can mean that around 1 in every 1,000 cases in adults over the age of 70 is fatal.

Complications can include:

postherpetic neuralgia eye problems Ramsay Hunt syndrome the rash becoming infected with bacteria white patches (a loss of pigment) or scarring in the area of the rash inflammation of the lungs (pneumonia), liver (hepatitis), brain (encephalitis), spinal cord (transverse myelitis), or protective membranes that surround the brain and spinal cord (meningitis) – these complications are rare.

Shortness of breath
of lungs and airways

It’s also one of the most common reasons people phone 999 for an ambulance.

It’s normal to get out of breath when you’ve overexerted yourself, but when breathlessness comes on suddenly and unexpectedly, it’s usually a warning sign of a medical condition.

The information below outlines the most common reasons for:

sudden shortness of breath long-term shortness of breath

This guide shouldn’t be used to self-diagnose your condition, but should give you an idea of what’s causing your breathlessness.


It’s normal to get out of breath when you’ve overexerted yourself, but when breathlessness comes on suddenly and unexpectedly, it’s usually a warning sign of a medical condition.

The information below outlines the most common reasons for:

sudden shortness of breath long-term shortness of breath

This guide shouldn’t be used to self-diagnose your condition, but should give you an idea of what’s causing your breathlessness.


The information below outlines the most common reasons for:

sudden shortness of breath long-term shortness of breath

This guide shouldn’t be used to self-diagnose your condition, but should give you an idea of what’s causing your breathlessness.

Causes

Sudden and unexpected breathlessness is most likely to be caused by one of the following health conditions. Click on the references at the end for more information about these conditions.

A problem with your lungs or airways

Sudden breathlessness could be an asthma attack. This means your airways have narrowed and you’ll produce more phlegm (sticky mucus), which causes you to wheeze and cough. You’ll feel breathless because it’s difficult to move air in and out of your airways.

Your GP may advise you to use a spacer device with your asthma inhaler. This delivers more medicine to your lungs, helping to relieve your breathlessness.

Pneumonia (lung inflammation) may also cause shortness of breath and a cough. It’s usually caused by an infection, so you’ll need to take antibiotics.

If you have COPD, it’s likely your breathlessness is a sign this condition has suddenly got worse.

A heart problem

It’s possible to have a “silent” heart attack without experiencing all the obvious symptoms, such as chest pain and overwhelming anxiety.

In this case, shortness of breath may be the only warning sign you’re having a heart attack. If you or your GP think this is the case, they’ll give you aspirin and admit you to hospital straight away.

Heart failure can also cause breathing difficulties. This life-threatening condition means your heart is having trouble pumping enough blood around your body, usually because the heart muscle has become too weak or stiff to work properly. It leads to a build-up of fluid inside the lungs, which makes breathing more difficult.

A combination of lifestyle changes and medicines or surgery will help the heart pump better and relieve your breathlessness.

Breathlessness could also relate to a problem with your heart rate or rhythm, such as atrial fibrillation (an irregular and fast heart rate) or supraventricular tachycardia (regular and fast heart rate).

Panic attack or anxiety

A panic attack or anxiety can cause you to take rapid or deep breaths, known as hyperventilating. Concentrating on slow breathing or breathing through a paper bag can bring your breathing back to normal but should only be done when you are certain anxiety is the cause of your breathlessness.

More unusual causes

These include:

a severe allergic reaction (anaphylaxis) pneumothorax – partial collapse of your lung caused by a small tear in the lung surface, which allows air to become trapped in the space around your lungs pulmonary embolism – a blockage in one of the blood vessels in the lung idiopathic pulmonary fibrosis – a rare and poorly understood lung condition that causes scarring of the lungs pleural effusion – a collection of fluid next to the lung diabetic ketoacidosis – a complication of diabetes where acids build up in your blood and urine


Long-term breathlessness is usually caused by:

obesity or being unfit poorly controlled asthma chronic obstructive pulmonary disease (COPD) – permanent damage to the lungs usually caused by years of smoking anaemia – a low level of oxygen in the blood caused by a lack of red blood cells or haemoglobin (the part of red blood cells that carries oxygen) heart failure – when your heart is having trouble pumping enough blood around your body, usually because the heart muscle has become too weak or stiff to work properly a problem with your heart rate or rhythm, such as atrial fibrillation (an irregular and fast heart rate) or supraventricular tachycardia (regular and fast heart rate)

More unusual causes of long-term breathlessness are:

bronchiectasis – a lung condition where the airways are abnormally widened and you have a persistent phlegmy cough pulmonary embolism – a recurrent blockage in a blood vessel in the lung partial collapse of your lung caused by lung cancer pleural effusion – a collection of fluid next to the lung narrowing of the main heart valve, restricting blood flow to the rest of the body frequent panic attacks, which can cause you to hyperventilate (take rapid or deep breaths)

Treatments

You should phone your GP immediately if you have sudden unexpected shortness of breath, as there may be a problem with your airways or heart.

Your GP will assess you over the phone, and may either visit you at home or admit you to hospital. If your shortness of breath is mild or the result of anxiety, you may be asked to come to the surgery rather than a home visit.

If you’ve struggled with your breathing for a while, don’t ignore it. See your GP as it’s likely you have a long-term condition, such as obesity, asthma or chronic obstructive pulmonary disease (COPD), which needs to be managed properly.

