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If you are overweight and are serious about losing weight, the Lipotrim Pharmacy Programme could help you reach your goal, knowing you have a highly trained healthcare professional on hand for information, advice and encouragement.

  • You need to be overweight and serious about losing it .
  • There are a few medical restrictions so you will need to fill out a medical screening form at the pharmacy to make sure the programme is suitable for you.
  • If you are accepted for the programme, you will have to attend the pharmacy weekly for weight measurements and, where possible at the pharmacy, a urine test to measure ketones.
  • The pharmacy is also where you will pick up weekly supplies of Lipotrim products.
  • An essential short video/DVD and written materials are available to assist you on the programme.
  • This programme is pharmacy-based and run by the pharmacist. It is not available for over the counter sale or mail order.

Buy Asthma Inhalers straight from your pharmacist

Your Pharmacist is now qualified to sell you a salbutamol (blue) asthama inhaler after a short consultation in the private consultation room.

This is not an NHS service and you will be required to pay for the inhaler, but there is no need for an appointment and provided you are suitable for the product you can leave with it straight away.

Salbutamol (sal-bue-tar-moll) is a medicine which is used in asthma and bronchospasm.

The information in this Medicine Guide for salbutamol varies according to the condition being treated and the particular preparation used.

Your medicine

In breathing disorders, Salbutamol relaxes muscles in the air passages of the lungs. It helps to keep the airways open, making it easier to breathe.

Inhaled preparations of Salbutamol are fast acting. They can make your breathing easier and relieve bronchospasm within minutes.

Always have your inhaler with you in case you need it. Ask your prescriber or nurse for advice on what to do if you have an asthma attack.

You can use Salbutamol to prevent asthma attacks caused by triggers such as house dust, pollen, cats, dogs and exercise.

When you are having an asthma attack you should use a fast acting preparation of Salbutamol as directed by your prescriber. If your normal inhaled dose of Salbutamol does not give you the same amount of relief then you should contact your prescriber for more advice. They may want you to have additional treatment.

You need to use Salbutamol as prescribed in order to get the best results from using it. The pharmacy label will tell you how much you should take.

Other information about Salbutamol:

  • in certain situations your prescriber may advise you to use a higher dose of your medicine than normal
  • Do not share your medicine with other people. It may not be suitable for them and may harm them.
  • The pharmacy label on your medicine tells you how much medicine you should use. It also tells you how often you should use your medicine. This is the dose that you and your prescriber have agreed you should use. You should not change the dose of your medicine unless you are told to do so by your prescriber.
  • If you feel that the medicine is making you unwell or you do not think it is working, then talk to your prescriber.

Whether this medicine is suitable for you

Salbutamol is not suitable for everyone and some people should never use it. Other people should only use it with special care. It is important that the person prescribing this medicine knows your full medical history.

Your prescriber may only prescribe this medicine with special care or may not prescribe it at all if you:

are allergic or sensitive to or have had a reaction to any of the ingredients in the medicine
have a low level of oxygen in the blood
have heartdisease
have thyrotoxicosis
Furthermore the prescriber may only prescribe this medicine with special care or may not prescribe it at all for a child under four years of age.

As part of the process of assessing suitability to take this medicine a prescriber may also arrange tests:

to check that this medicine is not having any undesired effects
Over time it is possible that Salbutamol can become unsuitable for some people, or they may become unsuitable for it. If at any time it appears that Salbutamol has become unsuitable, it is important that the prescriber is contacted immediately.

Low-dose aspirin

  1. About low-dose aspirin
  2. Key facts
  3. Who can and can't take low-dose aspirin
  4. How and when to take it
  5. Side effects
  6. How to cope with side effects
  7. Pregnancy and breastfeeding
  8. Cautions with other medicines
  9. Common questions

 

1. About low-dose aspirin

Daily low-dose aspirin is a blood thinning medicine. Aspirin is also known as acetylsalicylic acid.

Low-dose aspirin helps to prevent heart attacks and strokes in people at high risk of them.

Your doctor may suggest that you take a daily low dose if you have had a stroke or a heart attack to help stop you having another one.

Or, if you're at high risk of heart attack - for example, if you have had heart surgery or if you have chest pain caused by heart disease (angina).

Only take daily low-dose aspirin if your doctor recommends it.

Low-dose aspirin comes as tablets. It's available on prescription. You can also buy it from pharmacies, shops and supermarkets.

Children are sometimes treated with low-dose aspirin after heart surgery or to treat a rare illness called Kawasaki disease. Children should only take low-dose aspirin if their doctor prescribes it.

Taking low-dose aspirin to prevent heart attacks and strokes is not the same as taking aspirin as a painkiller. Read our information on aspirin for pain relief.

2. Key facts

  • Daily low-dose aspirin makes the blood less sticky and helps to prevent heart attacks and stroke.
  • It's usual to take a dose of 75mg once a day. Sometimes doses may be higher.
  • It's best to take low-dose aspirin with food so it doesn't upset your stomach.
  • Taking low-dose aspirin isn't safe for everyone. Only take low-dose aspirin if your doctor recommends it.
  • Low-dose aspirin is also called by the brand names Caprin, Danamep, Micropirin and Nu-seals.

3. Who can and can't take low-dose aspirin

Most people aged 16 or over can safely take low-dose aspirin if their doctor recommends it.

Low-dose aspirin isn't suitable for certain people.

It's sometimes called baby aspirin because of the small dose, but it's not safe for children.

Never give aspirin to a child younger than 16, unless their doctor prescribes it.

There's a possible link between aspirin and Reye's syndrome in children.

Reye's syndrome is a very rare illness that can cause serious liver and brain damage.

Important

Never give aspirin to children younger than 16, unless their doctor prescribes it.

To make sure low-dose aspirin is safe for you, tell your doctor if you have:

  • an allergy to aspirin or similar painkillers such as ibuprofen
  • ever had a stomach ulcer
  • high blood pressure
  • indigestion
  • heavy periods - taking daily aspirin can make them heavier
  • recently had a stroke (low-dose aspirin isn't suitable for some types of stroke)
  • asthma or lung disease
  • ever had a blood clotting problem
  • liver or kidney problems
  • gout - it can get worse if you take daily aspirin

Check with your doctor that it's safe for you to take low-dose aspirin if you're pregnant, trying to get pregnant, or if you want to breastfeed.

4. How and when to take it

Take low-dose aspirin once a day. Don't take it on an empty stomach. It's best to take it with or just after food. This will make it less likely to upset your stomach.

How much should I take?

Your doctor will discuss what dose is right for you. It's important to take low-dose aspirin exactly as recommended by your doctor.

The usual dose to prevent a heart attack or stroke is 75mg once a day (a regular strength tablet for pain relief is 300mg).

The daily dose may be higher - up to 300mg once a day - especially if you have just had a stroke, heart attack or heart bypass surgery.

Different types of low-dose aspirin tablets

Low-dose aspirin comes as several different types of tablet:

  • standard tablets - that you swallow whole with water
  • soluble tablets - that you dissolve in a glass of water
  • enteric coated tablets - that you swallow whole with water. These tablets have a special coating that means they may be gentler on your stomach. Do not chew or crush them because it'll stop the coating working. If you also take indigestion remedies, take them at least 2 hours before or after you take your aspirin. The antacid in the indigestion remedy affects the way the coating on these tablets works.

