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Our range of general and specialised products are sourced from many national and international manufacturers, suppliers and wholesalers.

Over the years we have found that professional practitioners, health and beauty experts have become increasingly aware of their important position as reliable providers of healthcare and well-being advice.

Out of this demand our range of key products has slowly grown to cover most body systems and a wide range of health issues. These include the following:-

  • 1. Allergic response ( See Below )
  • 1.1. Allergy
  • 2. Analgesics ( See Below )
  • 2.2. Analgesics ( oral )
  • 2.2. Analgesics ( topical)
  • 3. Cardiovascular ( See Below )
  • 4. CNS (Central Nervous System) ( See Below )
  • 4.1. Sleep disturbances ( temporary )
  • 4.2. Smoking cessation
  • 4.3. Travel sickness
  • 5. Coughs, colds & flu ( See Below )
  • 5.1. Colds & flu
  • 5.2. Coughs
  • 5.3. Sore throats
  • 6. Ears & eyes ( See Below )
  • 6.1. Ear problems
  • 6.2. Eye problems
  • 7. Female health ( See Below )
  • 7.1. Cystisis
  • 7.2. Period pains and PMS
  • 7.3. Thrush and vaginitis
  • 8. Gastro-intestinal ( See Below )
  • 8.1. Constipation
  • 8.2. Diarrhoea
  • 8.3. Haemorrhoids
  • 8.4. Indigestion
  • 8.5. Irritable Bowel Syndrome ( IBS )
  • 8.6. Worms
  • 9. Infants ( See Below )
  • 9.1. Colic
  • 9.2. Cradle cap
  • 9.3. Nappy rash
  • 9.4. Teething
  • 10.Nutrition ( See Below )
  • 10.1. Iron preparations
  • 10.2. Tonics
  • 10.3. Vitamins and minerals
  • 11.Oral ( See Below )
  • 11.1. Oral hygiene
  • 12.Scalp conditions/infestations ( See Below )
  • 12.1. Hair loss
  • 12.2. Lice
  • 12.3. Scalp conditions
  • 13.Sexual health ( See Below )
  • 13.1. Emergency hormonal contraception ( EHC )
  • 13.2. Sexual Intercourse
  • 14.Skin conditions ( See Below )
  • 14.1. Acne
  • 14.2. Antiseptics
  • 14.3. Athlete's foot
  • 14.4. Cold sores
  • 14.5. Corns and calluses
  • 14.6. Scabies
  • 14.7. Skin problems
  • 14.8. Warts and verrucas
  • 15.Herbal medicines ( See Next Section )
  • 16.Homeopathic remedies ( See Next Section )
  • 17.Diagnostics ( See  Next Section )


1. Allergy
---------------


Up to 20 per cent of the population is affected by allergic rhinitis. Common symptoms are sneezing, watery eyes, runny nose, headaches, nasal congestion, itching of the nose or roof of the mouth, and general tiredness. These are caused by histamine release, which is triggered by contact with allergens.Seasonal allergic rhinitis, or hayfever, is an allergic response to pollen from trees, grasses and plants that usually occurs during the summer months. Symptoms can also be triggered by spores from moulds and fungi. It most commonly affects people between the ages of 10 and 40 years and the peak season for suffering is May to September. Pollen levels tend to be highest in the early morning and at dusk.
About half of sufferers experience symptoms all year round in a condition called perennial allergic rhinitis. This can be triggered by house dust mites, pets and certain foods, drugs and chemicals.
Urticaria (hives) is an allergic skin rash that can be either acute (lasting from a few hours up to six weeks) or chronic (lasting over six weeks). The rash consists of a number of raised weals that tend to migrate around the body.
Acute urticaria can be triggered by a variety of causes, including pets, shellfish, bee or wasp stings and certain drugs. Chronic symptoms are often labelled idiopathic.
Antihistamines are probably the treatment of choice for most people with allergy, although the older type (eg chlorphenamine and promethazine) cause drowsiness. The sedating drugs have significant antimuscarinic activity and should be avoided in patients with glaucoma. Antihistamines should be avoided in pregnancy and breast-feeding. Three corticosteroids - beclometasone, fluticasone and flunisolide - are now available as P medicinal products in the form of nasal sprays. Corticosteroids suppress the allergic response and reduce inflammation and oedema.
Nasal decongestants, either in sprays or oral forms, may help relieve a blocked nose. Drops and sprays should be used only for a short period of time because of the risk of rebound congestion. Oral decongestants should not be recommended for patients with high blood pressure, those taking monoamine oxidase inhibitors or medication for heart conditions.
Manufacturers have reformulated products to remove phenylpropanolamine following concerns over the drug's safety at high doses.
Sodium cromoglycate, available as nasal sprays and eye drops, is thought to work by stabilising the mast cells which release histamine.
Used prophylactically, it can reduce the symptoms of hayfever and will work in 2-3 hours once the symptoms are present. Sufferers with itchy, red eyes may find eye drops useful. However, these are not recommended for patients with glaucoma or who wear contact lenses.
Anyone who reports wheezing or shortness of breath, severe coughing, tightness of the chest, painful ears or sinuses, or a yellow, sticky discharge from the eyes, should be refered to a doctor. Hayfever sufferers may also find some of the following self-help tips useful:
* Keep all windows closed, even at night.
* Avoid being out doors when the pollen count is highest.
* Avoid parks, fields and walking through long grass. Get someone else to cut the lawn.
* Wear glasses on warm, sunny days.
* Wash hair after returning from the countryside and avoid stroking animals that pick up pollen on their coats, like cats.


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2. Analgesics
---------------------

2.1. Analgesics (oral)


Analgesics form the largest category of medicines sold over the counter in pharmacies. Most products in the contain aspirin, paracetamol or ibuprofen, alone or in combination with codeine or dihydrocodeine. Most could be used to treat a wide variety of aches and pains, but some are aimed at a narrower range of specific indications.
They are suitable for headaches, cold and flu pains, toothaches, fever, period pain and for the relief of muscular or rheumatic pain. Aspirin has antipyretic, analgesic and anti-inflammatory properties. It acts by inhibiting prostaglandin production. However, it causes gastric irritation and can damage the gastric mucosa. Therefore it should not be taken on an empty stomach and is contra-indicated in patients with gastric ulcers. Asthmatics should also avoid aspirin and other NSAIDs.
There is a link between aspirin dosage in childhood and Reye's syndrome, a rare brain and liver disease. Aspirin and aloxiprin (a polymeric product of aspirin) are no longer recommended for use in children under 16 years of age. Packs should carry the warning : "Do not give to children aged under 16 years unless on the advice of a doctor".
Paracetamol has analgesic and antipyretic properties, but little anti-inflammatory action, so is less useful for muscular problems. Overdosage with paracetamol causes hepatic damage which may not become apparent for 4-6 days. Patients should be advised not to exceed the stated dose, and be aware of other sources of paracetamol, such as cold and flu remedies.
Ibuprofen, like aspirin, has analgesic, anti-inflammatory and anti-pyretic activity. However, ibuprofen is unlikeley to damage the gastric mucosa, especially at non-prescription dose levels.
Codeine and dihydrocodeine, both morphine derivatives, are the strongest analgesics available for OTC sale. They are only available OTC in combination products at relatively low doses.



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2.2. Analgesics (topical)


Topical analgesics, applied externally to relieve pain, can be divided into two classes: the non-steroidal anti-inflammatory agents, and the rubifacients or counter-irritants.
Topical analgesics are indicated for muscular and rheumatic pain, fibrositis, sciatica, lumbago, sprains, strains, bruises and stiffness, and unbroken chilblains.
Topical NSAIDs such as piroxicam, felbinac, diclofenac, ibuprofen, ketoprofen, salicylic acid and bezydamine probably act systemically and locally, and are now widely used for sports injuries, sprains and strains. Some topical NSAIDs are formulated in alcohol gels which provide a cooling effect as they dry. See analgesics-oral section, for warnings about ibuprofen, which apply to all NSAIDs.
Rubefacients or counter-irritants contain methy, ethyl or other esters of salicylic acid, a mild topical irritant, and volatile oils such as camphor and menthol which cause local vasodilatoin and mild analgesia. Other ingredients include capsicum, a potent irritant. These agents should not be applied to broken skin.
Local anaethetics such as benzocaine and lignocaine are included in some topical preparations where they relieve pain by numbing the area.
Local pain is produced as a reaction to an adverse condition and patients with persistent pain are advised to consult their doctor.

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3. Cardiovascular
---------------------------


The anti-platelet aggregation properties of aspirin have been known for some time, with increasing awareness among the public. Low dose (75mg-300mg) daily preparations are now available, intended for over the counter sale.
Aspirin inhibits thrombus formation and may be of use in secondary prophylaxis following myocardial infarction (heart attacks), or in unstable angina or cerebral transient ischaemic attacks ('mini strokes') or following by-pass surgery.
Although patients may want to take aspirin prophylactically, often because of something they have read in the health pages of newspapers or magazines, it should be prescribed by a doctor in the first instances. Daily aspirin is not appropriate for everyone, and may be contra-indicated in some instances, especially if there are bleeding disorders or concerns over the likehood of strokes. Aspirin should be used with caution in asthmatics, uncontrolled hypertension or in pregnancy.
The appropriate dose should also be decided by the doctor (see the British National Formulary). Enteric coated preparations may offer more protection against gastric discomfort by dissolving further down the intestine.
Although these are low dose aspirin preparations, aspirin should not be taken by people under the age of 16 years. Sales of aspirin are restricted (see Analgesics-oral introduction).
The role of omega-3 acid ethyl esters is becoming established in the management of hyper-triglyceridaemia and its cardiovascular effects, along with its role in the secondary prevention of myocardial infarction. This latter use is an adjunct to other treatments including statins, antiplatelet drugs, beta blockers and ACE inhibitors.

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4. Central Nervous System (CNS)
---------------------------------------------------

4.1. Sleep disturbances - (temporary)


Certain antihistamines products are licensed OTC to relieve temporary sleep disturbances in adults. Research has shown that 30 per cent of the population suffer from temporary sleep disorders generally caused by stresses such as disturbance of normal routines, impending exams, deadlines and bereavements.
Patients should be advised to avoid alcohol, daytime sleeping, and to take some form of physical exercise. The patient should be warned that an antihistamine may well have residual effects the following morning and may interfere with alertness and performance. Diphenhydramine has a shorter duration of action than promethazine and so is less likely to cause drowsiness next morning. Sleeping aids should be used for short periods only for occasional episodes of sleeplessness caused by well defined stresses.
The sedating antihistamines have significant antimuscarinic activity and should be avoided in patients with glaucoma. They should also be avoided in pregnancy and breast-feeding. Alcohol should be avoided.
Be aware that patients may be taking other OTC medicines that could also contain antihistamines. Pharmacists should also be aware of the potential for abuse of certain preparations.