Your doctor may ask you some questions, such as:

Did the breathlessness come on suddenly or gradually? Did anything trigger it, such as exercise? How bad is it? Does it only happen when you’ve been active, or when you’re not doing anything? Is there any pain when you breathe? Do you have a cough? Do certain positions make it worse – for example, are you unable to lie down?

Feeling like you can’t get enough air can be terrifying, but doctors are well trained in managing this. You may be given extra oxygen to breathe if this is needed.

Sickle cell disease
of blood and lymph

Sickle cell disease is the name for a group of blood disorders. The most severe is sickle cell anaemia. These disorders are inherited, meaning they are passed on through your genes.

You can have a blood test at any time to find out if you carry the gene for sickle cell disease, or if you have sickle cell disease.

Sickle cell disease affects how your body produces red blood cells. Normal red blood cells are round – red blood cells affected by sickle cell disease harden and become sickle-shaped, like a crescent moon. This causes them to die too quickly and block blood vessels, leading to symptoms that are often painful.

People from particular ethnic backgrounds are more likely to have sickle cell disease or carry the gene. You are more likely to have sickle cell disease if you are from one of these ethnic backgrounds:

African Asian Caribbean Eastern Mediterranean Middle Eastern

There are treatments to manage sickle cell disease, but no cure yet – it’s a lifelong condition.

Find out about symptoms and diagnosis

Find out about treating sickle cell disease

Find out about living with sickle cell disease

Find out about screening to see if you’re a sickle cell carrier

Symptoms

The main symptoms of sickle cell disease are sickle cell crises (very painful episodes affecting different parts of the body), infections, and anaemia.

Getting immediate medical advice

There are a number of serious problems that can appear suddenly as a result of sickle cell disease. If you experience any of the following symptoms, you should get medical advice immediately:

high temperature (a fever) going to 38C (100.4F) or higher difficulty breathing drowsiness, confusion, or slurred speech a severe headache, stiff neck, or dizziness skin or lips that are very pale fits (seizures) serious pain that isn’t responding to treatments at home sudden swelling in the tummy priapism – a painful erection lasting two hours or more weakness on one or both sides of your body sudden vision loss, or changes in your vision

If you develop any of the symptoms listed above, phone your GP or care team immediately. If you can’t contact your GP or care team, go to your closest Accident and Emergency (A&E) department. Dial 999 for an ambulance if you aren’t able to travel yourself.

It’s important to make sure that the medical team looking after you know that you have sickle cell disease.

Sickle cell crises

Episodes of pain known as sickle cell crises happen when the blood vessels that go to one part of your body become blocked. The pain can be severe.

Sickle cell crises are one of the most common symptoms of sickle cell disease and, on average, occur once a year and last up to seven days. Some people have sickle cell crises every few weeks – others experience them less than once a year.

A sickle cell crisis typically affects one part of the body at a time. The most common parts affected are:

hands or feet (this is especially common in young children) ribs and breastbone spine pelvis tummy legs and arms

Sickle cell crises have different causes. They can be triggered by cold, rainy or windy weather, stress, dehydration, or exercise that leaves you severely out of breath.

Infection

Sickle cell disease leaves people – especially children – extra vulnerable to infection because their bodies aren’t as effective at dealing with bacteria and viruses. This leaves them more vulnerable to viruses like the common cold, as well as severe and potentially life-threatening conditions like meningitis.

As well as keeping up to date with their vaccinations, many people with sickle cell disease take daily doses of antibiotics in order to prevent infections.

Anaemia

Almost everyone with sickle cell disease has anaemia. Haemoglobin is found in red blood cells – it’s the substance that transports oxygen around the body. People with anaemia have low levels of haemoglobin in their blood.

Most of the time anaemia doesn’t cause symptoms, but if you’re infected with parvovirus, the virus that causes slapped cheek syndrome, the anaemia can get worse. When that happens, it causes:

headaches a fast heartbeat fainting dizziness

If these symptoms occur, the anaemia is usually treated with a blood transfusion.

Sudden anaemia can happen in young children if they experience swelling of the spleen. This is also treated with a blood transfusion.

Other sickle cell disease symptoms

There’s a wide range of other issues that can be caused by sickle cell disease. These include:

a serious lung condition called acute chest syndrome that can cause chest pain, a cough, breathing difficulties and fever pain in bones and joints delayed puberty delayed growth in childhood kidney or urinary problems, including bedwetting and blood in the urine gallstones – these are stones in the gallbladder that can cause jaundice (yellow eyes and skin) and abdominal (tummy) pain ulcers on the lower legs (open sores that can be very painful) priapism – a painful, persistent erection that can last for several hours high blood pressure (pulmonary hypertension) transient ischaemic attacks (TIAs) or strokes – these happen when blood flow to the brain is interrupted or blocked enlarged spleen – this can cause a fast heartbeat, worsening of anaemia, a swollen tummy, shortness of breath and abdominal pain vision problems like floaters, worsened night vision, blurred vision, patchy vision and, occasionally, sudden vision loss

These symptoms can be treated – see Treating sickle cell disease for more information.

Diagnosing sickle cell disease

You can have a blood test any time to find out if you have sickle cell disease, or find out if you’re a carrier who could have a child with the condition.