You can buy low-dose enteric coated aspirin and low-dose soluble aspirin from pharmacies, shops and supermarkets.

What if I forget to take it?

If you forget to take a dose of aspirin, take it as soon as you remember. If you don't remember until the following day, skip the missed dose.

Do not take a double dose to make up for a forgotten dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember to take your medicine.

What if I take too much?

Taking 1 or 2 extra tablets by accident is unlikely to be harmful.

The amount of aspirin that can lead to overdose varies from person to person.

Urgent advice:

Call your doctor straight away if:

You take too much aspirin by accident and experience side effects such as:

  • feeling sick (nausea)
  • ringing in the ears (tinnitus)
  • hearing problems
  • confusion
  • dizziness

If you need to go to a hospital accident and emergency (A&E) department, do not drive yourself - get someone else to drive you or call for an ambulance.

Take the aspirin packet or leaflet inside it, plus any remaining medicine, with you.

5. Side effects

Like all medicines, aspirin can cause side effects, although not everyone gets them.

Common side effects

Common side effects of aspirin happen in more than 1 in 100 people.

Talk to your doctor or pharmacist if the side effects bother you or don't go away:

  • mild indigestion
  • bleeding more easily than normal - because aspirin thins your blood, it can sometimes make you bleed more easily. For example, you may get nosebleeds and bruise more easily, and if you cut yourself, the bleeding may take longer than normal to stop.

Serious side effects

It happens rarely, but some people have serious side effects after taking low-dose aspirin.

Call a doctor straight away if you get:

  • red, blistered and peeling skin
  • coughing up blood or blood in your pee, poo or vomit
  • yellow skin or the whites of your eyes turn yellow - this can be a sign of liver problems
  • painful joints in the hands and feet - this can be a sign of high levels of uric acid in the blood
  • swollen hands or feet - this can be a sign of water retention

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction to aspirin.

Immediate action required:

Call 999 or go to A&E if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These aren't all the side effects of aspirin.

For a full list, see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

  • mild indigestion - take your aspirin with food. If the indigestion still doesn't go away, it could be a sign that the aspirin has caused a stomach ulcer. Talk to your doctor - they may prescribe something to protect your stomach or switch you to a different medicine.
  • bleeding more easily than normal - be careful when doing activities that might cause an injury or a cut. Always wear a helmet when cycling. Wear gloves when you use sharp objects like scissors, knives, and gardening tools. Use an electric razor instead of wet shaving, and use a soft toothbrush and waxed dental floss to clean your teeth. See a doctor if you're worried about any bleeding.

7. Pregnancy and breastfeeding

Pregnancy and low-dose aspirin

It's generally safe to take low-dose aspirin during pregnancy, as long as your doctor has said it's OK.

Your doctor may advise you to take low-dose aspirin during pregnancy:

  • to help prevent heart attack and stroke
  • to help prevent pre-eclampsia (pregnancy-related high blood pressure)
  • if you're having fertility treatment
  • if you have had several previous miscarriages

For more information about how low-dose aspirin can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPS) website.

Breastfeeding and low-dose aspirin

Aspirin is not generally recommended while you're breastfeeding.

But your doctor may suggest that you take low-dose aspirin while you're breastfeeding if they think the benefits of the medicine outweigh the possible harm.

Non-urgent advice:

Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

8. Cautions with other medicines

Some medicines interfere with the way aspirin works.

Tell your doctor if you're taking these medicines before you start taking aspirin:

  • medicines to thin blood or prevent blood clots, such as clopidogrel and warfarin - taking them with aspirin might cause bleeding problems
  • medicines for pain and inflammation, such as ibuprofen and prednisolone
  • medicines to prevent organ rejection after a transplant, such as ciclosporin and tacrolimus
  • medicines to treat high blood pressure, such as furosemide and ramipril
  • digoxin, a medicine for heart problems
  • lithium, a medicine for mental health problems
  • acetazolamide, for an eye problem called glaucoma
  • methotrexate, a medicine used to stop the immune system overreacting and sometimes to treat some types of cancer
  • diabetes medicines, such as insulin and gliclazide

Mixing low-dose aspirin with painkillers

It's safe to take paracetamol with low-dose aspirin.

But don't take ibuprofen at the same time as low-dose aspirin without talking to your doctor.

Aspirin and ibuprofen both belong to the same group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs).

If you take them together, it can increase your chances of side effects like stomach irritation.

Mixing low-dose aspirin with herbal remedies or supplements

Aspirin may not mix well with quite a lot of complementary and herbal medicines. Aspirin could change the way they work and increase your chances of side effects.

For safety, speak to your pharmacist or doctor before taking any herbal or alternative remedies with aspirin.

Important

Tell your doctor or pharmacist if you are taking any other medicines, including herbal medicines, vitamins or supplements.

Antimalarial medication is used to prevent and treat malaria.

You should always consider taking antimalarial medicine when travelling to areas where there's a risk of malaria. Visit your GP or local travel clinic for malaria advice as soon as you know when and where you're going to be travelling.

It's very important to take the correct dose and finish the course of antimalarial treatment. If you're unsure, ask your GP or pharmacist how long you should take your medication for.

Preventing malaria

It's usually recommended you take antimalarial tablets if you're visiting an area where there's a malaria risk as they can reduce your risk of malaria by about 90%.

The type of antimalarial tablets you will be prescribed is based on the following information:

  • where you're going
  • any relevant family medical history
  • your medical history, including any allergies to medication
  • any medication you're currently taking
  • any problems you've had with antimalarial medicines in the past
  • your age
  • whether you're pregnant

You may need to take a short trial course of antimalarial tablets before travelling. This is to check that you don't have an adverse reaction or side effects. If you do, alternative antimalarials can be prescribed before you leave.

Types of antimalarial medication

The main types of antimalarials used to prevent malaria are described below.

Atovaquone plus proguanil

  • Dosage – the adult dose is 1 adult-strength tablet a day. Child dosage is also once a day, but the amount depends on the child's weight. It should be started 1 or 2 days before your trip and taken every day you're in a risk area, and for 7 days after you return.
  • Recommendations – a lack of clear evidence means this antimalarial shouldn't be taken by pregnant or breastfeeding women. It's also not recommended for people with severe kidney problems.
  • Possible side effects – stomach upset, headaches, skin rash and mouth ulcers.
  • Other factors – it can be more expensive than other antimalarials, so may be more suitable for short trips.

Doxycycline (also known as Vibramycin-D)

  • Dosage – the dose is 100mg daily as a tablet or capsule. You should start the tablets 2 days before you travel and take them each day you're in a risk area, and for 4 weeks after you return.
  • Recommendations – not normally recommended for pregnant or breastfeeding women, but your GP will advise. Not recommended for children under the age of 12 (because of the risk of permanent tooth discolouration), people who are sensitive to tetracycline antibiotics, or people with liver problems.
  • Possible side effects – stomach upset, heartburn, thrush, and sunburn as a result of light sensitivity. It should always be taken with food, preferably when standing or sitting.
  • Other factors – it is relatively cheap. If you take doxycycline for acne, it will also provide protection against malaria as long as you're taking an adequate dose. Ask your GP.