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4.2. Smoking cessation

More than 120,000 people in the UK are killed by smoking-related diseases each year. It remains the largest single preventable cause of death in the UK.
People who smoke are more likely to get cancer of the lung, mouth, throat, oesophagus, bladder, kidney, pancreas and cervix. They are at increased risk of heart attack, stroke and circulatory problems that can lead to gangrene and amputation. Smokers are more likeley to get gastric and duodenal ulcers and their ulcers take longer to heal. On average smokers take about twice as many days off sick as non-smokers.
Giving up smoking requires immense determination and motivation, and pharmacy staff can be of great service in giving helpful non-judgemental and positive advice.
Nicotine replacement therapy together with brief advice increases the number of smokers abstinent for over six months by six months by 6 per cent compared to brief advice alone. However, a combination of behavioural support (eg a smokers' clinic) plus NRT can increase long term abstinence rates by up to 16 per cent.
Telephone helplines can provide genuine support for would-be quitters. Each of the three major NRT manufacturers offer their own. QUIT, the UK charity that helps people give up smoking runs:  Quitline - 0800 002 200 and NHS runs a smoking helpline - 0800 169 0 169.
NRT helps patients overcome the withdrawal symptoms associated with quitting. Products include patches, chewing gum, sub-lingual tablets, nasal spray, capsules for inhalation and lozenges. All formats are prescribable and low strength gum is available on GSL.
Nicotine patches release nicotine into the blood stream through the skin. Depending on the brand used, a fresh patch is applied daily for 16 or 24 hours over a period of ten weeks or three months. The 16 hour patches may be preferable for smokers who experience sleep disturbances, while the 24 hour format may be more effective for those who crave a cigarette soon after waking.
Nicotine gum should be chewed correctly for maximum effectiveness and to minimise side effects. It is chewed until a strong taste is experienced and then placed between the gum and cheek until the taste has gone; this is then repeated. Those who smoke fewer than 20 cigarettes a day should start with the 2mg strength, while smokers over 20 a day should start on 4mg. Lozenges should be allowed to dissolve slowly and not sucked, chewed or swallowed. Mouth ulcers are a common nicotine withdrawal symptom and are not due to the gum or lozenges.
The nicotine inhaler is suitable for people who need something to occupy their hands. The nasal spray should not be used when driving or operating machinery because sneezing or watering eyes could be dangerous.
A number of non-nicotine containg in products are used in aversion therapy. They produce an unpleasant taste on smoking and claim to ease withdrawal symptoms.

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4.3. Travel sickness

About a third of the population suffers from travel sickness, or motion sickness as it is often called. Children commonly suffer. Travel sickness occurs when the body moves in an unusual manner and the brain receives conflicting messages. The inner ear contains three fluid-filled semi-circular canals, set at right angles to each other, which detect changes in the body's position. Sickness occurs when signals from the inner ear to the brain indicate movement but the visual message says the body is stationary.
Symptoms include dizziness, nausea, vomiting, sweating and increased saliva production. Prolonged attacks can lead to dehydration and depression.
There are two main groups of drugs used to treat travel sickness OTC - anticholinergics and antihistamines. Hyoscine, an anticholinergic, is the most effective drug for travel sickness. It acts quickly but has a short duration of action. Side effects are not usually a problem at the doses used for travel sickness but may include drowsiness, blurred vision, dry mouth and urinary retention. Anticholinergics are not recommended in glaucoma, and should be used with caution in patients with urinary problems, hypertension and heart disease.
Antihistamines, such as meclozine and cinnarizine have a longer duration of action. Phenothiazine-type antihistamines, such as promethazine, may also cause sensitivity to sunlight which may be a problem on summer holidays. Drowsiness may be a problem but cinnarizine is less sedating than promethazine.
Anyone prone to travel sickness should take a remedy before leaving home. Most are of little use once an attack has begun because vomiting prevents the drugs being absorbed. Also the exit from the stomach may close preventing the tablets reaching their site of absorption in the small intestine. Symptoms can be reduced by avoiding large meals and alcohol before and during travel. On a ship, the best place to be is in the centre of the vessel, fixing the eyes on the horizon. In cars, sufferers should avoid reading and make sure there is plenty of fresh air. Child seats can be fixed so that children can look out of the window.


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5. Coughs, colds & flu
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5.1. Cold & flu


Cough are a contagious infection of the upper respiratory passages, caused by one or more of 100 different rhinoviruses. Sneezing and a sore throat are accompanied by fever, headache, general malaise, a runny or stuffed nose and reddened, watering eyes. many people will claim they have flu in the pharmacy but are really suffering from a cold.
There is no cure for the common cold but a wide range of products offer symptomatic relief.
Aches and pains, and fever can be relieved with paracetamol, ibuprofen or aspirin. The patient's attention should be drawn to the paracetamol content of a cold remedy and the maximum daily dose, as overdosage may occur if the patient takes other analgesics concurrently. asthmatics and those with stomach problems should not take aspirin or ibuprofen.
Antihistamines are often included in cold remedies for their drying effect. The older drugs, such as chlorphenamine and brompheniramine, can cause drowsiness. sedating antihistamines have significant antimuscarinic activity and should be avoided in patients with glaucoma. antihistamines should be avoided in pregnancy and breast feeding.
Adrenergic agents such as ephedrine, phenylephrine, pseudoephedrine, oxymetazoline and xylometazoline, are included in cold remedies for their decongestant effect. Manufacturers have reformulated products to remove phenylpropanolamine following concerns over the drug's safety at high doses.
Topical preparations, such as nasal sprays, are only intended for short terms use as they can cause rebound congestion if used for longer periods. These products have sympathomimetic effects and should not be recommended to patients with high blood pressure, hyperthyroidism, coronary heart disease, diabetes, gluaucoma, enlarged prostate, or those on monoamine oxidase inhibitors (MAOIs). They also have varying stimulant effects and should be avoided at bedtime if affected.
Inhalations of warm moist air are helpful and can be encouraged with the use of volatile substances such as menthol and eucalyptus.
An acute cold has serious implications for patients with long-term chest conditions, such as bronchitis or emphysema, and these patients should be referred to the doctor.
Bacterial infection is a possible complication and patients with a sustained high temperature, or those with white or yellow spots on the tonsils require further investigation.
Although it has been suggested that zinc is useful in reducing the severity of a cold, no OTC products are proven to be effective.


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5.2. Coughs


A cough is a protective mechanism which clears the airways of irritants and obstructions. Voluntary coughs are deliberate actions to clear the lungs and throat. Involuntary coughs are caused by mechanical, chemical or nervous stimulation, such as chest infections, smoke, foreign bodies, dust and mucus.
Productive coughs are often described as 'loose' or 'chesty' and they bring up phlegm or mucus. Cough mixtures containing directly acting expectorants, such as ammonium chloride, ipecacuanha, and guaifenesin, facilitate coughing. Steam inhalation is effective in liquefying mucus.
Cough suppressants should not be recommended for patients with a chesty cough.
Green-yellow or rusty coloured phlegm is symptomatic of a lung infection and the patient should be referred. The same applies to patients coughing up blood.
Non-productive coughs are the dry, barking cough and the nocturnal tickle that keep patients awake at night. Non-productive coughs which have been present for any length of time require further investigation. Dry coughs only require treatment if they are preventing sleep or causing distress or inconvenience. If sips of water, warm drinks or bland linctuses do not resolve the problem, cough suppressants such as codeine, pholcodeine and dextromethorphan can be used. Codeine can cause constipation and is commonly abused. Demulcents such as simple linctus and glycerin, honey and lemon soothe and coat the pharynx and are suitable for children as antihistamines or decongestants - see Colds and flu section for further information. Patients with a long-standing cough, shortness of breath, severe pain on breathing in,
or weight loss, require further investigation and probably referral.

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5.3. Sore throats

Most sore throats are caused by viruses and last between  3 to 7 days.
Symptoms commonly associated with a sore throat include a raw feeling, pain on swallowing, and sometimes hoarseness.
Sore throat treatments offer symptomatic relief. Pastilles soothe the throat by stimulating saliva production, which keeps the inflamed surface moist. Demulcents such as glycerine have a soothing effect.
Many preparations contain antibacterial and antifungal agents such as cetalkonium chloride, dequalinium chloride and cetylpyridinium chloride. Local anaesthetics like benzocaine relieve pain by numbing the throat and tongue. However, the loss of sensation can make swallowing difficult in children and the elderly. Antibacterial and
anti-inflammatory sprays, mouthwashes and gargles are effective as local treatment tends to give better results. Sprays can generally be used in children over six, but correct mouthwash technique is usually beyond children until they reach their teenage years.
Flurbiprofen lozenges have been switched from POM to P. They are not for use in the under 12s and the same cautions apply as with all oral NSAIDs.
Accompanying pyrexia in children suggests a bacterial infection and require a doctor's attention. Patients complaining of hoarseness lasting more than two weeks with difficulty in swallowing should also be refered to their GP.

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6. Ears & Eyes
----------------------

6.1. Ear problems


The softening and removal of ear wax and mild otitis externa are the only ear problems that can be safely treated without medical advice.
The presence of pain indicates a more serious condition.
Removal of hard wax can only be achieved effectively by syringing, but drops for softening wax can be used for a few days before syringing or as a preventative measure in patients prone to wax build up.
The ear has various self-cleaning mechanisms which help protect it from infection. Patients should be dissuaded from inserting cotton buds or other devices into the outer ear canal as this can impact the wax still further or even perforate the ear drum.
Otitis externa is an inflammation of the outer auditory canal, often referred to as swimmer's ear. Excessive exposure to water leads to removal of the protective, ceruminous coat. Many cases recover after thorough cleansing by suction or gentle syringing. Corticosteroid ear drops or astringents such as aluminium acetate solution are considered to be the most effective treatments. OTC acetic acid acts as an antifungal and antibacterial in the external ear canal. It can be used to treat mild otitis externa but in severe cases an anti-inflammatory preparation with or without an anti-infective drug is required. Topical aminoglycosides, polymyxins or chlorhexidine should be avoided in patients with a perforated tympanic membrane as they may increase the risk of drug-induced deafness. Systemic antibiotics and analgesics may
be required if there is severe pain.
Acute otitis media is characterised by severe pain and deafness, possibly accompanied by fever, nausea and vomiting. Severe attacks of bacterial origins may be treated with systemic antibiotics but if the infection is viral, treatment is with a simple analgesic.
Sero-mucinous otitis media or 'glue ear' is characterised by a viscous fluid in the middle ear. It is most common in children and often follows repeated attacks of acute otitis media arising from respiratory tract infections. The condition is referred to hospital as it can result in permanent deafness.