Sickle cell disease is usually diagnosed during pregnancy – free screening to find out if a baby is at risk of having the condition is offered to every pregnant woman in Scotland.

Even if your family background doesn’t make it likely your child will have sickle cell disease, you can still request a test.

If possible, screening should be done before the tenth week of pregnancy, so that there’s time to think about further tests that can find out if your baby will be born with sickle cell disease.

Newborn babies are screened for sickle cell disease as part of the newborn blood spot test – the heel prick test. There are a few reasons for this:

if a baby’s parents weren’t screened during pregnancy, this test identifies if the child has sickle cell disease if screening during pregnancy showed that the baby had a high risk of having sickle cell disease, but no more testing was done, the heel prick test will determine if the child has the condition or not this test shows if the baby is a carrier of sickle cell, and could one day have children of their own who have the condition (find out more about sickle cell carriers here) the heel prick test identifies other inherited conditions, like cystic fibrosis

Another blood test will be used to confirm the diagnosis if the heel prick test suggests that the baby could have sickle cell disease.

Learn about being tested to see if you carry the sickle cell gene

Causes

Sickle cell disease is caused by a gene problem that is inherited from your parents. It isn’t something you can catch, and it’s not caused by anything the parents did during or before pregnancy.

Inheriting sickle cell disease

You inherit one set of genes from your mother, and one from your father. Genes always come in pairs. Children born with sickle cell disease inherit a copy of the sickle cell gene from both of their parents, so each one of the pair of genes is faulty.

This happens when both parents are “carriers” – they carry the faulty gene for sickle cell. This is also known as having the sickle cell trait.

Carriers don’t have sickle cell disease, but if their partner is a carrier too they may have a child with the condition.

When both of a child’s parents are sickle cell carriers:

there’s a 25% (one in four) chance that each of their children won’t inherit any faulty genes – they won’t have sickle cell disease, and they won’t be able to pass it on to their children there’s a 50% (one in two) chance that each child will inherit a copy of the faulty gene from just one parent, and be a sickle cell carrier there’s a 25% (one in four) chance that each child will inherit copies of the sickle cell gene from both of their parents, and have sickle cell disease when they’re born

You can find more information about how sickle cell disease is inherited from the Sickle Cell Society.

Learn more about sickle cell carriers and screening

Diagnoses

The main symptoms of sickle cell disease are sickle cell crises (very painful episodes affecting different parts of the body), infections, and anaemia.

Getting immediate medical advice

There are a number of serious problems that can appear suddenly as a result of sickle cell disease. If you experience any of the following symptoms, you should get medical advice immediately:

high temperature (a fever) going to 38C (100.4F) or higher difficulty breathing drowsiness, confusion, or slurred speech a severe headache, stiff neck, or dizziness skin or lips that are very pale fits (seizures) serious pain that isn’t responding to treatments at home sudden swelling in the tummy priapism – a painful erection lasting two hours or more weakness on one or both sides of your body sudden vision loss, or changes in your vision

If you develop any of the symptoms listed above, phone your GP or care team immediately. If you can’t contact your GP or care team, go to your closest Accident and Emergency (A&E) department. Dial 999 for an ambulance if you aren’t able to travel yourself.

It’s important to make sure that the medical team looking after you know that you have sickle cell disease.

Sickle cell crises

Episodes of pain known as sickle cell crises happen when the blood vessels that go to one part of your body become blocked. The pain can be severe.

Sickle cell crises are one of the most common symptoms of sickle cell disease and, on average, occur once a year and last up to seven days. Some people have sickle cell crises every few weeks – others experience them less than once a year.

A sickle cell crisis typically affects one part of the body at a time. The most common parts affected are:

hands or feet (this is especially common in young children) ribs and breastbone spine pelvis tummy legs and arms

Sickle cell crises have different causes. They can be triggered by cold, rainy or windy weather, stress, dehydration, or exercise that leaves you severely out of breath.

Infection

Sickle cell disease leaves people – especially children – extra vulnerable to infection because their bodies aren’t as effective at dealing with bacteria and viruses. This leaves them more vulnerable to viruses like the common cold, as well as severe and potentially life-threatening conditions like meningitis.

As well as keeping up to date with their vaccinations, many people with sickle cell disease take daily doses of antibiotics in order to prevent infections.

Anaemia

Almost everyone with sickle cell disease has anaemia. Haemoglobin is found in red blood cells – it’s the substance that transports oxygen around the body. People with anaemia have low levels of haemoglobin in their blood.

Most of the time anaemia doesn’t cause symptoms, but if you’re infected with parvovirus, the virus that causes slapped cheek syndrome, the anaemia can get worse. When that happens, it causes:

headaches a fast heartbeat fainting dizziness

If these symptoms occur, the anaemia is usually treated with a blood transfusion.

Sudden anaemia can happen in young children if they experience swelling of the spleen. This is also treated with a blood transfusion.