Mefloquine (also known as Lariam)

  • Dosage – the adult dose is 1 tablet weekly. Child dosage is also once a week, but the amount will depend on their weight. It should be started 3 weeks before you travel and taken all the time you're in a risk area, and for 4 weeks after you get back.
  • Recommendations – it's not recommended if you have epilepsy, seizures, depression or other mental health problems, or if a close relative has any of these conditions. It's not usually recommended for people with severe heart or liver problems.
  • Possible side effects – dizziness, headache, sleep disturbances (insomnia and vivid dreams) and psychiatric reactions (anxiety, depression, panic attacks and hallucinations). It's very important to tell your doctor about any previous mental health problems, including mild depression. Don't take this medication if you have a seizure disorder.
  • Other factors – if you haven't taken mefloquine before, it's recommended you do a 3-week trial before you travel to see whether you develop any side effects.

Chloroquine and proguanil

A combination of antimalarial medications called chloroquine and proguanil is also available, although these are rarely recommended nowadays because they're largely ineffective against the most common and dangerous type of malaria parasite, Plasmodium falciparum.

However, chloroquine and proguanil may occasionally be recommended for certain destinations where the Plasmodium falciparum parasite is less common than other types, such as India and Sri Lanka.

Treating malaria

If malaria is diagnosed and treated promptly, a full recovery can be expected. Treatment should be started as soon as a blood test confirms malaria.

Many of the same antimalarial medicines used to prevent malaria can also be used to treat the disease. However, if you've taken an antimalarial to prevent malaria, you shouldn't take the same one to treat it. This means it's important to tell your doctor the name of the antimalarials you took.

The type of antimalarial medicine and how long you need to take it will depend on:

  • the type of malaria you have
  • where you caught malaria
  • the severity of your symptoms
  • whether you took preventative antimalarial tablets
  • your age
  • whether you're pregnant

Your doctor may recommend using a combination of different antimalarials to overcome strains of malaria that have become resistant to single types of medication.

Antimalarial medication is usually given as tablets or capsules. If someone is very ill, it will be given through a drip into a vein in the arm (intravenously) in hospital.

Treatment for malaria can leave you feeling very tired and weak for several weeks.

Emergency standby treatment

In some cases, you may be prescribed emergency standby treatment for malaria before you travel. This is usually if there's a risk of you becoming infected with malaria while travelling in a remote area with little or no access to medical care.

Examples of emergency standby medications include:

  • atovaquone with proguanil
  • artemether with lumefantrine
  • quinine plus doxycycline
  • quinine plus clindamycin

Your GP may decide to seek advice from a travel health specialist before prescribing standby emergency treatment.

Read more about standby emergency treatment for malaria.

Antimalarials in pregnancy

If you're pregnant, it's advisable to avoid travelling to areas where there's a risk of malaria.

Pregnant women have an increased risk of developing severe malaria, and both the baby and mother could experience serious complications.

It's very important to take the right antimalarial medicine if you're pregnant and unable to postpone or cancel your trip to an area where there's a malaria risk.

Some of the antimalarials used to prevent and treat malaria are unsuitable for pregnant women because they can cause side effects for both mother and baby.

The list below outlines which medications are safe or unsafe to use while pregnant:

  • Mefloquine – not usually prescribed during the first trimester of pregnancy, or if pregnancy is a possibility during the first 3 months after preventative antimalarial medication is stopped. This is a precaution, even though there's no evidence to suggest mefloquine is harmful to an unborn baby.
  • Doxycycline – never recommended for pregnant or breastfeeding women as it could harm the baby.
  • Atovaquone plus proguanil – not generally recommended during pregnancy or breastfeeding because research into the effects is limited. However, if the risk of malaria is high, they may be recommended if there's no suitable alternative.

Chloroquine combined with proguanil is suitable during pregnancy, but it is rarely used as it's not very effective against the most common and dangerous type of malaria parasite.

Antihistamines are medicines often used to relieve symptoms of allergies, such as hay fever, hives, conjunctivitis and reactions to insect bites or stings.

They're also sometimes used to prevent motion sickness and as a short-term treatment for insomnia.

Most antihistamines can be bought from pharmacies and shops, but some are only available on prescription.

Types of antihistamine

There are many types of antihistamine.

They're usually divided into 2 main groups:

  • antihistamines that make you feel sleepy – such as chlorphenamine (including Piriton), hydroxyzine and promethazine
  • non-drowsy antihistamines that are less likely to make you feel sleepy – such as cetirizine, fexofenadine and loratadine

They also come in several different forms – including tablets, capsules, liquids, syrups, creams, lotions, gels, eyedrops and nasal sprays.

Which type is best?

There's not much evidence to suggest any particular antihistamine is better than any other at relieving allergy symptoms.

Some people find certain types work well for them and others do not. You may need to try several types to find one that works for you.

Non-drowsy antihistamines are generally the best option, as they're less likely to make you feel sleepy. But types that make you feel sleepy may be better if your symptoms stop you sleeping.

Ask a pharmacist for advice if you're unsure which medicine to try as not all antihistamines are suitable for everyone.

How to take antihistamines

Take your medicine as advised by the pharmacist or doctor, or as described in the leaflet that comes with it.

Before taking an antihistamine, you should know:

  • how to take it – including whether it needs to be taken with water or food, or how to use it correctly (if eyedrops or a nasal spray)
  • how much to take (the dose) – this can vary depending on things such as your age and weight
  • when to take it – including how many times a day you can take it and when to take it (some types should be taken before bedtime)
  • how long to take it for – some types can be used for a long time, but some are only recommended for a few days
  • what to do if you miss a dose or take too much (overdose)

The advice varies depending on the exact medicine you're taking. If you're not sure how to take your medicine, ask a pharmacist.

Side effects of antihistamines

Like all medicines, antihistamines can cause side effects.

Side effects of antihistamines that make you drowsy can include:

  • sleepiness (drowsiness) and reduced co-ordination, reaction speed and judgement – do not drive or use machinery after taking these antihistamines
  • dry mouth
  • blurred vision
  • difficulty peeing

Side effects of non-drowsy antihistamines can include:

  • headache
  • dry mouth
  • feeling sick
  • drowsiness – although this is less common than with older types of antihistamines

Check the leaflet that comes with your medicine for a full list of possible side effects and advice about when to get medical help.

If you think your medicine has caused an unwanted side effect, you can report it through the Yellow Card Scheme.

Taking antihistamines with other medicines, food or alcohol

Speak to a pharmacist or GP before taking antihistamines if you're already taking other medicines.

There may be a risk the medicines do not mix, which could stop either from working properly or increase the risk of side effects.

Examples of medicines that could cause problems if taken with antihistamines include some types of:

  • antidepressants
  • stomach ulcer or indigestion medicines
  • cough and cold remedies that also contain an antihistamine

Try not to drink alcohol while taking an antihistamine, particularly if it's a type that makes you drowsy, as it can increase the chances of it making you feel sleepy.

Food and other drinks do not affect most antihistamines, but check the leaflet that comes with your medicine to make sure.