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6.2. Eye problems


Many of the preparations listed in this section are for minor irritations caused by tiredness, dust and so on. Conjunctivitis or 'red eye', which is potentially more serious, is an inflammation of the membranes covering the outside of the eye, resulting in a burning or itching sensation. It may be caused by an allergy, for example to pollen, which is eased by preparations containing antihistamines such as antazoline or levocabastine, or sodium cromoglycate. Sodium
cromoglycate is thought to stabilise mast cells which release histamine in the allergic response.
The presence of a discharge as well as redness, particularly if there is difficulty opening the eyes in the morning, suggests a bacterial infection for which a specific antibacterial agent is indicated. More severe cases should be referred to a doctor, particularly if there is pain or sensitivity to light.
Viral conjunctivitis may be herpetic or non-herpetic; in both cases medical attention should be sought. Herpes simplex, which can affect both the eyelids and the eye, is a threat to sight so the patient should not self-medicate but visit a doctor as soon as possible.
Blepharitis is an inflammation of the eyelids, which appear reddened and thickened along the edge. Treatment in simple cases involves bathing with salt solution to remove the dandruff-like crust. In unresponsive cases a weak steroid ointment and/or antibiotic may be needed. A stye is an infection of a single eyelash follicle. It should be bathed with warm water; antibacterial ointments may be needed. If crops of styes occur, a course of antibiotics may be needed.
Any eye condition that does not clear up after 2-3 days of treatment, or gets worse, should be referred to a doctor.
If there is any sudden pain or blurred vision, the patient should be referred as quickly as possible.
Artificial tear preparations are used when natural tear production is inadequate. Dry eye is common in the elderly and those who work in air conditioned environments. It is often associated with connective tissue disease such as arthritis.
Many eye preparations must not be used by contact lens wearers, particularly those with soft lenses. Check packs for details. Eye drops should usually be discarded within a month of opening.

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7. Female Health
---------------------------


7.1. Cystitis


Cystitis is an inflammation of the bladder (or perhaps more accurately in most cases, the urethra) which affects over two million women a year. Although it is a rare event for some, others are particularly susceptible and suffer repeated, often frequent, attacks. It is far less common in men and children.
About half of all cases of cystitis are due to bacterial infection.
These bacteria usually live in and around the anal opening but because in women the opening of the anus, vagina and urinary tract are close together, bacteria can easily pass to the urinary tract. This may happen during sexual intercourse, the insertion of tampons, wiping the bottom from back to front after going to the toilet, and even wearing tight trousers. Once inside the bladder the bacteria find the ideal environment to multiply.
The first symptom is usually a stabbing or pricking sensation around the entrance of the urethra. This is followed by a burning or stinging sensation when passing water. The women may feel she needs to go to the toilet urgently although there may be hardly any urine to pass.
Sometimes the urine becomes dark or cloudy and may smell unpleasant. A raised temperature, vaginal discharge or pain in the lower back may be reported.
The majority of OTC treatments for cystitis contain either potassium or
sodium salts. It is the presence of bacteria in the urine, making it more acidic than normal, that causes the stinging and burning. These products make the urine more alkaline and render conditions less favourable for the bacteria. Sufferers should increase their fluid intake to flush out bacteria from the bladder. These remedies should be taken as soon as possible after the onset of symptoms for maximum benefit.
Potassium-containing products should not be taken by patients on potassium-sparing diuretics, aldosterone antagonists or ACE inhibitors.
Sodium-containing products should not be given to people with high blood pressure or heart conditions, or to pregnant women.
If a man or child reports symptoms of cystitis they should be referred to the doctor, as should any woman in whom symptoms persist despite trying an OTC remedy. Also refer anyone with fever, vomiting, unusual vaginal dishcharge, blood in the urine, pregnant women, or recurrent symptoms with an increased thirst, weight loss and thrush a possible sign of diabetes.

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7.2. Period pain and PMS


Perhaps as many as half of all menstruating women suffer from period pain, or dysmenorrhoea, and about one in ten may be incapacitated for at least one day a month. Dysmenorrhoea is usually classified as either primary - which occurs soon after the woman first starts menstruating, and secondary - in which the pain starts much later in life. The latter is more likely to be associated with a medical cause.
Period pain is characteristically a mild cramp-like pain in the lower abdomen, back and even legs, felt at the start of the period, and which lasts for a day or two. It usually subsides rapidly and does not interfere with the woman's daily routine. However, in about 5 percent of cases the symptoms include nausea, vomiting, diarrhoea, headache, dizziness and fainting.
Aspirin and ibuprofen are often beneficial in dysmenorrhoea because of their effects against prostaglandins, which are thought to be implicated in period pain. Analgesic products marketed specifically for dysmenorrhoea are listed although some of the general analgesics listed elsewhere in this guide are also applicable.
The term premenstrual syndrome (PMS) is often used to describe a variety of physical, emotional and behavioural changes that many women suffer from before their period. It is estimated that between 15 and 90 per cent of women suffer.
Altered hormone levels, water retention caused by this change, and lack of certain nutrients, in particular the essential fatty acid gammalinolenic acid, have been linked to many PMS symptoms. Suggested therapies may include pyridoxine, magnesium, diuretics, evening primrose oil, multivitamins and minerals, relaxation methods, and even lithium.
Following concerns over plans to restrict the availability of high dose vitamins B6 (pyridoxine), the Government is recommending that people wanting to take daily doses of vitamin B6 higher than 10mg should only do so on medical advice. The Royal Pharmaceutical Society advises pharmacists that they may decide whether to put high dose vitamin B6 products on open sale or to treat them as P medicines. It asks pharmacists to bear in mind the unresolved safety issues when advising customers about higher dose products.


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7.3. Thrush and vaginitis


Vaginal candidiasis, or thrush, is the most common vaginal infection.
About half of all women aged 16 to 60 will suffer at some time and over a third will have an attack at least once a year.
Thrush is caused by the yeast-like organism, candida albicans, which is a normal inhabitant of the vagina, mouth, skin and GI tract.
The exact reason why this organism sometimes grows out of control is not known but there are a number of possible causes including being run down or under stress. Tight trousers or underwear can create the warm, moist environment in which thrush flourishes, while the overuse of harsh or perfumed bath additives can irritate the delicate skin of the vulva and make it more prone to infection. Candida can be carried from the bowel to the vagina, so women should wipe from front to back after using the toilet. Certain groups of women, including pregnant women and diabetics are more prone to thrush than others. Thrush is also more likely to occur in people taking antibiotics, the contraceptive pill or steroids.
Possible reservoirs of infection may lead to recontamination and should be treated. These include other skin sites such as the digits, nail beds and umbilicus, as well as the GI tract and bladder.
The most common symptoms are itching and soreness of the vulva and vagina accompanied by redness or swelling of the vaginal area. A thick white discharge is also common. Other women may report dryness of the vagina, causing discomfort during sexual intercourse or pain when passing urine.
There are a number of OTC products which help relieve external symptoms such as itching. Creams and pessaries for internal use are also available OTC. These contain antifungal imidazoles: clotrimazole, econazole and miconazole. Internal treatments consist of a single dose, while creams are used externally for up to seven days. However, some relief may be experienced after the first application. Creams and pessaries (particularly those containing miconazole) may damage latex contraceptives.
Fluconazole, taken as a single dose, is licensed for the oral treatment of thrush. Symptoms are said to be relieved within 24 hours and complete relief achieved within two days.
Some thrush preparations are now also indicated for the treatment of men carrying candida on their penis (candidal balantis). Consideration should be given to treating the partners of infected women, particularly if the woman suffers recurrent infection.
Anyone with the following characteristics should not self-treat and be refered to the doctor:
*First time sufferers
*Anyone who has had more than two attacks in the last six months
*Pregnant and breastfeeding woman
*Girls under the age of 16 or woman over 60
*Blood stained vaginal discharge or irregular vaginal bleeding
*Abdominal pain
*Pain or difficulty passing urine
*Fever or chills
*Diarrhoea, nausea or vomiting
*Ulcers or blisters on the vagina or vulva
*A previous history of sexually transmitted disease
*No improvement in seven days.
Vaginitis is an inflammation of the vagina that may be caused by infection (including thrush), an allergic reaction, hormone deficiency in older women or the presence of a foreign body, such as a forgotten tampon, in the vagina. Treatment depends on the cause: antibiotic or antifungal therapy, avoiding irritant agents or oestrogen supplements. OTC treatment generally relieve irritation.

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8. Gastro-intestinal
------------------------------


8.1. Constipation


Constipation is difficult to define because it is not, as many people believe, simply a case of not going to the toilet every day. No bodily function is more variable than the opening of the bowels and being 'regular' can mean going once every three days for one person or three times a day for another. Probably the best definition of constipation is the infrequent passage of hard, dry stools.
The colon adsorbs water and salts from the contents of the bowel. If too much water is absorbed then the contents remain fluid diarrhoea.
There are a number of causes of constipation and before an over-the-counter remedy is recommended, inquiries should be made to rule out other conditions such as haemorrhoids, colitis or diverticular disease.
Constipation may occur as a result of ignoring the call to stool, lack of exercise, poor diet and/or a change in eating habits and reduced fluid intake. Many drugs may be implicated, including aluminium salts found in antacids and codeine in analgesics. Danger signs include: blood in the stools; a recent onset of constipation not due to any particular cause; unexplained weight loss; loss of appetite, jaundice or the passage of mucus with the stools.
OTC laxatives are usually classed according to their mode of action.
Simulant laxatives, such as senna and bisacodol, increase the speed at which the contents move through the bowel. Osmotic laxatives, such as lactulose, macrogol and magnesium sulphate, work by drawing water into, or retaining it in the bowel, so softening the stools. Docusate sodium is a stool-softening agent which works by a surfactant action, breaking up stools and allowing them to be passed. Glycerin suppositories have a direct softening effect.
Bulk-forming laxatives, such as bran, isphagula husk, methylcellulose and sterculia, take longer to exert an effect. The addition of bulk to the stools makes them softer and easier to pass. This type of product is often recommended for patients with haemorrhoids or irritable bowel syndrome.
Prevention is better than cure and customers should be advised to review their diet and increase the amount of fibre-rich food eaten.
Increasing fluid intake and exercise is important, and so is acting on the call to stool. Constipation that persists is a matter for the GP.
Laxatives can be abused. Anorexics often make regular purchases of stimulant laxatives as part of their determination to stay thin. Over use of stimulant laxatives can also lead to dependency, so they should only be used for short periods to correct temporary constipation.
Phenolphthalein, which used to be available OTC, was restricted to POM following concerns about carcinogenicity. Liquid paraffin is a softening agent that is no longer recommended for regular use as it can cause anal seepage and irritation, lipoid pneumonia and malabsorption of lipid-soluble vitamins.