Other sickle cell disease symptoms

There’s a wide range of other issues that can be caused by sickle cell disease. These include:

a serious lung condition called acute chest syndrome that can cause chest pain, a cough, breathing difficulties and fever pain in bones and joints delayed puberty delayed growth in childhood kidney or urinary problems, including bedwetting and blood in the urine gallstones – these are stones in the gallbladder that can cause jaundice (yellow eyes and skin) and abdominal (tummy) pain ulcers on the lower legs (open sores that can be very painful) priapism – a painful, persistent erection that can last for several hours high blood pressure (pulmonary hypertension) transient ischaemic attacks (TIAs) or strokes – these happen when blood flow to the brain is interrupted or blocked enlarged spleen – this can cause a fast heartbeat, worsening of anaemia, a swollen tummy, shortness of breath and abdominal pain vision problems like floaters, worsened night vision, blurred vision, patchy vision and, occasionally, sudden vision loss

These symptoms can be treated – see Treating sickle cell disease for more information.

Diagnosing sickle cell disease

You can have a blood test any time to find out if you have sickle cell disease, or find out if you’re a carrier who could have a child with the condition.

Sickle cell disease is usually diagnosed during pregnancy – free screening to find out if a baby is at risk of having the condition is offered to every pregnant woman in Scotland.

Even if your family background doesn’t make it likely your child will have sickle cell disease, you can still request a test.

If possible, screening should be done before the tenth week of pregnancy, so that there’s time to think about further tests that can find out if your baby will be born with sickle cell disease.

Newborn babies are screened for sickle cell disease as part of the newborn blood spot test – the heel prick test. There are a few reasons for this:

if a baby’s parents weren’t screened during pregnancy, this test identifies if the child has sickle cell disease if screening during pregnancy showed that the baby had a high risk of having sickle cell disease, but no more testing was done, the heel prick test will determine if the child has the condition or not this test shows if the baby is a carrier of sickle cell, and could one day have children of their own who have the condition (find out more about sickle cell carriers here) the heel prick test identifies other inherited conditions, like cystic fibrosis

Another blood test will be used to confirm the diagnosis if the heel prick test suggests that the baby could have sickle cell disease.

Learn about being tested to see if you carry the sickle cell gene

Treatments

People of all ages with sickle cell disease are supported by a team of medical professionals in a specialist sickle cell centre. A specialised care plan will be developed with you that helps you to fully understand the condition and find the best way of managing it.

Treating and preventing sickle cell crises

Sickle cell crises can usually be managed at home. The following steps are recommended for adults or children experiencing a sickle cell crisis:

over the counter painkillers like paracetamol and ibuprofen can help – although aspirin should not be given to anyone under 16 – and if needed, your GP may prescribe stronger painkillers heating pads or warm towels can be placed on the area and massaged to ease the pain – pharmacies usually sell heating pads you can use for this drink plenty – staying hydrated will help relaxing distractions like reading, videos, and computer games are a good way to distract your mind, or your child’s mind, from the pain

If none of the above measures help, or the pain is very severe, phone your GP. You or your child should go to the local accident and emergency (A&E) if it’s not possible to contact your GP. It may be necessary for you or your child to spend a few days in hospital being treated with stronger pain relief.

The best way to prevent a sickle cell crisis is by being aware of potential triggers and avoiding them.

Prevent dehydration by drinking plenty of fluids –especially water. Avoid alcohol – alcohol causes dehydration. Stay warm with enough layers of clothing to avoid getting cold, and avoid extreme temperatures. Don’t expose yourself to sudden changes in temperature – for example, avoid swimming in cold water. The lack of oxygen at high altitudes can trigger a sickle cell crisis, so be careful if you’re at high altitude for any reason. However, plane travel shouldn’t be an issue because planes maintain a consistent oxygen level due to being pressurised. Make sure to stay active, but avoid activities that leave you severely out of breath. Don’t smoke – smoking can trigger acute chest syndrome. Stay relaxed as much as you can – sickle cell crises can be triggered by stress, so consider learning relaxation techniques like breathing exercises.

Your care team may recommend a medication called hydroxycarbamide (hydroxyurea) if you keep experiencing sickle cell crises. This is a capsule that is taken once a day. It works by reducing how many other types of blood cell, like white blood cells and platelets (clotting cells) there are in the body.

This means that you’ll need regular blood tests to make sure you’re healthy.

Treating and preventing infections

Children who have sickle cell disease should be kept up to date on all of their routine vaccinations, and may also need additional vaccinations like the hepatitis B vaccine and the annual flu vaccine.

If you have sickle cell disease, you’ll most likely need to take a dose of antibiotics every day, usually penicillin. This will not pose serious health risks.

Reduce risk in day-to-day life by being careful about activities that can make you vulnerable to infection. Always follow good food hygiene measures, for example.

If you’re planning to go abroad, talk to your GP as far in advance as you can. You might need extra vaccinations or medication, such as anti-malarials if you’re going to a place where malaria is a risk. It may also be a good idea to take extra precautions when it comes to food and water.

Treating anaemia

Most of the time, anaemia doesn’t have any symptoms and you won’t require any treatment for it. However, children with sickle cell anaemia who are also on a restricted diet (such as a vegan or vegetarian diet) may need folic acid supplements. Folic acid helps your body to create more red blood cells, so it can help to improve anaemia.

It’s important to be aware that this type of anaemia isn’t the same as the anaemia caused by iron deficiency, so don’t take iron supplements without talking to your care team first. Taking iron supplements with the anaemia caused by sickle cell disease can be dangerous.

Blood transfusions or hydroxycarbamide may be necessary for serious or persistent anaemia.