Who can take antihistamines

Most people can safely take antihistamines.

But speak to a pharmacist or GP for advice if you:

  • are pregnant – read about taking hay fever medicines in pregnancy
  • are breastfeeding – read about taking hay fever medicines while breastfeeding
  • are looking for a medicine for a young child
  • are taking other medicines
  • have an underlying health condition, such as heart disease, liver disease, kidney disease or epilepsy

Some antihistamines may not be suitable in these cases. A pharmacist or doctor can recommend one that's best for you.

Always read the leaflet that comes with your medicine to check it's safe for you before taking it or giving it to your child.

How antihistamines work

Antihistamines block the effects of a substance called histamine in your body.

Histamine is normally released when your body detects something harmful, such as an infection. It causes blood vessels to expand and the skin to swell, which helps protect the body.

But in people with allergies, the body mistakes something harmless – such as pollen, animal hair or house dust – for a threat and produces histamine. The histamine causes an allergic reaction with unpleasant symptoms including itchy, watering eyes, a running or blocked nose, sneezing and skin rashes.

Antihistamines help stop this happening if you take them before you come into contact with the substance you're allergic to. Or they can reduce the severity of symptoms if you take them afterwards.

Antifungal medicines are used to treat fungal infections, which most commonly affect your skin, hair and nails.

You can get some antifungal medicines over the counter from your pharmacy, but you may need a prescription from your GP for other types.

Infections antifungals can treat

Fungal infections commonly treated with antifungals include:

  • ringworm
  • athlete's foot
  • fungal nail infection
  • vaginal thrush
  • some kinds of severe dandruff

Less commonly, there are also more serious fungal infections that develop deep inside the body tissues, which may need to be treated in hospital.

Examples include:

  • aspergillosis, which affects the lungs
  • fungal meningitis, which affects the brain

You're more at risk of getting one of these more serious fungal infections if you have a weakened immune system – for example, if you're taking medicines to suppress your immunity.

Types of antifungal medicines

Antifungal medicines are available as:

  • topical antifungals – a cream, gel, ointment or spray you can apply directly to your skin, hair or nails
  • oral antifungals – a capsule, tablet or liquid medicine that you swallow
  • intravenous antifungals – an injection into a vein in your arm, usually given in hospital
  • intravaginal antifungal pessaries – small, soft tablets you can insert into the vagina

Some common names for antifungal medicines include:

  • clotrimazole
  • econazole
  • miconazole
  • terbinafine
  • fluconazole
  • ketoconazole
  • amphotericin

How antifungal medicines work

Antifungal medicines work by either:

  • killing the fungal cells – for example, by affecting a substance in the cell walls, causing the contents of the fungal cells to leak out and the cells to die
  • preventing the fungal cells growing and reproducing

When to see a pharmacist or GP

See a pharmacist or GP if you think you have a fungal infection. They will advise you on which antifungal medicine to take and how to take or use it. See below for some questions you may want to ask them.

The patient information leaflet that comes with your medicine will also contain advice on using your medicine.

Speak to your pharmacist or GP if you accidentally take too much of your antifungal medicine. You may be advised to visit your nearest hospital's accident and emergency (A&E) department if you've taken excessive amounts.

If you're advised to go to hospital, take the medicine's packaging with you so the healthcare professionals who treat you know what you've taken.

Things to consider when using antifungal drugs

Before taking antifungal medicines, speak to a pharmacist or your GP about:

  • any existing conditions or allergies that may affect your treatment for fungal infection
  • the possible side effects of antifungal medicines
  • whether the antifungal medicine may interact with other medicines you may already be taking (known as drug interactions)
  • whether your antifungal medicine is suitable to take during pregnancy or while breastfeeding – many aren't suitable

You can also check the patient information leaflet that comes with your antifungal medicine for more information.

Side effects of antifungal medicines

Your antifungal medicine may cause side effects. These are usually mild and only last for a short period of time.

They can include:

  • itching or burning
  • redness
  • feeling sick
  • tummy (abdominal) pain
  • diarrhoea
  • a rash

Occasionally, your antifungal medicine may cause a more severe reaction, such as:

  • an allergic reaction – your face, neck or tongue may swell and you may have difficulty breathing
  • a severe skin reaction – such as peeling or blistering skin
  • liver damage (occurs very rarely) – you may experience loss of appetite, vomiting, nausea, jaundice, dark urine or pale faeces, tiredness or weakness

Stop using the medicine if you have these severe side effects, and see your GP or pharmacist to find an alternative.

If you're having difficulty breathing, visit the accident and emergency (A&E) department of your nearest hospital or call 999 for an ambulance.

Reporting side effects

If you suspect that a medicine has made you unwell, you can report this side effect through the Yellow Card Scheme.

The scheme is run by a medicines safety watchdog called the Medicines and Healthcare Products Regulatory Agency (MHRA).

Antifungal medicines for children

Some antifungal medicines can be used on children and babies – for example, miconazole oral gel can be used to treat oral thrush in babies.

But different doses are usually needed for children of different ages

Antacids are medicines that counteract (neutralise) the acid in your stomach to relieve indigestion and heartburn.

They come as a liquid or chewable tablets and can be bought from pharmacies and shops without a prescription.

When antacids are used

Antacids may help if you have:

  • indigestion
  • heartburn or acid reflux – also known as gastro-oesophageal reflux disease (GORD)
  • a stomach ulcer
  • gastritis (inflammation of the stomach lining) 

They can quickly relieve your symptoms for a few hours. But they do not treat the underlying cause and long-term use is not recommended.

Speak to a GP if you find you need to take antacids regularly.

Common types of antacids

Many different types of antacid are available. Some are sold under a brand name and others are named after their main ingredient.

Ingredients to look for include:

  • aluminium hydroxide
  • magnesium carbonate
  • magnesium trisilicate
  • magnesium hydroxide
  • calcium carbonate
  • sodium bicarbonate

Some antacids also contain other medicines, such as an alginate (which coats your gullet with a protective layer) and simeticone (which reduces flatulence).

How and when to take antacids

Check the instructions on the packet or leaflet to see how much antacid to take and how often. This depends on the exact medicine you're taking.

Antacids should be used when you have symptoms or think you will get them soon – for most people, the best time to take them is with or soon after meals, and just before going to bed.

Remember that doses for children may be lower than for adults.

Contact a GP or pharmacist, or call NHS 111, if you take too much of the medicine and start to feel unwell.

Taking antacids with food, alcohol and other medicines

It's best to take antacids with food or soon after eating because this is when you're most likely to get indigestion or heartburn.

The effect of the medicine may also last longer if taken with food.

Antacids can affect how well other medicines work, so do not take other medicines within 2 to 4 hours of taking an antacid.

You can drink alcohol while taking antacids, but alcohol can irritate your stomach and make your symptoms worse.

Side effects of antacids

Antacids do not usually have many side effects if they're only taken occasionally and at the recommended dose.

But sometimes they can cause:

  • diarrhoea or constipation
  • flatulence (wind)
  • stomach cramps
  • feeling sick or vomiting

These should pass once you stop taking the medicine.

Speak to a pharmacist or a GP if side effects do not improve or are troublesome. You may need to switch to another medicine.