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8.2. Diarrhoea


Diarrhoea is characterised by the passing of watery, unformed stools at frequent intervals. Acute diarrhoea is a common problem which affects most people at some time or another. It is usually self-limiting but can be an inconvenience, especially when abroad on holiday. Acute diarrhoea is usually caused by bacteria or viruses. Rotaviruses and Escherichia Coli, Shingella and Salmonella are the most common causes.
These micro-organisms are usually ingested with contaminated food and drink. However, non-microbiological causes include a change of climate, stress, hot spicy food, excess alcohol consumption and certain medicines like antibiotics.
In addition to watery, unformed stools, other symptoms may include abdominal cramps, nausea, vomiting and headaches. A 24-hour break from all food and drink, except for water and soft drinks, is advisable with acute diarrhoea. Milk should be avoided.
OTC treatments for diarrhoea include opiates, such as morphine or codeine, which delay the intestinal transit time, allowing more water to be absorbed from the stools. Absorbents such as kaolin, attapulgite and charcoal act by adsorbing the toxins that the bacteria produce.
Antimuscurinics like belladonna alkaloids reduce the activity of the colon and are often used in conjunction with other ingredients. The opiates derivatives loperamide is considered by many to be the short-term treatment of choice for adults with uncomplicated , acute diarrhoea. It is not recommended for children under 12 years old.
Infants and the elderly are most at risk from diarrhoea, because they are more susceptible to dehydration and electrolyte depletion, which may lead to additional symptoms of headache and tiredness. Severe dehydration can be life-threatening and require immediate admission to hospital. A number of oral rehydration products are available OTC as either soluble tablets or sachets. These are a combination of salts and glucose and help replace those lost in the diarrhoea. Preparation and dosage instructions should be followed closely. For infants and young children it may be necessary to boil and cool the water before preparation.

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8.3. Haemorrhoids


Commonly known as piles, haemorrhoids are varicose veins that occur in or around the rectum. They are described as first, second or third degree haemorrhoids depending on their severity, and as internal and external haemorrhoids depending on where they occur. Severe haemorrhoids may prolapse or protrude out of the anus when passing stools or straining.
There are a number of possible causes of haemorrhoids, although in some people there may be several contributing factors. People whose job involves sitting or standing all day may be more prone than others, as may those whose work requires a lot of muscular straining. Constipation, obesity, pregnancy and childbirth can all cause haemorrhoids.
While medication may not actually cause haemorrhoids, some drugs can make the existing situation worse. Anticoagulants, aspirin and non-steroidal anti-inflammatory drugs can worsen rectal bleeding.
Aluminium salts in antacids and opioid analgesics cause constipation and can aggravate the haemorrhoids.
Common symptoms of haemorrhoids include itching, discomfort and sometimes pain with a dull ache. Haemorrhoids may also bleed when the bowels are open. This is usually seen as traces of blood on toilet paper or on the surface of stools. Anyone who reports significant amounts of bleeding or blood that is dark, or mixed in with the stools, should be referred for further investigation.
Patients should be advised to increase their fibre and fluid intake to avoid constipation, and bulk laxatives can be recommended if necessary.
Good toilet hygiene is essential to minimise itching and irritation.
Moist or antiseptic toilet tissue can help.
Persistent symptoms, a change in bowel habit, abdominal pain or distension, weight loss, frequent vomiting or the passage of mucus with the stools all require refferal.
OTC products usually contain a combination of a local anaesthetic, an antiseptic, and an astringent to contract the swelling. Hydrocortisone reduces inflammation but should not be used for more than seven days, in pregnant women or anyone under 18. Creams and ointments relieve symptoms of both internal and external haemorrhoids. They should be discontinued if a rash develops. Suppositories can be recommended for internal haemorrhoids. Preparations should be used morning and night and after every bowel movement.


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8.4. Indigestion


One of the problems with 'indigestion' is that it is a term used by different people to describe many different conditions. Most commonly, the patient who complains of indigestion refers to symptoms relating to meals, such as discomfort, distension, belching or heartburn.
Occasionally, more serious conditions present in a similar way. Anyone using large quantities of indigestion remedies should be refered to a doctor, as should any middle aged patient who has sudden onset of symptoms or sudden weight loss, and patients complaining of difficulty swallowing.
Symptoms described as indigestion may have a number of causes. It may be due to incomplete digestion or delayed emptying of food from the stomach. Certain foods or medicines, such as aspirin, ibuprofen or other arthritis drugs irritate the stomach lining and gas can become trapped which causes a bloated feeling with belching. The most common symptoms are pain, nausea and vomiting, bloating and flatulence. Anyone presenting with indigestion should be asked if their symptoms are worse
before or after food, at night, sitting up or lying down. Patients with severe or persistent pain should be referred.
The overweight, heavy drinkers and smokers are particularly prone to indigestion. Sufferers should avoid greasy food, coffee, chocolate and alcohol. Stress and rushed meals can also aggravate symptoms.
The more common OTC indigestion products are antacids, usually a mixture of magnesium and aluminium salts, calcium carbonate or sodium bicarbonate. Magnesium salts tend to cause diarrhoea and aluminium salts constipation, so they are often combined to cancel out these effects. Products high in sodium are not suitable for hypertensive patients or those with heart conditions. Bismuth compounds are found in some OTC products. These are thought to act by coating the wall of the stomach, protecting from further irritation.
Dimethicone and/or peppermint oil-containing products act as deflatulents. They have an anti-foaming action and release trapped gas to assist belching. Alginate products act by forming a 'raft' that floats on the stomach contents and forms a physical barrier between the acidic contents of the stomach and the oesophagus lining. They are
particularly appropriate when symptoms are caused by reflux of the stomach contents into the oesophagus.
The choice between tablet or liquid is often down to personal preference. But there is some evidence that liquids work quicker, while tablets have a longer lasting effect. Some tablets have a high sugar content.
Still relatively new OTC products are the H2 antagonists. These reduce gastric acid secretion by inhibiting the action of histamine in two ways - competing for histamine receptors on partial cells in the stomach and blocking the nervous and hormonal pathways to acid secretion in which histamine is involved. Famotidine, ranitidine and
cimetidine are available in OTC packs for the short term relief of symptoms of heartburn, dyspepsia and hyperacidity. The maximum treatment period is two weeks. Cimetidine is also licensed for heartburn associated with acid reflux. For specific precautions related to the sale of H2 antagonists, consult the product monographs. However, as OTC use of the H2-antagonists grows, their licensed indications are increasing to reflect more general 'indigestion' type usage.
Mebeverine is an antispasmodic switched from POM to P for relief of colicky pain with a maximum single dose of 100mg and a maximum daily dose of 300mg. For its use in IBS see the section on Irritable Bowel Syndrome.
Domperidone is a dopamine antagonist that stimulates gastric emptying and small intestinal transit, as well as enhancing the strength of oesophageal sphincter contraction. It can be sold as a P medicine provided that packs do not contain more than 200mg, and individual and total daily doses do not exceed 10mg and 40mg respectively. It is only for use in patients over 16 years old.
Prochlorperazine (Buccastem M) is a P medicine for adults over 18 years only. It has a P licence solely for the treatment of nausea and vomiting in previously diagnosed migraine. Patients should be counselled on administration of the tablets, which are placed high between upper lip and gum and left to dissolve.


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8.5. Irritable bowel syndrome


Irritable Bowel Syndrome (IBS) will affect an estimated one in five of the population at some time in their life. Women are three times more likely than men to suffer.
Diagnosis tends to be by exclusion and should be confirmed by a doctor.
Symptoms can vary between episodes and may affect both the upper and lower gastro-intestinal tract. Symptoms can vary between episodes and may affect both the upper and lower gastro-intestinal tract. They include one or all of the following: abdominal pain; bloating; diarrhoea; constipation; excessive wind, changed stools and rectal discomfort. Patients who complain of dark stools or the presence of blood in them, weight loss, or anaemia-like symptoms should be referred immediately.
Stress and food ingestion are often the main triggers of IBS, but a change in diet or an infection can precipitate an episode. However, IBS may develop some time after the trigger has been eliminated from the body. Patients should be treated sympathetically. The subject can be embarrassing and many feel their GP considers them a nuisance with such 'trivial' symptoms.
Dietary changes such as increasing fibre or eliminating foods that cause wind or loose stools can help. Exercise may be of benefit, especially if the patient complains of trapped gas or constipation.
Treatment includes peppermint oil which has a carminative and antispasmodic action. Alverine, mebeverine and the anti-muscarinic hyoscine and the anti-muscurinic hyoscine are antispasmodics that relax smooth muscle.
Alverine citrate, previously a POM can be recommended for the relief of GI spasm, such as irritable bowel syndrome. Products containing hyoscine's anticholinergic action alleviates the colicky pain of smooth muscle spasm but does not mask the symptoms of more serious GI complaints. However, symptom severity should be determined and patients referred if necessary. Hyoscine is non-sedative but may occasionally cause dry mouth, blurred vision or palpitations. It should not be used by patients with glaucoma.
Mebeverine has been switched from POM to P for symptomatic relief of irritable bowel syndrome provided that the maximum single dose and maximum daily doses are 135mg and 405mg respectively. For use in colicky pain, see the Indegestion section.


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8.6. Worms


Worms, or helminths, are well developed parasites with a number of species of medical importance to man. Light infections, particularly of gastro-intestinal helminths, may be asymptomatic but poor sanitation and hygiene when eating or handling food may lead to re-infection.
Tapeworms occur worldwide in areas where poor standards of sewage disposal exist. The two main types - beef tapeworm and pork tapeworm -
are contracted by eating undercooked or raw meat containing the worm's eggs. Once inside the gut, adult tapeworms can reach lengths of up to 10 metres and live for as long as 20 years. The sufferer is usually alerted by a 'crawling' sensation when sections of the worm are passed in the faeces.
Roundworms, particularly common in warm climates, are caught when eggs are ingested in contaminated food and water. The hatched worms pass from the gut into the lymphatic system and travel via the bloodstream, lungs and oesophagus. Mature female worms, which may be up to 30cm in length, produce eggs which pass out of the body in the faeces. Symptoms include fever, cough, dyspnoea and urticaria. Large infections cause diarrhoea, colic and intestinal obstruction.
Threadworms (pinworms) measure up to half an inch in length and look like threads of cotton. They can be seen, often moving, in stools, and are the most common worm complaint dealt with in pharmacies. They are highly contagious and eggs can remain viable outside the body for seversl weeks. Children often pick up the eggs by sharing toys, food, school books and even pencils and get infected when the eggs are transferred to their mouths. The most common symptom is severe itching around the anus, particularly at night.
Threadworms are usually treated with piperazine or mebendazole.
Piperazine is available in granules, taken in two doses separated by a fortnight to ensure all worms are expelled, or as an elixir taken daily for seven days. Mebendazole is available as a one-off, single dose tablet which should kill all worms. a follow-up dose can be taken 14 days later if re-infection occurs, but this is unlikely to be needed if hygiene rules are followed.