Treating other sickle cell disease-related issues

There are a range of treatments for other problems that can be caused by sickle cell disease, depending on the type of symptom and how severe it is:

people with acute chest syndrome need emergency treatment – this involves oxygen, blood transfusions, antibiotics, and fluids given through a vein, as well as possibly hydroxycarbamide to prevent it happening again painkillers can treat joint and bone pain a short course of hormones can be given to children in order to trigger delayed puberty gallbladder removal surgery is used to treat gallstones for persistent priapism, medication can stimulate blood flow, or a needle can be used to drain blood from the penis regular blood transfusions or hydroxycarbamide are given to people who have had a stroke or who are at greater risk of having one

In addition to the treatments above, chelation therapy involves taking medication to make the level of iron in your blood lower, bringing it to safe levels. This treatment is given to people who need a lot of blood transfusions.

Learn more about living with sickle cell disease here

Sinusitis
of ears nose and throat

Sinusitis is a common condition in which the lining of the sinuses becomes inflamed. It’s usually caused by a viral infection and often improves within two or three weeks.

The sinuses are small, air-filled cavities behind your cheekbones and forehead.

The mucus produced by your sinuses usually drains into your nose through small channels. In sinusitis, these channels become blocked because the sinus linings are inflamed (swollen).

Symptoms

Sinusitis usually occurs after an upper respiratory tract infection, such as a cold. If you have a persistent cold and develop the symptoms below, you may have sinusitis.

Symptoms of sinusitis include:

a green or yellow discharge from your nose a blocked nose pain and tenderness around your cheeks, eyes or forehead a sinus headache a high temperature (fever) of 38C (100.4F) or more toothache a reduced sense of smell bad breath (halitosis)

Children with sinusitis may be irritable, breathe through their mouth, and have difficulty feeding. Their speech may also sound nasal (as though they have a stuffy cold).

The symptoms of sinusitis often clear up within a few weeks (acute sinusitis), although occasionally they can last three months or more (chronic sinusitis).

Causes

Sinusitis is usually the result of a cold or flu virus spreading to the sinuses from the upper airways. Only a few cases are caused by bacteria infecting the sinuses.

An infected tooth or fungal infection can also occasionally cause the sinuses to become inflamed.

It’s not clear exactly what causes sinusitis to become chronic (long-lasting), but it has been associated with:

allergies and related conditions, including allergic rhinitis, asthma and hay fever nasal polyps (growths inside the nose) smoking a weakened immune system

Making sure underlying conditions such as allergies and asthma are well controlled may improve the symptoms of chronic sinusitis.

Diagnoses

Your GP can usually diagnose sinusitis from your symptoms.

Sinusitis is nearly always caused by a viral infection, such as the common cold or flu, and is diagnosed based on the presence of:

nasal blockage or runny nose with facial pain, and/or a reduction or loss of sense of smell

Loss of smell is more common and facial pain less common in chronic (persistent) sinusitis.

Treatments

If your symptoms are mild and getting better, you don’t usually need to see your GP and can look after yourself at home.

See your GP if:

your symptoms are severe or getting worse your symptoms haven’t started to improve after around 7-10 days you experience episodes of sinusitis frequently

Your GP will usually be able to diagnose sinusitis from your symptoms and by examining the inside of your nose.

If you have severe or recurrent sinusitis, they may refer you to an ear, nose and throat (ENT) specialist for further assessment.


Most people with sinusitis will feel better within two or three weeks and can look after themselves at home.

You can help relieve your symptoms by:

taking over-the-counter painkillers such as paracetamol or ibuprofen using nasal decongestants – these shouldn’t be used for more than a week, as this might make things worse holding warm packs to your face regularly cleaning the inside of your nose with a saline solution – you can make this at home yourself or use sachets of ingredients bought from a pharmacy

If your symptoms aren’t improving or are getting worse, your GP may prescribe antibiotics or corticosteroid spray or drops to see if they help.

If your symptoms don’t get better after trying these treatments, you may be referred to an ENT specialist for surgery to improve the drainage of your sinuses.

Read more about treating sinusitis


Most people with sinusitis don’t need to see their GP. The condition is normally caused by a viral infection that clears up on its own.

Your symptoms will usually pass within two or three weeks (acute sinusitis) and you can look after yourself at home.

If the condition is severe, gets worse, or doesn’t improve (chronic sinusitis), you may need additional treatment from your GP or a hospital specialist. This can be difficult to treat and it may be several months before you’re feeling better.


See your GP if your symptoms are severe, don’t start to improve within 7 to 10 days, or are getting worse. They may recommend additional treatment with corticosteroid drops or sprays, or antibiotics.

If these treatments don’t help, you GP may refer you to an ear, nose and throat (ENT) specialist for an assessment and to discuss whether surgery is a suitable option.

Corticosteroid drops or sprays

Corticosteroids, also known as steroids, are a group of medications that can help to reduce inflammation.

If you have persistent symptoms of sinusitis, your GP may prescribe steroid nasal drops or sprays to help reduce the swelling in your sinuses. These may need to be used for several months.

Possible side effects include nasal irritation, a sore throat and nosebleeds.

Antibiotics

If your GP thinks your sinuses may be infected with bacteria, they will prescribe a course of antibiotic tablets or capsules to treat the infection.