Who may not be able to take antacids

Antacids are safe for most people to take, but they're not suitable for everyone.

Speak to a pharmacist or a GP for advice first if you:

  • are pregnant or breastfeeding – most antacids are considered safe to take while pregnant or breastfeeding, but always get advice first
  • are looking for a medicine for a child under 12 years of age – some antacids are not recommended for children
  • have liver disease, kidney disease or heart failure – some antacids may not be safe if you have one of these problems
  • have an illness that means you need to control how much salt (sodium) is in your diet, such as high blood pressure or cirrhosis – some antacids contain high levels of sodium, which could make you unwell
  • are taking other medicines – antacids can interfere with other medicines and may need be avoided or taken at a different time

You can get altitude sickness if you travel to a high altitude too quickly.

Breathing becomes difficult because you're not able to take in as much oxygen.

Altitude sickness, also called acute mountain sickness (AMS), can become a medical emergency if ignored.

Your age, sex or physical fitness do not affect your likelihood of getting altitude sickness.

Also, just because you may not have had it before, this does not mean you will not get it on another trip.

Symptoms of altitude sickness

Symptoms of altitude sickness usually develop between 6 and 24 hours after reaching altitudes more than 2,500m above sea level.

Symptoms are similar to those of a bad hangover and include:

  • headache
  • feeling and being sick
  • dizziness
  • tiredness
  • loss of appetite
  • shortness of breath

The symptoms are usually worse at night.

Altitude sickness does not only affect mountain climbers. Tourists travelling to cities that are 2,500m above sea level or higher, such as La Paz in Bolivia or Bogotá in Colombia, can also get altitude sickness.

It's not possible to get altitude sickness in the UK because the highest mountain, Ben Nevis in Scotland, is only 1,345m.

Preventing altitude sickness

The best way to prevent getting altitude sickness is to travel to altitudes above 2,500m slowly.

It usually takes a few days for your body to get used to a change in altitude.

You should also:

  • avoid flying directly to areas of high altitude, if possible
  • take 2 to 3 days to get used to high altitudes before going above 2,500m
  • avoid climbing more than 300m to 500m a day
  • have a rest day every 600m to 900m you go up, or rest every 3 to 4 days
  • make sure you're drinking enough water
  • avoid smoking and alcohol
  • avoid strenuous exercise for the first 24 hours
  • eat a light but high-calorie diet

Medicines

Consider travelling with these medicines for altitude sickness:

  • acetazolamide to prevent and treat high-altitude sickness
  • ibuprofen and paracetamol for headaches
  • anti-sickness medicine, such as promethazine, for nausea

In the UK, acetazolamide is not licensed to treat altitude sickness. But it's available from most travel clinics and some GPs may prescribe it.

Promethazine is available from pharmacies. You do not need a prescription to buy it.

Begin taking acetazolamide 1 to 2 days before you start to go up in altitude and continue to take it while going up.

You should still go up gradually and follow the prevention advice, including taking time to acclimatise, having regular rest days and drinking plenty of water.

If you get symptoms of altitude sickness while taking acetazolamide, rest or go down until you feel better before going up again.

Treating altitude sickness

If you think you have altitude sickness:

  • stop and rest where you are
  • do not go any higher for at least 24 to 48 hours
  • if you have a headache, take ibuprofen or paracetamol
  • if you feel sick, take an anti-sickness medicine, such as promethazine
  • make sure you're drinking enough water
  • do not smoke, drink alcohol, or exercise

Acetazolamide can be used to reduce the severity of your symptoms, but it will not completely get rid of them.

Tell your travel companions how you feel, even if your symptoms are mild – there's a danger your judgement may not be clear.

You can continue going up with care once you feel you have fully recovered.

If you do not feel any better after 24 hours, go down by at least 500m (about 1,600 feet).

Do not attempt to climb again until your symptoms have completely disappeared.

After 2 to 3 days, your body should have adjusted to the altitude and your symptoms should disappear.

See a doctor if your symptoms do not improve or get worse.

Complications

If the symptoms of altitude sickness are ignored, they can lead to life-threatening conditions affecting the brain or lungs.

High altitude cerebral oedema (HACE)

High altitude cerebral oedema (HACE) is swelling of the brain caused by a lack of oxygen.

Symptoms of HACE include:

  • headache
  • weakness
  • feeling and being sick
  • loss of coordination
  • feeling confused
  • hallucinations (seeing and hearing things that are not there)

A person with HACE will often not realise they're ill. They may insist they're OK and want to be left alone.

HACE can develop quickly over a few hours. It can be fatal if it's not treated immediately.

Treating HACE:

  • move down to a lower altitude immediately
  • take dexamethasone
  • give bottled oxygen, if available

Dexamethasone is a steroid medicine that reduces swelling of the brain. It's often carried by professional mountain climbers as part of their medical supplies.

If you cannot go down immediately, dexamethasone can help relieve symptoms until it's safe to do so.

You should go to hospital as soon as possible for follow-up treatment.

High altitude pulmonary oedema (HAPE)

High altitude pulmonary oedema (HAPE) is a build-up of fluid in the lungs.

Symptoms of HAPE:

  • blue tinge to the skin or lips (cyanosis)
  • breathing difficulties, even when resting
  • tightness in the chest
  • a persistent cough, bringing up pink or white frothy liquid (sputum)
  • tiredness and weakness

The symptoms of HAPE can start to appear a few days after arrival at high altitude. It can be fatal if it's not treated immediately.

Treating HAPE:

  • move down to a lower altitude immediately
  • take nifedipine
  • give bottled oxygen, if available

Nifedipine is a medicine that helps to reduce chest tightness and make breathing easier. It's also often part of an expedition's medical supplies

You should go to hospital as soon as possible for follow-up treatment.

If you've had HAPE, you can register with the International HAPE Database to help develop new treatments for the condition.

An allergy is a reaction the body has to a particular food or substance.

Allergies are very common. They're thought to affect more than 1 in 4 people in the UK at some point in their lives.

They're particularly common in children. Some allergies go away as a child gets older, although many are lifelong.

Adults can develop allergies to things they were not previously allergic to.

Having an allergy can be a nuisance and affect your everyday activities, but most allergic reactions are mild and can be largely kept under control.

Severe reactions can occasionally occur, but these are uncommon.

Common allergies

Substances that cause allergic reactions are called allergens.

The more common allergens include:

  • grass and tree pollen – an allergy to these is known as hay fever (allergic rhinitis)
  • dust mites
  • animal dander, tiny flakes of skin or hair
  • food – particularly nuts, fruit, shellfish, eggs and cows' milk
  • insect bites and stings
  • medicines – including ibuprofen, aspirin and certain antibiotics
  • latex – used to make some gloves and condoms
  • mould – these can release small particles into the air that you can breathe in
  • household chemicals – including those in detergents and hair dyes

Most of these allergens are generally harmless to people who are not allergic to them.

Symptoms of an allergic reaction

Allergic reactions usually happen quickly within a few minutes of exposure to an allergen.