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9. Infants
---------------

9.1. Colic



Colic describes repeated episodes of excessive crying that cannot be explained in an otherwise healthy, well-fed baby.
The crying bouts usually occur in the late afternoon or evening. Bouts start around two to four weeks of age and last for three or four months. It is most common in a first child and is uncommon in babies older than six months.
The cause of colic is unknown. Some possible causes are overfeeding, faulty feeding technique where the baby gulps air with the milk, hunger, tiredness or excess wind.
There are no specific preventative measures but the symptoms can sometimes be relieved. Gripe mixtures are thought to settle the stomach by getting rid of wind. Other products used for colic in infants contain dimethicone which is claimed to disperse the trapped gas causing the pain. Formulas containing anti-spasmodics such as dicyclomine should never be given to infants under six months. If the crying is accompanied by vomiting, sickness or pallor or a rise in rectal temperature to 35 degrees centigrade or higher, the doctor should be seen.

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9.2. Cradle cap

Cradle cap is a type of dermatitis in which baby's scalp is scaly with crusting. It occurs during the first three months of life and generally resolves spontaneously within a year. It is most common on the crown of the head, but appears under the hair. Shampoos and creams in this section contain antiseptics which are sufficient to clear the condition. They should not, however, be applied to broken or inflamed skin. If cradle cap has spread to the face, the baby should be seen by the doctor.

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9.3. Nappy rash


Nappy rash, a form of dermatitis, is one of the common disorders of infancy. Painful, red, spotty and itchy skin in the nappy area is the most obvious sign.The causes of nappy rash are excessive ammonia on the wet nappy and skin caused by bacterial action, fungal infection or an allergy to soap, detergent or other chemicals. Prolonged contact with wet nappies increases the risk. Nappies should be changed as soon as possible after soiling and the area washed with warm water and dried thoroughly with a soft towel. Water-proof pants should be avoided as they keep the skin wet.The incidence of nappy rash has been decreasing since the introduction of disposable nappies that draw urine away from the surface of the nappy, leaving the infant's skin dry. A mild preparartion such as zinc and caster oil ointment, white petroleum jelly or barrier cream contain antibacterials such as cetrimide and benzalkonium chloride to reduce the number of bacteria and prevent secondary infection. Nappy rash may be complicated by fungal infection, in which case an antifungal preparation can be recommended or the baby referred to the doctor.


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9.4. Teething


Baby teeth erupt continually from the age of six months to three years. Between the ages of six and 12 years, children lose baby teeth which are replaced by an adult set. Tooth eruption is associated with excess salivation and drooling and pain, although this cannot be proved. It is not usually accompanied by bleeding. The child may be restless and take up thumb-sucking. A teething biscuit or ring may offer relief. If the teething is dirupting the child's sleep topical anaesthetics gels may be necessary.


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10.Nutrition
------------------


10.1. Iron preparations


Most iron preparations are indicated for the treatment of iron deficiency anaemia and are supplied on prescription because, even on an iron-deficient diet, iron deficiency is unlikely to develop without abnormal blood loss or long-term deprivation. Supplements are often prescribed to prevent iron deficiency, particularly in pregnancy. These may also contain folic acid.
Ferrous salts are generally preferred to ferric salts as they are better absorbed. Ascorbic acid enhances the absorption of ferrous iron.
Iron salts are normally recommended as they are better absorbed. Iron salts are stringent and may cause gastro-intestinal irritation and diarrhoea. Oral iron preparations may have a constipating effect in elderly patients. To calculate the ferrous iron content of different iron salts, see the
British national Formulary (BNF).


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10.2. Tonics


In addition to vitamins and minerals, tonics often contain bitter ingredients, such as gentian infusions, which are thought to stimulate the appetite. Caffeine and glycerophosphates are two other common ingredients of tonics. The alcohol content of tonics can be considerable therefore interactions with other substances that depress the central nervous system are possible.


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10.3. Vitamins and minerals



Vitamins and minerals are essential for health and normal development. In most cases the body cannot manufacture any or enough of these substances so they have to be obtained from the diet.
Primary deficiency disease occur when one vitamin is absent from the diet. Vitamin A deficiency causes xerophthalmia, a dry eye syndrome.
Deficiency of vitamin B1 produces beri beri, lack of vitamin C causes scurvy and vitamin D deficiency leads to rickets. Secondary deficiency diseases occur when absorption processes fail due to poor digestion, alimentary tract disorders or laxative abuse.
A balanced diet usually provides the minute quantities of vitamins require by the body. However, certain groups of people are at greater risk of developing vitamin deficiency and might need vitamin supplements:
*the elderly because of loss of appetite, poor diet or malabsorption disorders
*dieters who are not eating a balanced diet
*vegetarians, at increased risk of vitamin B12 deficiency
*Asian immigrants from an environment with high exposure to sunlight often develop citamin D deficiency
*pregnant and lactating women with higher nutritional needs
*alcoholics who often have impaired vitamin B12, folic acid and thiamine absorption.
The current levels of folic acid recommended for women trying to conceive are: 0.4mg daily in women with no history of children suffering neural tube defects; 5mg daily for those with a child suffering from neural tube defects. Folic acid should be taken while
trying to conceive and into the twelfth week of pregnancy. Rich sources of folate/folic acid are green vegetables, oranges, wholemeal bread and fortified breakfast cereals. Pregnant women are advised against eating liver because of the very high levels of vitamin A may harm the unborn baby.
Vitamins can be divided into fat soluble (A, D, E and K) and water soluble (B group and vitamin C). Their sources in the diet and functions in the body are listed in a table.
Iron and calcium are often found combined with other vitamins and minerals or as single preparations. High doses should only be taken under supervision of a doctor.
Following concerns over plans to restrict the availability of high dose vitamin B6 (pyridoxine), the Government is recommending that people wanting to take daily doses of vitamin B6 higher than 10mg should only do so on medical advice. The Royal Pharmaceutical Society advises pharmacists that they may decide whether they wish to put high dose vitamin B6 products on open sale or to treat them as P medicines. It asks pharmacists to bear in mind the still unresolved safety issues
when advising patients.

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11.Oral
-----------

11.1. Oral hygiene

Ailments affecting the mouth are extremely common and include gingivitis, periodontitis, toothache, dental caries, mouth ulcers, sensitive gums, dry mouth and halitosis. Diagnosis and treatment of these conditions is carried out by the dentist and a wide range of products is available for OTC treatment.
Gels and mouthwashes containing antibacterial agents such as chlorhexidine or one of the quaternary ammonium compounds can be used in the treatment of gingivitis and periodontitis.
Mouth ulcers, although common, are still poorly understood. Ill-fitting dentures, ovulation, vitamin C deficiency and some forms of cancer treatments have been cited as possible causes. Relief from symptoms may be obtained with preparations containing local anaesthetics, analgesics and astringents. Hydrocortisone lozenges or triamcinolone in adhesive base can be used to treat recurrent mouth ulcers.
Dry mouth can be alleviated with saliva substitute sprays or pastilles.

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12.Scalp conditions/infestations
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12.1. Hair loss

Premature hair loss in one form or another affects up to nine million people in the UK, of which 20 per cent are women.
Male pattern baldness can start in the late teens in men, and by the age of 35 nearly 40 per cent of men will have some form of premature balding. In women, the main problem is hair thinning, usually occurring from their mid-thirties onwards.
Minoxidil was found to stimulate hair growth in patients taking the drug for high blood pressure. Topical preparations have been shown to have a similar effect if applied to the scalp.
About a third of male users with partial hair loss see hair growth after about four months, which develops into good growth within 12 months with continued use. Another third get soft, downy growth. It usually takes four months or more for any effect to be noticed. If hair regrowth occurs twice daily application is needed for sustained growth.
Any new hair falls out two months after treatment is stopped. If no hair growth is seen in 12 months, treatment should be discontinued.
Regaine is currently the only licensed OTC medicine but is not available on the NHS. It is available as 2 and 5 percent minoxidil, with the higher strength only suitable for men. The stronger solution may produce over 40 per cent more hair regrowth in men with hereditary hair loss, compared to the lower strength. It can also stimulate hair growth over an eight week period that is twice as fast with the 2 per cent solution says the manufacturer.
Regaine is not indicated where hair loss is sudden or unexpected, where associated with certain conditions such as pregnancy or thyroid disorders, or if there are inflamed patches. Regaine Extra Strength should not be used if the scalp has been shaved, if the patient is using occlusive dressings or other topical medicines on the scalp, or if they have hypertension. If there is concern over hair loss with an unknown cause, the patient should be refered to their doctor.


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hair loss? - 2 Answers

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12.2. Lice

Headlice are small, wingless insects which use large claws to the end of each leg to hold onto the shafts of hair. They feed off human blood obtained by biting the scalp. In order to stop the blood clotting while feeding, the lice injects a small amount of saliva containing an anticoagulant and an anaesthetic. Some people are sensitive to these compounds, causing the itching that is a symptom of headlice infestation after a few months.
Adult female lice glue their eggs to the base of the hair shaft near the scalp. The young lice hatch and these egg cases - 'nits' - remain attached to the hairs, appearing as small white grains. They are the most easily detected sign of headlice infestation, particularly above and behind the ears and at the back of the neck.
There are a number of insecticides which will eradicate headlice, available as lotions, shampoos or creme rinses. Lotions are recommended rather that shampoo preparations as they remain in contact with the hair for longer. Alcoholic solutions are not recommended for younger children or asthmatics. Hair should be dried naturally, not with a hair dryer or sitting near a fire.
Carbaryl-containing products are only available on prescription following recommendations by the Committee on Safety of medicines and animal study data suggesting carcinogenicity.
Rotation policies help prevent headlice developing resistance. Products may be changed at regular intervals or different customers may be sold different products in a 'mosaic' pattern. This may be policy for PCTs or health boards.
There is little evidence for the effectiveness of wet combing. It is time consuming and its success depends on high levels of commitment and regular use.
Most products used to kill headlice are also effective against body lice or pubic lice (crabs). Read the manufacturer's instructions carefully.