You’ll usually need to take these for a week, although sometimes a longer course may be prescribed.

Possible side effects of antibiotics include feeling and being sick, diarrhoea and abdominal (tummy) pain.

Complications

Complications of sinusitis are more common in children than in adults. If your child has had sinusitis and has swelling around the cheekbone or eyelid, it may be a bacterial infection of the skin and soft tissue or an infection of the tissue surrounding the eye. Read about cellulitis for more information.

If you notice these symptoms, take your child to see your GP, who may refer them to an ear, nose and throat (ENT) specialist. Alternatively, you can call NHS 24’s 111 service.

Sjogren’s syndrome
of immune system

Sjögren’s (pronounced Show-grin’s) syndrome is an autoimmune disorder. The body’s immune system attacks glands that secrete fluid, such as the tear and saliva glands.

The effects of Sjögren’s syndrome can be widespread. Certain glands become inflamed, which reduces the production of tears and saliva, causing the main symptoms of Sjögren’s syndrome, which are dry eyes and dry mouth.

In women (who are most commonly affected), the glands that keep the vagina moist can also be affected, leading to vaginal dryness.

Read more about the symptoms of Sjögren’s syndrome

Symptoms

The most commonly reported symptoms of Sjögren’s syndrome are a dry mouth and eyes, which can lead to other associated symptoms.

However, these symptoms can be common in old age, and most people with dry eyes or a dry mouth do not have Sjögren’s syndrome.

Many women also experience vaginal dryness, which can make sex painful.


A dry mouth can lead to:

tooth decay and gum disease dry cough difficulty swallowing and chewing hoarse voice difficulty speaking swollen salivary glands (located between your jaw and ears) repeated fungal infections in the mouth (oral thrush) – symptoms of which can include a coated or white tongue


Dry eyes can lead to:

burning or stinging eyes itchy eyes a feeling that there’s grit in your eyes irritated and swollen eyelids sensitivity to light (photophobia) tired eyes mucus discharge from your eyes

These symptoms can get worse when you’re:

in a windy or smoky environment in an air-conditioned building travelling on aeroplane


In more serious cases of Sjögren’s syndrome, the immune system can attack other parts of the body, causing symptoms and conditions such as:

dry skin tiredness and fatigue – which are common and can lead to total exhaustion muscle pain joint pain, stiffness and swelling vasculitis (inflammation of blood vessels) difficulty concentrating, remembering and reasoning


Dry skin

Several soaps and creams are specifically designed for people with dry skin. Your pharmacist or GP can advise you.

Vaginal dryness

Vaginal dryness can be treated using a lubricant. Some women also use oestrogen creams or hormone replacement therapy (HRT).

Muscle and joint pains

Muscle and joint pains can be treated with an over-the-counter non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen. If this doesn’t work, see your GP, as stronger NSAIDs are available on prescription.

NSAIDs can increase your risk of developing stomach ulcers and internal bleeding, particularly if they’re taken on a long-term basis.

If you find swallowing NSAIDs difficult because of your dry mouth, you can try an NSAID cream that’s rubbed into affected joints.

NSAIDs aren’t recommended for pregnant or breastfeeding women, or for people with pre-existing risk factors for cardiovascular or kidney conditions.

Causes

Sjögren’s syndrome is an autoimmune condition, which means that instead of protecting the body from infection or illness, the immune system reacts abnormally and starts attacking healthy cells and tissue.

In Sjögren’s syndrome, the immune system attacks the tear and saliva glands, and other secretory glands throughout the body.

The reasons for this remains unknown, but research suggests that it’s triggered by a combination of genetic, environmental and, possibly, hormonal factors.

Some people are thought to be more vulnerable to the syndrome when they’re born and that certain events, such an infection, can trigger the problems with the immune system.

Read more about the causes of Sjögren’s syndrome

Healthcare professionals classify Sjögren’s syndrome as being either:

primary – when the syndrome develops by itself and not as the result of another condition secondary – when the syndrome develops in combination with another autoimmune disorder, such as lupus or rheumatoid arthritis


It’s not known exactly what causes Sjögren’s syndrome, but it’s thought to be linked to a problem with the immune system.

Diagnoses

Sjögren’s syndrome can be difficult to diagnose, because it has similar symptoms to other conditions and there is no single test for it.

Your doctor will ask about your symptoms and carry out a test to see how dry your mouth and eyes are.

Read more about diagnosing Sjögren’s syndrome


Sjögren’s syndrome can be difficult to diagnose because the symptoms are similar to those of other health conditions.

You may see different health professionals for your different symptoms, such as a dentist for a dry mouth, an optician for dry eyes and a gynaecologist for a dry vagina, which can sometimes make it difficult to reach a firm diagnosis.

See your GP if you experience any symptoms of dryness, particularly of your eyes and mouth.


Tests used to diagnose Sjögren’s syndrome include:

tear break-up time and Schirmer tests a lip biopsy blood tests salivary flow rate

These are explained below.

Tear break-up time and Schirmer tests

Tear break-up time and Schirmer tests are usually carried out by an ophthalmologist (a doctor who specialises in treating eye conditions).

The tear break-up time test measures how effective your tear glands are. A non-toxic dye is dropped onto the surface of your eye and the colour of the dye allows the ophthalmologist to see how well your tear film is functioning and how long it takes for your tears to evaporate.