They can cause:

  • sneezing
  • a runny or blocked nose
  • red, itchy, watery eyes
  • wheezing and coughing
  • a red, itchy rash
  • worsening of asthma or eczema symptoms

Most allergic reactions are mild, but occasionally a severe reaction called anaphylaxis or anaphylactic shock can occur.

This is a medical emergency and needs urgent treatment.

Getting help for allergies

See a GP if you think you or your child might have had an allergic reaction to something.

The symptoms of an allergic reaction can also be caused by other conditions.

A GP can help determine whether it's likely you have an allergy.

If they think you might have a mild allergy, they can offer advice and treatment to help manage the condition.

If your allergy is particularly severe or it's not clear what you're allergic to, they may refer you to an allergy specialist for testing and advice about treatment.

Find out more about allergy testing

How to manage an allergy

In many cases, the most effective way of managing an allergy is to avoid the allergen that causes the reaction whenever possible.

For example, if you have a food allergy, you should check a food's ingredients list for allergens before eating it.

There are also several medicines available to help control symptoms of allergic reactions, including:

  • antihistamines – these can be taken when you notice the symptoms of a reaction, or before being exposed to an allergen, to stop a reaction occurring
  • decongestants – tablets, capsules, nasal sprays or liquids that can be used as a short-term treatment for a blocked nose
  • lotions and creams, such as moisturising creams (emollients) – these can reduce skin redness and itchiness
  • steroid medicines – sprays, drops, creams, inhalers and tablets that can help reduce redness and swelling caused by an allergic reaction

For some people with very severe allergies, a treatment called immunotherapy may be recommended.

This involves being exposed to the allergen in a controlled way over a number of years so your body gets used to it and does not react to it so severely.

What causes allergies?

Allergies occur when the body's immune system reacts to a particular substance as though it's harmful.

It's not clear why this happens, but most people affected have a family history of allergies or have closely related conditions, such as asthma or eczema.

The number of people with allergies is increasing every year.

The reasons for this are not understood, but 1 of the main theories is it's the result of living in a cleaner, germ-free environment, which reduces the number of germs our immune system has to deal with.

It's thought this may cause it to overreact when it comes into contact with harmless substances.

Is it an allergy, sensitivity or intolerance?

Allergy

A reaction produced by the body's immune system when exposed to a normally harmless substance.

Sensitivity

The exaggeration of the normal effects of a substance. For example, the caffeine in a cup of coffee may cause extreme symptoms, such as palpitations and trembling.

Intolerance

Where a substance causes unpleasant symptoms, such as diarrhoea, but does not involve the immune system.

People with an intolerance to certain foods can typically eat a small amount without having any problems.

Symptoms of an allergic reaction usually develop within a few minutes of being exposed to something you're allergic to, although occasionally they can develop gradually over a few hours.

Although allergic reactions can be a nuisance and hamper your normal activities, most are mild.

Very occasionally, a severe reaction called anaphylaxis can occur.

Main allergy symptoms

Common symptoms of an allergic reaction include:

  • sneezing and an itchy, runny or blocked nose (allergic rhinitis)
  • itchy, red, watering eyes (conjunctivitis)
  • wheezing, chest tightness, shortness of breath and a cough
  • a raised, itchy, red rash (hives)
  • swollen lips, tongue, eyes or face
  • tummy pain, feeling sick, vomiting or diarrhoea
  • dry, red and cracked skin

Itchy, red, watering eyes

Raised, itchy, red rash (hives)

The symptoms vary depending on what you're allergic to and how you come into contact with it.

For example, you may have a runny nose if exposed to pollen, develop a rash if you have a skin allergy, or feel sick if you eat something you're allergic to.

See your GP if you or your child might have had an allergic reaction to something. They can help determine whether the symptoms are caused by an allergy or another condition.

Read more about diagnosing allergies.

Severe allergic reaction (anaphylaxis)

In rare cases, an allergy can lead to a severe allergic reaction, called anaphylaxis or anaphylactic shock, which can be life threatening.

This affects the whole body and usually develops within minutes of exposure to something you're allergic to.

Signs of anaphylaxis include any of the symptoms above, as well as:

  • swelling of the throat and mouth
  • difficulty breathing
  • lightheadedness
  • confusion
  • blue skin or lips
  • collapsing and losing consciousness

Anaphylaxis is a medical emergency that requires immediate treatment.

Read more about anaphylaxis for information about what to do if it occurs.

If you think you have an allergy, tell your GP about the symptoms you're having, when they happen, how often they occur and if anything seems to trigger them.

Your GP can offer advice and treatment for mild allergies with a clear cause.

If your allergy is more severe or it's not obvious what you're allergic to, you may be referred for allergy testing at a specialist allergy clinic.

Find your nearest NHS allergy clinic

The tests that may be carried out are described on this page.

Skin prick testing

Skin prick testing is one of the most common allergy tests.

It involves putting a drop of liquid onto your forearm that contains a substance you may be allergic to. The skin under the drop is then gently pricked.

If you're allergic to the substance, an itchy, red bump will appear within 15 minutes.

Most people find skin prick testing not particularly painful, but it can be a little uncomfortable. It's also very safe.

Make sure you do not take antihistamines before the test, as they can interfere with the results.

Blood tests

Blood tests may be used instead of, or alongside, skin prick tests to help diagnose common allergies.

A sample of your blood is removed and analysed for specific antibodies produced by your immune system in response to an allergen.

Patch tests

Patch tests are used to investigate a type of eczema known as contact dermatitis, which can be caused by your skin being exposed to an allergen.

A small amount of the suspected allergen is added to special metal discs, which are then taped to your skin for 48 hours and monitored for a reaction.

Elimination diet

If you have a suspected food allergy, you may be advised to avoid eating a particular food to see if your symptoms improve.

After a few weeks, you may then be asked to eat the food again to check if you have another reaction.

Do not attempt to do this yourself without discussing it with a qualified healthcare professional.

Challenge testing

In a few cases, a test called a food challenge may also be used to diagnose a food allergy.

During the test, you're given the food you think you're allergic to in gradually increasing amounts to see how you react under close supervision.

This test is riskier than other forms of testing, as it could cause a severe reaction, but is the most accurate way to diagnose food allergies.

And challenge testing is always carried out in a clinic where a severe reaction can be treated if it does develop.

Allergy testing kits

The use of commercial allergy-testing kits isn't recommended.

These tests are often of a lower standard than those provided by the NHS or accredited private clinics, and are generally considered to be unreliable.

Allergy tests should be interpreted by a qualified professional who has detailed knowledge of your symptoms and medical history.

The treatment for an allergy depends on what you're allergic to. In many cases, a GP will be able to offer advice and treatment.

They'll advise you about taking steps to avoid exposure to the substance you're allergic to, and can recommend medicines to control your symptoms.

Avoiding exposure to allergens

The best way to keep your symptoms under control is often to avoid the things you're allergic to, although this is not always practical.

For example, you may be able to help manage:

  • food allergies by being careful about what you eat
  • animal allergies by keeping pets outside as much as possible and washing them regularly
  • mould allergies by keeping your home dry and well-ventilated, and dealing with any damp and condensation
  • hay fever by staying indoors and avoiding grassy areas when the pollen count is high
  • dust mite allergies by using allergy-proof duvets and pillows, and fitting wooden floors rather than carpets

Allergy medicines

Medicines for mild allergies are available from pharmacies without a prescription.