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12.3. Scalp conditions

Dandruff is the most common of all the scalp conditions and as many as three-quarters of the population will suffer at some time in their lives. It commonly occurs between the ages of ten and 20 but is rare in younger children.
Dandruff is flakes of skin which, instead of being gradually worn away, are shed in large clumps. Although some people find their scalp itches with dandruff, others will be more concerned about their appearance.
Severe forms of dandruff are often refered to as 'seborrhoeic dermatitis', and in these cases the scalp becomes inflamed with  a yellowish, greasy scaling. Eczema or psoriasis may also occur on the scalp but usually in localised patches.
The effectiveness of antimicrobial shampoos suggests the condition may be an infection of some sort and the yeast-like organism, Pityrosporum ovule, has been implicated. Increasing the frequency of shampooing may help in the first instance. Overdrying the scalp with hair dryers should be avoided. Pyrithione zinc and selenium sulphide are two effective antimicrobial ingredients commonly found in shampoos ranging from television advertised brands to the more 'medical' products in the list. Ketoconazole shampoo, with its potent anti-fungal action, is suitable for dandruff and seborrhoeic dermatitis.
Coal tar solutions and extracts are found in many anti-dandruff shampoos and they are the principal ingredients in many prescribed products for scaly skin conditions.

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13. Sexual health
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13.1. Emergency hormonal contraception

Emergency hormonal contraception (EHC), (the 'morning after pill') in the form of levonorgestrel became available as a Pharmacy medicine on January 1, 2001. Although prior to this EHC had been supplied by selected pharmacist without prescription under patient group directions (patient protocols), over the counter status means that patients 16 years or over may now purchase EHC from pharmacies. Girls under the age of 16 should not be sold EHC but be directed to a GP or family planning clinic. Emergency contraception is also available from hospital  A&E departments.
The sooner that EHC is taken the better its chance of success. Levonorgestrel is now taken in one dose. Greatest efficacy is seen if the dose is taken within 12 hours of unprotected intercourse. Efficacy falls off significantly after this time. If the dose is not taken within 72 hours, the woman must be referred to a doctor or specialist nurse.
Besides the legal requirements, certain professional standards are expected with the sale or supply of OTC levonorgestrel.

The Royal Pharmaceutical Society set out the following standards:
*Pharmacists must deal with the request personally and decide whether to supply the product or refer the patient to an appropriate healthcare professional
*Pharmacists must ensure that all necessary advice and information is provided to patients
*Requests for EHC should be handled sensitively with due regard given to the customer's right to privacy
*Only in exceptional circumstances should pharmacists supply the product to a person other than the patient
*Where possible, pharmacists should take reasonable measures to inform patients of regular methods of contraception, disease prevention and sources of help

Before sale or supply of EHC, pharmacists should establish the following:
*Whether the patient is present in person
*Whether the patient has been placed at risk of pregnancy within the last 72 hours
*Whether the patient is already pregnant or likely to be pregnant
*Whether EHC has been used since the last period
*Whether the patient is taking any other medicines - both prescription or OTC or any herbal preparations (see below)
*whether the patient has any condition that might affect the absorption of EHC eg gastro-intestinal disturbance
*Whether the patient has previously experienced severe allergic reactions to progestogen-containing contraceptives
*Whether the patient has severely impaired hepatic function.
As enzyme-inducing drugs can affect the metabolism of levonorgestrel, reducing its blood levels and impairing its efficacy, it is important to check that the patient is not taking any of the following medicines:
Carbamazepine, phenytoin, primidone, phenobarbitone, rifampicin, rifabutin, griseofulvin, ritonavir, St John's Wort.
In addition, levonorgestrel may increase the risk of ciclosporin toxicity by inhibiting its metabolism.
If the woman is taking any of the above drugs, she should be referred to a doctor, or arrangements made for a telephoned prescription, as the doctor may wish to alter dosage, outside the market authorisation of levonorgestrel as a P medicine.
Supply can be made in exceptional circumstances to a third party, for example if the woman involved is house bound, but the pharmacist should be satisfied the request is genuine. There is no requirement to keep records of EHC sale or supply.

Patients should be advised of the following:
*Vomiting is possible, although unlikely, with progestogen-only EHC. If the patient vomits within three hours of taking the tablet, she should then obtain another pack of EHC and take this tablet immediately to complete the course. If the woman has vomited three hours after taking the tablet then there is no need to take further tablets.
*EHC does not protect against pregnancy for the rest of the menstraul cycle so other forms of contraception should be used.
*EHC will not bring on a period straight away. It may however affect the onset of the next period, normally to within three days either side of the expected time.
*Repeated use of EHC is likely to disrupt of the menstrual cycle and is less effective than other forms of oral contraception.
Consideration should be given as to whether the woman is breast feeding, as small amounts of levonorgestrel may be passed in the breast milk.
EHC is not 100 per cent effective. Patients should be encouraged to consult their doctor or family planning service should either of these circumstances occur:
* If the next period is light. more than three days late, or unusual in any way (possible pregnancy)
* If the pharmacist thinks that the patient would benefit from a referral to obtain more contraceptive advice.
There is an increased risk of a pregnancy being ectopic if the contraceptive fails, and the main contraceptive used has been a progestogen-only pill. Consequently, the Committee on Safety of medicines has advised that:
* Women should be encouraged to seek treatment as early as possible after unprotected sex and advised that treatment failure may occur.
* Women who do not experience a normal period after Levonelle should be followed up so that pregnancy can be excluded.
* The possibility of an ectopic pregnancy should be considered, particularly in women with a previous ectopic pregnancy, fallopian tube surgery, or pelvic inflammatory disease.
Although pharmacists may choose not to supply EHC on moral or religious grounds, the Royal Pharmaceutical Society expects them to advise on an appropriate alternative local source within the necessary time frame.
It is suggested that pharmacists draw up an aide-memoir of questions to be asked of the woman before supply. It may also be useful to have a list of local services for referral or for on-going care or to provide further information about sexual health.


13.2. Intercourse


Spermicides are designed to immobilise and destroy sperm. The active ingredient in all spermicides in nonoxynol-9, which is a surfactant that acts by disrupting the sperm cell membranes. It is presented in creams, jellies, spermicidally lubricated condoms, foam and pessaries. The carrier vehicle may itself inhibit sperm activity.
When used alone spermicides have failure rates ranging from 11 to 30 per 100 women years. They should therefore be used in conjunction with a barrier method of contraception such as a diaphragm or condom. All spermicides come in a water-based vehicle that does not damage latex diaphragms or condoms.
Nonoxynol-9 also has limited effect against some sexually transmitted diseases such as gonorrhoea and chlamydia. Spermicides are therfore sometimes used with IUDs to help prevent infection. However nonoxynol-9 does not protect against HIV infection and may even make transmission of the virus more likely.

14. Skin conditions
------------------------------

14.1. Acne

Acne, particularly acne vulgaris, is the most frequently encountered skin disorder in the teenage and young adult population. Girls tend to suffer earlier in life but boys tend to have more severe acne. In most cases acne resolves before the age of 30.
Acne is a disorder of the skin's sebaceous follicles and is associated with the extra greasiness of the skin due to hormonal changes at puberty. Areas typically affected are the face, neck and shoulders, where the greatest number of oil-producing skin result in the formation of comedones (white and black heads). Micro-organisms in the skin then break down the excess sebum into fatty acids which cause inflammation and irritation.
Treatments for acne help by preventing the cause of the condition (antibacterials) or by alleviating symptoms (anti-inflammatory), and for mild to moderate acne are usually topical. However, systemic antibiotics may be prescribed for moderate to severe acne.
Topical treatments fall into two main categories - keratolytics and antibacterials. Keratolytics like benzyl peroxide, salicylic acid, resorcinol and sulphur are abrasives and act upon keratin in the skin to break open blocked follicles and generally increase the skin's turnover rate. Antibacterials, such as benzoyl peroxide and triclosan, are used to reduce the number of bacteria on the skin and prevent re-infection. Nicotinamide is now available as a topical preparation and is indicated for mild to moderate acne. Cleansing agents (detergents and alcohol) help remove excess sebum and loose cells from the skin's surface and so help prevent the formation of spots.
Hygiene is important. Simple washing with soap and water - an antibacterial soap is preferable - will help manage the condition.
Drying vigorously with a rough towel removes oil and helps break up any blackheads. The use of lots of greasy make-up should be avoided as it may make the condition worse.
Any acne treatment will take weeks, if not a couple of months, to produce any real effect. Customers should be warned not to expect instant results. If the condition does not improve within a couple of months, antibiotics may be necessary. Occurring, as it does, during teenage years, when self-confidence is important, acne needs to be approached with tact.


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14.2. Antiseptics

There are many general antiseptics which can be used for a variety of skin problems including cuts and grazes, burns and scalds, sunburn and insect bites and stings. This section contains many ointments, creams and sprays for general first aid use and the exact indications and methods of application are included under each product.
Specific products for sunburn and for insect bites and stings are listed in a separate section on Skin problems, the introduction to which gives further details about these conditions.
These are topical products and are for external use only. They should
not be used near the eyes or in the mouth unless specified.


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14.3.. Athlete's foot


Athlete's foot is an unsightly and irritating fungal infection that affects the skin of the feet. It is common among all ages, with the exception of young children. the infection doesn't only develop on the feet of sportsmen, but the fungus thrives in warm, damp shoes such as trainers.
Athlete's foot (tinea pedisis) is caused by a dermatophyte fungus. It is contagious and the infection can be picked up simply by walking barefoot across a damp floor, for example in a communal shower or changing room. The fungal spores are transferred from one person to another within the fragments of skin protein (keratin) that are continually shed from the feet. They flourish in the moist, warm, environment between the toes. At first the skin becomes itchy and sore, then it starts to crack and peel. Sometimes the skin may appear white or inflamed and weepy.
Most customers can recognise athlete's foot and will ask for a treatment over the counter. As it is usually a mild condition there are a number of effective products that can be recommended.
OTC athlete's foot preparations are available from the pharmacy as creams, sprays or powders. They usually contain an imidazole antifungal (clotrimazole, econazole, miconazole, ketoconazole or tioconazole) and sometimes additional agents which help to dry out the skin and/or an antiseptic to eradicate any bacteria which may present as a secondary infection. Some contain hydrocortisone to treat inflammation. Treatment should be continued for two weeks after the symptoms have disappeared to ensure it is completely cured. Terbinafine is another antifungal which remains in the skin for seven days after treatment has ceased and can provide up to three month's protection against the fungus. There are a number of practical measures which customers can adopt to prevent reinfection:
*dry the feet carefully, paying attention to the area between the toes
*use a separate foot towel and do not share towels with any one else
*cotton socks and leather shoes should be chosen which allow the feet to breathe
*socks should be changed daily and washed before being re-used.