This test is also carried out using a slit lamp. A slit lamp is a low-power microscope with a high-intensity light source that can be focused to shine in a narrow beam. The specialist will use the slit lamp to examine your tear glands more closely.

In the Schirmer test, small strips of blotting paper are placed into your lower eyelid. After five minutes, the strips are removed to see how much of the paper is soaked with tears.

Lip biopsy

During a lip biopsy, a small tissue sample is removed from your inner lip and examined under a microscope. A local anaesthetic is injected into the inner surface of your lower lip to numb the area, before a small cut is made to remove a few of your minor salivary glands.

Clusters of lymphocytes (a type of white blood cell) in the tissue can indicate Sjögren’s syndrome.

Blood tests

Blood tests are carried out to look for antibodies known as anti-Ro and anti-La (or SS-A and SS-B), which are produced when the immune system has been affected by Sjögren’s syndrome.

These antibodies are only present in about 60% of people with Sjögren’s syndrome, so it’s possible to have a negative blood test result and still have the condition.

Salivary flow rate

A salivary flow rate test measures how much saliva your glands produce.

You’ll usually be asked to spit as much saliva as you can into a cup over a five-minute period. The amount of saliva is then weighed or measured. An unusually low flow rate can indicate Sjögren’s syndrome.

Treatments

There is no cure for Sjögren’s syndrome, but treatments can help control symptoms.

Dry eyes and mouth can usually be helped with artificial tears and saliva.

It’s important to maintain good eye and mouth hygiene, because your risk of developing an infection is greater. Taking care of your eyes and mouth can help prevent problems such as corneal ulcers and tooth decay.

In severe cases, medication or surgery may be recommended.

Read more about treating Sjögren’s syndrome


There’s no cure for Sjögren’s syndrome, but treatments help relieve symptoms such as eye and mouth dryness.

Sjögren’s syndrome affects everyone in different ways, so your treatment plan will be tailored to suit you.


Dry skin

Several soaps and creams are specifically designed for people with dry skin. Your pharmacist or GP can advise you.

Vaginal dryness

Vaginal dryness can be treated using a lubricant. Some women also use oestrogen creams or hormone replacement therapy (HRT).

Muscle and joint pains

Muscle and joint pains can be treated with an over-the-counter non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen. If this doesn’t work, see your GP, as stronger NSAIDs are available on prescription.

NSAIDs can increase your risk of developing stomach ulcers and internal bleeding, particularly if they’re taken on a long-term basis.

If you find swallowing NSAIDs difficult because of your dry mouth, you can try an NSAID cream that’s rubbed into affected joints.

NSAIDs aren’t recommended for pregnant or breastfeeding women, or for people with pre-existing risk factors for cardiovascular or kidney conditions.

Complications

Sjögren’s syndrome can sometimes lead to complications. For example, your eyesight could be permanently damaged if the reduced tear production isn’t treated.

Sjögren’s syndrome also increases your risk of developing non-Hodgkin lymphoma, which is a cancer of the lymph glands. However, the chances are still low, at around 5%.

Women with Sjögren’s syndrome have an increased risk of having children with a temporary “lupus” rash or heart abnormalities. Any pregnancy will be closely monitored for potential problems.

Read more about the complications of Sjögren’s syndrome


Sjögren’s syndrome isn’t usually life-threatening, but it is linked to more seriousproblems.

Skin cancer (melanoma)
of cancer, cancer types in adults

Melanoma is a type of skin cancer that can spread to other organs in the body.

The most common sign of melanoma is the appearance of a new mole or a change in an existing mole. This can happen anywhere on the body, but the back, legs, arms and face are most commonly affected.

In most cases, melanomas have an irregular shape and more than 1 colour. They may also be larger than normal moles and can sometimes be itchy or bleed.

An ‘ABCDE checklist’ has been developed for people to tell the difference between a normal mole and a melanoma. 

Read more about the symptoms of melanoma.

These pages mainly cover a type of melanoma known as superficial spreading melanoma, which accounts for around 70% of all melanomas in the UK.

Symptoms

The first sign of a melanoma is often a new mole or a change in the appearance of an existing mole.

Normal moles are usually round or oval, with a smooth edge, and no bigger than 6mm (1/4 inch) in diameter.

Speak to your GP as soon as possible if you notice changes in a mole, freckle or patch of skin, especially if the changes happen over a few weeks or months.

Signs to look out for include a mole that is:

getting bigger changing shape changing colour bleeding or becoming crusty itchy or painful

A helpful way to tell the difference between a normal mole and a melanoma is the ABCDE checklist:

Asymmetrical – melanomas have 2 very different halves and are an irregular shape Border – melanomas have a notched or ragged border Colours – melanomas will be a mix of 2 or more colours Diameter – melanomas are larger than 6mm (1/4 inch) in diameter. Enlargement or elevation – a mole that changes size over time is more likely to be a melanoma

Melanomas can appear anywhere on your body, but they most commonly appear on the back, legs, arms and face. They may sometimes develop underneath a nail.

In rare cases, melanoma can develop in the eye. Noticing a dark spot or changes in vision can be signs, although it is more likely to be diagnosed during a routine eye examination.