But always ask a pharmacist or GP for advice before starting any new medicine, as they're not suitable for everyone.

Antihistamines

Antihistamines are the main medicines for allergies.

They can be used:

  • as and when you notice the symptoms of an allergic reaction
  • to prevent allergic reactions – for example, you may take them in the morning if you have hay fever and you know the pollen count is high that day

Antihistamines can be taken as tablets, capsules, creams, liquids, eye drops or nasal sprays, depending on which part of your body is affected by your allergy.

Decongestants

Decongestants can be used as a short-term treatment for a blocked nose caused by an allergic reaction.

They can be taken as tablets, capsules, nasal sprays or liquids.

Do not use them for more than a week at a time, as using them for long periods can make your symptoms worse.

Lotions and creams

Red and itchy skin caused by an allergic reaction can sometimes be treated with over-the-counter creams and lotions, such as:

  • moisturising creams (emollients) to keep the skin moist and protect it from allergens
  • calamine lotion to reduce itchiness
  • steroids to reduce inflammation

Steroids

Steroid medicines can help reduce inflammation caused by an allergic reaction.

They're available as:

  • nasal sprays and eye drops for an inflamed nose and eyes
  • creams for eczema and contact dermatitis
  • inhalers for asthma
  • tablets for hives (urticaria)

Sprays, drops and weak steroid creams are available without a prescription.

Stronger creams, inhalers and tablets are available on prescription from a GP.

Immunotherapy (desensitisation) 

Immunotherapy may be an option for a small number of people with certain severe and persistent allergies who are unable to control their symptoms using the measures above.

The treatment involves being given occasional small doses of the allergen, either as an injection, or as drops or tablets under the tongue, over the course of several years.

The injection can only be performed in a specialist clinic under the supervision of a doctor, as there's a small risk of a severe reaction.

The drops or tablets can usually be taken at home.

The aim of treatment is to help your body get used to the allergen so it does not react to it so severely.

This will not necessarily cure your allergy, but it'll make it milder and mean you can take less medicine.

Treating severe allergic reactions (anaphylaxis)

Some people with severe allergies may experience life-threatening reactions, known as anaphylaxis or anaphylactic shock.

If you're at risk of this, you'll be given special injectors containing a medicine called adrenaline to use in an emergency.

If you develop symptoms of anaphylaxis, such as difficulty breathing, you should inject yourself in the outer thigh before seeking emergency medical help.

Treating specific allergic conditions

Use the links below to find information about how specific allergies and related conditions are treated:

  • hay fever
  • food allergies
  • allergic rhinitis
  • conjunctivitis
  • hives (urticaria)
  • eczema
  • contact dermatitis
  • asthma

Acne is a common skin condition that affects most people at some point. It causes spots, oily skin and sometimes skin that's hot or painful to touch.

Symptoms of acne

Acne most commonly develops on the:

  • face – this affects almost everyone with acne
  • back – this affects more than half of people with acne
  • chest – this affects about 15% of people with acne

Types of spots

There are 6 main types of spot caused by acne:

  • blackheads – small black or yellowish bumps that develop on the skin; they're not filled with dirt, but are black because the inner lining of the hair follicle produces colour
  • whiteheads – have a similar appearance to blackheads, but may be firmer and will not empty when squeezed
  • papules – small red bumps that may feel tender or sore
  • pustules – similar to papules, but have a white tip in the centre, caused by a build-up of pus
  • nodules – large hard lumps that build up beneath the surface of the skin and can be painful
  • cysts – the most severe type of spot caused by acne; they're large pus-filled lumps that look similar to boils and carry the greatest risk of causing permanent scarring

Things you can try if you have acne

These self-help techniques may be useful:

  • Do not wash affected areas of skin more than twice a day. Frequent washing can irritate the skin and make symptoms worse.
  • Wash the affected area with a mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse.
  • Do not try to "clean out" blackheads or squeeze spots. This can make them worse and cause permanent scarring.
  • Avoid using too much make-up and cosmetics. Use water-based products that are described as non-comedogenic. This means the product is less likely to block the pores in your skin.
  • Completely remove make-up before going to bed.
  • If dry skin is a problem, use a fragrance-free water-based emollient.
  • Regular exercise cannot improve your acne, but it can boost your mood and improve your self-esteem. Shower as soon as possible once you finish exercising as sweat can irritate your acne.
  • Wash your hair regularly and try to avoid letting your hair fall across your face.

Although acne cannot be cured, it can be controlled with treatment.

If you develop mild acne, it's a good idea to speak to a pharmacist for advice.

Several creams, lotions and gels for treating spots are available to buy from pharmacies.

Products containing a low concentration of benzoyl peroxide may be recommended, but be careful as this can bleach clothing.

If your acne is severe or appears on your chest and back, it may need to be treated with antibiotics or stronger creams that are only available on prescription.

When to seek medical advice

If you have mild acne, speak to a pharmacist about medicines to treat it.

If these do not control your acne, or it's making you feel very unhappy, see a GP.

You should see a GP if you have moderate or severe acne or you develop nodules or cysts, as they need to be treated properly to avoid scarring.

Try to resist the temptation to pick or squeeze the spots, as this can lead to permanent scarring.

Treatments can take up to 3 months to work, so do not expect results overnight. Once they do start to work, the results are usually good.

Why do I have acne?

Acne is most commonly linked to the changes in hormone levels during puberty, but can start at any age.

Certain hormones cause the grease-producing glands next to hair follicles in the skin to produce larger amounts of oil (abnormal sebum).

This abnormal sebum changes the activity of a usually harmless skin bacterium called P. acnes, which becomes more aggressive and causes inflammation and pus.

The hormones also thicken the inner lining of the hair follicle, causing blockage of the pores. Cleaning the skin does not help to remove this blockage.

Other possible causes

Acne is known to run in families. If both your mother and father had acne, it's likely that you'll also have acne.

Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can also lead to episodes of acne in women.

There's no evidence that diet, poor hygiene or sexual activity play a role in acne.

Who's affected?

Acne is very common in teenagers and younger adults. About 95% of people aged 11 to 30 are affected by acne to some extent.

Acne is most common in girls from the ages of 14 to 17, and in boys from the ages of 16 to 19.

Most people have acne on and off for several years before their symptoms start to improve as they get older.

Acne often disappears when a person is in their mid-20s.

In some cases, acne can continue into adult life. About 3% of adults have acne over the age of 35.

Acne is caused when tiny holes in the skin, known as hair follicles, become blocked.

Sebaceous glands are tiny glands found near the surface of your skin. The glands are attached to hair follicles, which are small holes in your skin that an individual hair grows out of.

Sebaceous glands lubricate the hair and the skin to stop it drying out. They do this by producing an oily substance called sebum.

In acne, the glands begin to produce too much sebum. The excess sebum mixes with dead skin cells and both substances form a plug in the follicle.

If the plugged follicle is close to the surface of the skin, it bulges outwards, creating a whitehead. Alternatively, the plugged follicle can be open to the skin, creating a blackhead.