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14.4. Cold sores


Cold sores are a highly contagious viral infection. The initial infection usually occurs during childhood, probably by kissing an infected adult. Cold sores reappear several times during the year. An attack usually begins with a tingling sensation. A painful blister appears and then collapses to form a weeping sore which dries to form a
scab.The antiviral agent aciclovir, if used at the tingle stage, can prevent
the progress of the cold sore; either stopping the cold sore altogether or limiting the severity of the attack.
Other treatments available involve relief of pain and the application of soothing products which help the sore to dry up. Products containing iodine claim to affect a cold sore's progress if used quickly at the tingling stage. Sufferers should be advised to avoid physical contact with others and wash their hands often during an attack


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14.5. Corns and calluses


CCorns are small areas of thickened, often hardened skin with a central core found on the feet. They are usually found on the knuckles of the toes and, in particular, on the side of the little toe. Hard corns are usually found on the upper surface of the toes. Those found between the toes are termed soft corns. They are the body's normal response to pressure and friction and are genrally caused by badly fitting footwear
-either shoes of the wrong size or made from hard material, or with pointed toes or very high heels.
While corns can be removed by careful treatment, they will return if the cause is not removed. Soaking corns in warm water may soften them sufficiently to allow removal using pumice stone or emery board. This should always be done gently, for a number of days.
Corn removing treatments usually contain salicylic acid which itself softens the hard skin of a corn to allow removal with gentle scraping. Care should be taken with its use, however. Salicylic acid should only be applied to the corn; it may burn healthy skin. Felt rings are often used to protect the corn and ease the pressure of footwear.
Diabetics should not use OTC corn treatments. One of the side-effects of diabetes is poor circulation in the extremities. Inadequate blood supply means poor recovery from damage and a lack of sensitivity, making the application of skin-dissolving substances like salicyclic acid potentially dangerous. Diabetics should visit a chiropodist for regular check-ups and treatment. The elderly, patients with poor
circulation and people with persistent corns should also be referred to a chiropodist.
Calluses are more extensive patches of toughened skin that can occur on any part of the body, especially hands, feet or knees, that endure repeated pressure or irritation. treatment is the same as for corns.
Many products can affect those sensitive to salicylates, such as asthmatics.


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www.hfs.uk.net All foot issues dealt with by Hfs chiropodists. Book an appointment.WEB RESULTSMedlinePlus Medical Encyclopedia: Medical Encyclopedia. Corns and calluses. Contents of this page: Illustrations. Calluses and corns. Corns and calluses are thickened layers of skin caused by repeated pressure or friction.www.nlm.nih.gov/medlineplus/ency/article/001232.htm - 23k - Cached - More pages from this site - Save Corns and Calluses Resulting from Mechanical Hyperkeratosis - June 1, 2002 - American Family Physician Corns and Calluses Resulting from Mechanical Hyperkeratosis. DENISE B. FREEMAN, D.P.M., College of Podiatric Medicine and Surgery, Des Moines. University­Osteopathic Medical Center, Des Moines, Iowa ... The formation of corns and calluses can be caused by mechanical stresses from faulty ... abnormal pressure), and high levels of activity. Corns and calluses result from hyperkeratosis ...www.aafp.org/afp/20020601/2277.html - 32k - Cached - More pages from this site - Save Foot problems - corns and calluses A corn or callus is a patch of hard, thickened skin on the foot that is formed in response to pressure or friction. Corns and calluses may be signs of an underlying foot disorder, such as joint deformities. ... which can result in acute pain, swelling and redness. Corns and calluses may be a sign that you have an underlying ... The symptoms of corns and calluses can include ...betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/...?Open - 23k - Cached - More pages from this site - Save Corns and Calluses - Patient UK ... Corns and Calluses. Corns and calluses are thickenings of skin on the feet that can become painful ... podiatrist can par (cut away) corns and calluses and can advise on footwear ...www.patient.co.uk/showdoc.asp?doc=23068875 - 20k - Cached - More pages from this site - Save Corns and Calluses A callus (tyloma) is an area of skin that thickens after exposure to repetitive forces in order to protect the skin. A callus may not be painful. When it becomes ... eMedicineHealth Home > Corns and Calluses. Healthcare Professionals ...www.emedicinehealth.com/corns_and_calluses/article_em.htm - 25k - Cached - More pages from this site - Save Corns and Calluses Corns and Calluses: TIPS TO TREAT PAINFUL FEET. A Monthly Foot Fact from Foot.comwww.fitmoves.com/ArticleArchive/corns_and_calluses.htm - 7k - Cached - More pages from this site - Save Corns and calluses - MayoClinic.com Corns and calluses are thick, hardened layers of skin that build up because of friction and pressure. You can usually take care of them yourself. ... Your skin often protects itself by building up corns and calluses — thick, hardened layers of skin ...www.mayoclinic.com/health/corns-and-calluses/DS00033 - 19k - Cached - More pages from this site - Save InteliHealth: corns and calluses ... Corns and calluses are a thickening of the outer layer of skin. This thickening is known medically as hyperkeratosis. Corns and calluses develop as part of the skin's normal defense ...www.intelihealth.com/IH/ihtIH/WSIHW000/9339/24477.html - 63k - Cached - More pages from this site - Save Corns and calluses Corns and calluses are thickened layers of skin caused by repeated pressure or friction. ... Complications of corns and calluses are rare. People with diabetes are prone to ulcers and infections ... shoes or wearing gloves should resolve most problems with corns and calluses ...www.shands.org/health/information/001232trt.htm - 22k - Cached - More pages from this site - Save Corns and calluses Corns and calluses. Alternative Names: Calluses and corns. Treatment: Usually, preventing friction is the only treatment needed. ... Complications of corns and calluses are rare. People with diabetes are prone to ulcers and infections ... shoes or wearing gloves should resolve most problems with corns and calluses ...www.umm.edu/ency/article/001232trt.htm - 13k - Cached - More pages from this site - SaveSPONSOR RESULTSAdvertise your site here... Results Page:
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14.6. Scabies


Scabies is caused by tiny mite which burrows into the skin and feeds off the living cells of the epidermis. Mites are spread by close skin-to-skin contact such as holding hands and are most commonly found in the skin of the hands and wrists.
Symptoms occur about four to eight weeks after infection and although a rash may not be very obvious, the customer will complain of intense itching. Scabies is one of the few conditions where sufferers may scratch  themselves until they bleed.
Traditional treatments such as benzyl benzoate applications have been superseded in the main with products containing lindane, malathion or permethrin.

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www.pharmacy2u.co.uk Pharmacy2U is a convenient and discreet online pharmacy offering a full range of products at below high street prices.WEB RESULTSFacts About Causes, treatment, and prevention information about the skin rash caused by the Human Itch mite.Category: Scabieswww.safe2use.com/pests/scabies/scabies.htm - 11k - Cached - More pages from this site - Save Communicable Disease Fact Sheet ... What is scabies? Scabies is a fairly common infectious disease of the skin caused by a mite ... Who gets scabies? Scabies infestations can affect people from all socioeconomic levels ...www.health.state.ny.us/nysdoh/communicable_diseases/en/scabies.htm - 9k - Cached - More pages from this site - Save Medinfo: Scabies Itchy condition of the skin caused by a tiny mite (Sarcoptes scabiei). Symptoms, causes, diagnosis, and treatment.Category: Scabieswww.medinfo.co.uk/conditions/scabies.html - 6k - Cached - More pages from this site - Save Scabies Scabies is a skin infestation that can cause an intensely itchy rash. Learn about how to diagnosis and treat children with scabies. ... Although the rash that scabies induces is easy to see, the actual scabies mite is very tiny and can ...pediatrics.about.com/od/scabies/a/04_scabies.htm - 30k - Cached - More pages from this site - Save Scabies fact sheet Scabies is contagious skin irritation and is caused by a very tiny insect called the itch mite ... What is scabies? Scabies is a contagious skin infection that is caused by a type of mite ... How is scabies spread? Scabies is spread by direct skin-to-skin or ...www.metrokc.gov/health/prevcont/scabies.htm - 37k - Cached - More pages from this site - Save CDC: Scabies Fact Sheet Questions and answers about the condition.Category: Scabieswww.cdc.gov/ncidod/dpd/parasites/scabies/factsht_scabies.htm - 17k - Cached - More pages from this site - Save Scabies ... What is scabies? Scabies is a contagious skin disease caused by a mite (Sarcoptes scabiei), which is ... reasons that are unknown. Scabies spreads from person to person usually by ...www.netdoctor.co.uk/diseases/facts/scabies.htm - 49k - Cached - More pages from this site - Save DermAtlas: Online Dermatology Image Library dermatology image,scabies,insect bite reaction,scabies, crusted,scabies... DermAtlas: Dermatology Images- scabies,scabies,scabies,scabies,scabies,scabies,scabies,scabies,scabies,scabies,scabies,insect bite reaction,dermatology image, crusted, crusted, crusted, crusted, crusted, Norwegian, Norwegian, Norwegian, Norwegian... examination of the crusts revealed scabies mites, nymphs, larvae, eggs and stools ...dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=23 - 44k - Cached - More pages from this site - Save Scabies - Skin diseases, conditions and procedures on MedicineNet.com Information relating to the skin includes skin diseases and conditions, cosmetic surgery, medications, and treatment. ... How do you get scabies? Scabies mites are very fastidious ... It is hard, if not impossible, to catch scabies by shaking hands, hanging your coat next to someone who has ...www.medicinenet.com/scabies/article.htm - 47k - Cached - More pages from this site - Save Scabies Information page (The Little Surgery) A patient information leaflet - Scabies Information Page - This is one of a series of information leaflets available on The Little Surgery, Stamford, UK web site. ... Scabies. What is Scabies? What are the symptoms ... What is Scabies. Scabies is a skin infection, caused by itchy little mite, called sarcoptes scabiei ...web.ukonline.co.uk/ruth.livingstone/little/scabies.htm - 8k - Cached - More pages from this site - SaveScabies from Yahoo! Answers