Read further information:

Cancer Research UK: Melanoma symptoms

Causes

Melanoma happens when some cells in the skin begin to develop abnormally. It’s thought that exposure to ultraviolet (UV) light from natural or artificial sources may be partly responsible.

Certain things can increase your chances of developing melanoma, such as having:

lots of moles or freckles pale skin that burns easily red or blonde hair a family member who has had melanoma

Read more about the causes of melanoma.


Most skin cancer is caused by ultraviolet (UV) light damaging the DNA in skin cells. The main source of UV light is sunlight.

Sunlight contains 3 types of UV light:

ultraviolet A (UVA) ultraviolet B (UVB) ultraviolet C (UVC)

UVC is filtered out by the Earth’s atmosphere, but UVA and UVB damage skin over time, making it more likely for skin cancers to develop. UVB is thought to be the main cause of skin cancer.

Artificial sources of light, such as sunlamps and tanning beds, also increase your risk of developing skin cancer.

Repeated sunburn, either by the sun or artificial sources of light, increases the risk of melanoma in people of all ages.

Diagnoses

Speak to your GP if you notice any change to your moles. Your GP will refer you to a specialist clinic or hospital if they think you have melanoma.

In most cases, a suspicious mole will be surgically removed and studied to see if it is cancerous. This is known as a biopsy.

You may also have a test to check if the melanoma has spread elsewhere in your body. This is known as a sentinel node biopsy.

Read more about diagnosing melanoma.


A diagnosis of melanoma will usually begin with an examination of your skin. Your GP will refer you to a specialist if they suspect melanoma.

Some GPs take digital photographs of suspected tumours so they can email them to a specialist for assessment.

As melanoma is a relatively rare condition, many GPs will only see a case every few years. It’s important to monitor your moles and return to your GP if you notice any changes. Taking photos to document any changes will help with diagnosis.


Further tests will be carried out if there is a concern the cancer has spread into other organs, bones or your bloodstream.

Sentinel lymph node biopsy

If melanoma spreads, it will usually begin spreading through channels in the skin (called lymphatics) to the nearest group of glands (called lymph nodes). Lymph nodes are part of the body’s immune system, helping to remove unwanted bacteria and particles from the body.

Sentinel lymph node biopsy is a test to determine whether microscopic amounts of melanoma (less than would show up on any X-ray or scan) might have spread to the lymph nodes. It is usually carried out by a specialist plastic surgeon, while you are under general anaesthetic.

A combination of blue dye and a weak radioactive chemical is injected around your scar. This is usually done just before the wider area of skin is removed. The solution follows the same channels in the skin as any melanoma.

The first lymph node this reaches is known as the ‘sentinel’ lymph node. The surgeon can locate and remove the sentinel node, leaving the others intact. The node is then examined for microscopic specks of melanoma (this process can take several weeks).

If the sentinel lymph node is clear of melanoma, it’s extremely unlikely that any other lymph nodes are affected. This can be reassuring because if melanoma spreads to the lymph nodes, it’s more likely to spread elsewhere.

If the sentinel lymph node contains melanoma, there is a risk that other lymph nodes in the same group will contain melanoma.

Your surgeon should discuss the pros and cons of having a sentinel lymph node biopsy before you agree to the procedure. Sentinel lymph node biopsy does not cure melanoma, but is used to investigate the outlook of your condition.

An operation to remove the remaining lymph nodes in the group may be recommended. This is known as a completion lymph node dissection or completion lymphadenectomy.

Other tests you may have include:

a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan a positron emission tomography (PET) scan blood tests

Read further information:

Cancer Research UK: Melanoma tests Cancer Research UK: Further tests for melanoma

Treatments

The main treatment for melanoma is surgery, although your treatment will depend on your circumstances.

If melanoma is diagnosed and treated at an early stage, surgery is usually successful.

If melanoma isn’t diagnosed until an advanced stage, treatment is mainly used to slow the spread of the cancer and reduce symptoms. This usually involves medicines, such as chemotherapy.

Read more about treating melanoma.

Once you have had melanoma, there is a chance it may return. This risk is increased if your cancer was widespread and severe.

If your cancer team feels there is a significant risk of your melanoma returning, you will probably need regular check-ups to monitor your health. You will also be taught how to examine your skin and lymph nodes to help detect melanoma if it returns.



In recent years there have been major advancements in treating melanoma. The medications used to treat melanoma are changing as new formulations are being introduced into clinics.

The medications currently being used include:

vemurafenib ipilimumab nivolumab

However, not everyone is suitable for these drugs. Your specialist will discuss an appropriate treatment with you, and many people are entered into clinical trials.


Many of the treatments described have unpleasant side effects that can affect your quality of life. You may decide against having treatment if it is unlikely to significantly extend your life expectancy, or if you do not have symptoms causing you pain or discomfort.

This is entirely your decision and your healthcare team will respect it. If you decide not to receive treatment, pain relief and nursing care will be made available when you need it. This is called palliative care.

Read further information:

Accessing palliative care Cancer Research UK: Advanced melanoma (stage 4)

Preventions

Melanoma is not always preventable, but you can reduce your chances of developing it by limiting your exposure to UV light.

You can help protect yourself from sun damage by using sunscreen and dressing sensibly in the sun. Sunbeds and sunlamps should also be avoided.

Regularly checking your moles and freckles can help lead to early diagnosis and increase your chances of successful treatment.