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14.7. Skin problems

The products in this section are for skin problems. These include eczema, contact and irritant dermatitis, dry or sore skin, excessive perspiration, sunburn, and bites and stings.
Emollients are listed which soften and soothe dry skin and may be applied directly onto dry or wet skin, or used as a bath additive. Dermatitis and eczema are both characterised by an inflammatory response with typical red scaly eruptions. Eczema, a chronic allergic disorder, is often associated with hayfever and asthma. Treatment is usually managed by a doctor but now hydrocortisone is licensed for OTC sale in mild to moderate eczema.
Irritants like nickel, wool, detergents, perfumes or insect bites can cause dermatitis. The reaction is local and follows contact with the irritant. Hydrocortisone creams and ointments can be used for this reaction. Special cautions are included as there are strict guidelines for OTC hydrocortisone use.
Psoriasis is a chronic scaly skin disorder that tends to run in families. It is usually diagnosed by a doctor and the patient will be on a prescribed treatment. However, most of these are Pharmacy medicines, so customers may ask to buy named products they normally get on prescription.
Excessive perspiration can now be tackled OTC with aluminium chloride hexahydrate.
Sunburn can lead to serious consequences - if not immediately then later in life in the form of skin cancers - so prevention is the best approach and customers should be encouraged to take suitable sunscreens when going on holiday. Similarly, insect repellents are another wise buy.
Sunburnt skin should not be covered with dressings and blisters should be left alone, not burst. Cool baths will help, and drinking plenty of water will avoid dehydration. Alcohol should be avoided as this may cause further dehydration. If a sunburnt child is feverish or vomiting, see a doctor immediately.
Many of the creams and lotions listed are essentially cooling, although they may contain antiseptics and antihistamines. Many simple antiseptic creams (see  section on Antiseptics) can also be used for burns. The listing does not include simple generic creams and lotions, like calamine cream, which have long been stand-bys for sunburn.
The pain of bites and stings can be eased by applying a cold compress or sting relief preparation, after first removing any visible sting or jellyfish tentacles (be careful not to squeeze a bee sting or more poison may be forced out).
If a person is allergic to a wasp or bee sting, or suffers wheezing or breathlessness, seek immediate medical advice.
If bites or stings become inflamed, topical hydrocortisone preparations are recommended provided the usual precautions for OTC sale are followed.


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www.acnease.co.uk AcnEase® works to clear your acne or rosacea naturally and has no side effects, like irritated dry skin.WEB RESULTSThe Peter Gurney Guinea Pig Pages - ... Skin problems. Time and time and time again guinea pigs suffering from the advance stages of sever fungal ... guinea pigs suffer from parasitic skin problems, but they are also very ...www.oginet.com/pgurney/skinp.htm - 7k - Cached - More pages from this site - Save Skin problems Surface attraction: Skin problems in rabbits. Luckily, most rabbit skin problems are not particularly serious.www.rabbitwelfare.co.uk/rwf/articles/skin.htm - 27k - Cached - More pages from this site - Save Aidsmap | Skin problems patient information. YOU ARE HERE: Skin problems. Last updated: 21.12.05. translate this page. Español ... There are three main causes of skin problems in people with HIV: interactions between the immune system and ... creams or anti-histamines. Skin problems may also occur when the immune ...www.aidsmap.com/publications/factsheets/fs31.htm - 19k - Cached - More pages from this site - Save Skin Problems SKIN PROBLEMS. Exclusive Skin Analysis. Your skin under the microscope ... SKIN PROBLEMS. Go to skin analysis form ... reveals the most intimate aspects of the skin structure, even detecting problems which are not yet externally visible ...www.niniansmith.co.uk/skin.html - 28k - Cached - More pages from this site - Save Skin problems in Discount Beauty Shop Discount skin problems for beauty professionals: Fresh Orange Cream, SPA Anti-Cellulite Cream, SPA Anti-Cellulite Fossil Mud-Mineral Bath, SPA Cream-Sauna Effect, SPA Micronized Fucus, ... Depilation & Waxing. Skin problems. Equipment. Manicure & Pedicure ... Back to top. Skin problems > Skin ageing ...discountbeautyshop.com/paginas/...?id_categoria=7 - 202k - Cached - More pages from this site - Save skin problems ... one of a group of skin disorders known as urticaria ... or swelling of the skin and they can be extremely ... is the case, the skin rash should become less of ...www.nurseminerva.co.uk/skin.htm - 23k - Cached - More pages from this site - Save Animal Health Trust | Factsheets The Animal Health Trust is dedicated to fighting disease as a vital contribution towards animal welfare. ... President: HRH The Princess Royal. Allergic Skin Disease (ASD ... the immune system can manifest itself as skin disease ... proteins) that trigger allergic skin disease are called allergens ...www.aht.org.uk/fsheets/fsheets8.html - 10k - Cached - More pages from this site - Save Malehealth : Skin problems ... Weight problems. Skin problems. Acne. Eczema. Psoriasis. Rosacea. Shaving problems ... a variety of publications, and written books on peptic ulcers, skin problems and headaches and migraines ...www.malehealth.co.uk/userpage1.cfm?item_id=131 - 63k - Cached - More pages from this site - Save skin Skin Problems. The skin is the largest organ of the body and is subject to a variety of problems in advanced disease of any kind. ... Among the more common skin problems of patients with advanced cancer are decubitus ... tumors), itching or pruritus, infections, skin problems resulting from cancer treatment, and ...www3.baylor.edu/~Charles_Kemp/terminal_illness/skin.htm - 27k - Cached - More pages from this site - Save Veterinary Information - Skin Problems in Cats Hairloss, feline acne and other topics relating to feline skin problems. ... the medication is helping it is not likely that Aby is having. skin problems resulting from the medications ... his life he has had skin problems and i did take him ...www.vetinfo.com/catskin.html#Skin problems - persian cats - 50k - Cached - More pages from this site - SaveSkin problems from Yahoo! Answers



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14.8. Warts and verrucas


Warts are caused by a human papilloma-virus, which most frequently affects the hands, feet and anogenital region. They are contagious between people and between different areas of the same person. They occur, particularly in teenagers, where they are picked up at school and sports centres, usually through an area of skin damage.
Warts have a rough surface, irregular shape and clearly defined borders. There may be black spots in the centre, which are dead blood vessels. Sideways pressure may be painful. Getting rid of warts can be a slow process, and customers buying wart removers should be advised to continue treatment regularly and thoroughly until the wart has completely disappeared.
Treatments, which are not intended for use on the face or genitals, contain skin dissolving agents like salicylic acid, lactic acid and silver nitrate. Glutaraldehyde and formaldehyde act directly on the wart virus and dry out the wart. Paring down hard skin with a pumice stone or emery board may speed the treatment. Care must be taken to ensure the medication does not come into contact with surrounding skin.
Verrucas, or plantar warts, affect the feet. Plantar warts grow into the sole of the foot and can cause pain on walking. Treatment aims to gradually reduce the size of the wart by slowly dissolving the skin. Salicylic acid is the ingredient in many verruca treatments.
Podophyllin is licensed only for plantar warts. It acts by preventing skin cell division. Podophyllin is teratogenic and should not be used by pregnant or breast-feeding women as it can be percutaneously absorbed.
Treatment of verrucas is a long process. Customers should be advised
not to expect instant results. Application of the selected agent, avoiding the surrounding skin, is followed by gentle rubbing away of the skin so that the next application attacks the skin underneath.
Verrucas should not be attacked with a knife or razor blade. Cutting may cause more problems than it solves. Diabetics and others with severe circulatory disorders should be treated by a chiropodist.

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www.amoils.com Two day UK shipping. All natural formula, no burning, no scarring.WEB RESULTSWarts Warts are caused by a viral infection in the skin. Ordinary warts on the hands and feet are caused by viruses, which only affect humans. More than 60 different viruses that cause warts are known. ... Are warts and verrucas contagious? The wart virus is very contagious ... It can take several months for warts and verrucas to develop after infection ...www.netdoctor.co.uk/diseases/facts/warts.htm - 50k - Cached - More pages from this site - Save Medinfo: Warts and verrucas ... Warts and verrucas. Warts and verrucas are small thickened growths on the skin, which are caused by a ... is a virus that causes warts and verrucas. It may be that ...www.medinfo.co.uk/conditions/warts.html - 7k - Cached - More pages from this site - Save Warts and Verrucas ... Warts and Verrucas. What are warts? What is the difference between a wart and a ... What do warts and verrucas look like? Warts are usually skin coloured and have a ...www.irishhealth.com/?level=4&con=276 - 38k - Cached - More pages from this site - Save Warts & verrucas - plantar wart, treatment, HPV and cryotherapy BUPA health information factsheet on verrucas and warts, with information on the human papilloma virus (HPV), wart treatment, plantar warts and cryotherapy ... Warts and verrucas. Published by BUPA's Health Information Team ... Although warts and verrucas are very common, there is not a great deal of scientific evidence to say for sure which ...hcd2.bupa.co.uk/fact_sheets/html/warts.html - 50k - Cached - More pages from this site - Save Warts and Verrucas - Patient UK ... Warts and Verrucas. Warts are usually harmless, but may be unsightly. Warts on the feet (verrucas) are sometimes painful ... What are warts and verrucas? Warts are small rough lumps on ...www.patient.co.uk/showdoc/23068853 - 22k - Cached - More pages from this site - Save Warts and verrucas (PDF) ... Warts and verrucas. A wart is a fleshy growth on the skin caused by infection ... if it is painful or itchy. Although warts and verrucas are very ...hcd2.bupa.co.uk/fact_sheets/pdfs/warts.pdf - 54k - View as html - More pages from this site - Save Warts and verrucas Note: You are reading this message because you might not be able to see our stylesheets, or because you might not have a standards-compliant browser. ... available from your local pharmacist to treat warts and verrucas. The pharmacist will advise you on how ... The doctor can also freeze warts and verrucas away with liquid nitrogen ...tiscali.co.uk/lifestyle/healthfitness/health_advice/.../000073.html - 35k - Cached - More pages from this site - Save Warts and Verrucas The wart clinic is held every Monday afternoon at 4pm. Patients should see one of the GPs first to check that it is a wart suitable for treatment before attending the clinic. ... suitable for treatment before attending the clinic. Warts and verrucas that are causing problems can be treated at ... What are warts? Warts and verrucas are caused by a virus which ...www.castlemilkgp.co.uk/warts.htm - 9k - Cached - More pages from this site - Save BBC - Health - Conditions - Warts Warts and veruccas in children. ... There are several types of warts and verrucas for which treatments are available, or they can just ... Warts and verrucas are small, non-cancerous growths within the skin caused ...www.bbc.co.uk/health/conditions/wartsverrucas2.shtml - 36k - Cached - More pages from this site - Save Warts and Verrucas Warts and Verrucas. Common warts are small rough lumps on the skin. They are caused by a virus (human papilloma virus) which causes a reaction in the skin. Verrucas are essentially the same as warts. They are caused by the same virus. ... to the virus and never develop further warts. If left alone warts and verrucas will go although it ...www.eastquaymedicalcentre.com/pils/warts.htm - 8k - Cached - More pages from this site - SaveSPONSOR RESULTSBuy Verruca Wart Products at Pharmacy2U
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