Normally harmless bacteria that live on the skin can then contaminate and infect the plugged follicles, causing papules, pustules, nodules or cysts.

Testosterone 

Teenage acne is thought to be triggered by increased levels of a hormone called testosterone, which occurs during puberty. The hormone plays an important role in stimulating the growth and development of the penis and testicles in boys, and maintaining muscle and bone strength in girls.

The sebaceous glands are particularly sensitive to hormones. It's thought that increased levels of testosterone cause the glands to produce much more sebum than the skin needs.

Acne in families

Acne can run in families. If your parents had acne, it's likely that you'll also develop it.

One study has found that if both your parents had acne, you're more likely to get more severe acne at an early age. It also found that if one or both of your parents had adult acne, you're more likely to get adult acne too.

Acne in women

Women are more likely to have adult acne than men. It's thought that many cases of adult acne are caused by the changes in hormone levels that many women have at certain times.

These times include:

  • periods – some women have a flare-up of acne just before their period
  • pregnancy – many women have symptoms of acne at this time, usually during the first 3 months of their pregnancy
  • polycystic ovary syndrome – a common condition that can cause acne, weight gain and the formation of small cysts inside the ovary

Other triggers

Other possible triggers of an acne flare-up include:

  • some cosmetic products – however, this is less common as most products are now tested, so they do not cause spots (non-comedogenic)
  • certain medications – such as steroid medicines, lithium (used to treat depression and bipolar disorder) and some drugs used to treat epilepsy
  • regularly wearing items that place pressure on an affected area of skin, such as a headband or backpack
  • smoking – which can contribute to acne in older people

Acne myths

Despite being one of the most widespread skin conditions, acne is also one of the most poorly understood. There are many myths and misconceptions about it:

'Acne is caused by a poor diet'

So far, research has not found any foods that cause acne. Eating a healthy, balanced diet is recommended because it's good for your heart and your health in general.

'Acne is caused by having dirty skin and poor hygiene'

Most of the biological reactions that trigger acne occur beneath the skin, not on the surface, so the cleanliness of your skin has no effect on your acne. Washing your face more than twice a day could just aggravate your skin.

'Squeezing blackheads, whiteheads and spots is the best way to get rid of acne' 

This could actually make symptoms worse and may leave you with scarring.

'Sexual activity can influence acne'

Having sex or masturbating will not make acne any better or worse.

'Sunbathing, sunbeds and sunlamps help improve the symptoms of acne'

There's no conclusive evidence that prolonged exposure to sunlight or using sunbeds or sunlamps can improve acne. Many medicines used to treat acne can make your skin more sensitive to light, so exposure could cause painful damage to your skin, and also increase your risk of skin cancer.

'Acne is infectious'

You cannot pass acne on to other people.

A GP can diagnose acne by looking at your skin. This involves examining your face, chest or back for the different types of spot, such as blackheads or sore, red nodules.

How severe your acne is will determine where you should go for treatment and what treatment you should have.

The severity of acne is often categorised as:

  • mild – mostly whiteheads and blackheads, with a few papules and pustules
  • moderate – more widespread whiteheads and blackheads, with many papules and pustules
  • severe – lots of large, painful papules, pustules, nodules or cysts; you might also have some scarring

For mild acne, you should speak to a pharmacist for advice. For moderate or severe acne, speak to a GP.

Acne in women

If acne suddenly starts in adult women, it can be a sign of a hormonal imbalance, especially if it's accompanied by other symptoms such as:

  • excessive body hair (hirsutism)
  • irregular or light periods

The most common cause of hormonal imbalances in women is polycystic ovary syndrome (PCOS).

PCOS can be diagnosed using a combination of ultrasound scans and blood tests.

Treatment for acne depends on how severe it is. It can take several months of treatment before acne symptoms improve.

If you just have a few blackheads, whiteheads and spots, a pharmacist should be able to advise you on how to treat them successfully with over-the-counter gels or creams (topical treatments) that contain benzoyl peroxide.

Treatments from a GP

See a GP if your acne is moderate or severe, or medicine from your pharmacy has not worked, as you probably need prescription medicine.

Prescription medicines that can be used to treat acne include:

  • topical retinoids
  • topical antibiotics
  • azelaic acid
  • antibiotic tablets
  • in women, the combined oral contraceptive pill

If you have severe acne, your GP can refer you to an expert in treating skin conditions (dermatologist).

For example, if you have:

  • a large number of papules and pustules on your chest and back, as well as your face
  • painful nodules
  • scarring, or are at risk of scarring

A combination of antibiotic tablets and topical treatments is usually the first treatment option for severe acne.

Hormonal therapies or the combined oral contraceptive pill can also be effective in women who have acne.

But the progestogen-only pill or contraceptive implant can sometimes make acne worse.

Many of these treatments can take 2 to 3 months before they start to work.

It's important to be patient and persist with a recommended treatment, even if there's no immediate effect.

Topical treatments (gels, creams and lotions)

Benzoyl peroxide

Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin.

It also helps to reduce the number of whiteheads and blackheads, and has an anti-inflammatory effect.

Benzoyl peroxide is usually available as a cream or gel. It's used either once or twice a day.

It should be applied 20 minutes after washing to all of the parts of your face affected by acne.

It should be used sparingly, as too much can irritate your skin.

It also makes your face more sensitive to sunlight, so avoid too much sun and sources of ultraviolet (UV) light (such as sunbeds), or wear sun cream.

Benzoyl peroxide can have a bleaching effect, so avoid getting it on your hair or clothes.

Common side effects of benzoyl peroxide include:

  • dry and tense skin
  • a burning, itching or stinging sensation
  • some redness and peeling of the skin

Side effects are usually mild and should pass once the treatment has finished.

Most people need a 6-week course of treatment to clear most or all of their acne.

You may be advised to continue treatment less frequently to prevent acne returning.

Topical retinoids

Topical retinoids work by removing dead skin cells from the surface of the skin (exfoliating), which helps prevent them building up within hair follicles.

Tretinoin and adapalene are topical retinoids used to treat acne. They're available in a gel or cream and are usually applied once a day before you go to bed.

Apply to all the parts of your face affected by acne 20 minutes after washing your face.

It's important to apply topical retinoids sparingly and avoid excessive exposure to sunlight and UV.

Topical retinoids are not suitable for use during pregnancy, as there's a risk they might cause birth defects.

The most common side effects of topical retinoids are mild irritation and stinging of the skin.

A 6-week course is usually required, but you may be advised to continue using the medicine less frequently after this.

Topical antibiotics

Topical antibiotics help kill the bacteria on the skin that can infect plugged hair follicles. They're available as a lotion or gel that's applied once or twice a day.

A 6- to 8-week course is usually recommended. After this, treatment is usually stopped, as there's a risk that the bacteria on your face could become resistant to the antibiotics.

This could make your acne worse and cause additional infections.

Side effects are uncommon, but can include:

  • minor irritation of the skin
  • redness and burning of the skin
  • peeling of the skin

Azelaic acid

Azelaic acid is often used as an alternative treatment for acne if the side effects of benzoyl peroxide or topical retinoids are particularly irritating or painful.

Azelaic acid works by getting rid of dead skin and killing bacteria.

It's available as a cream or gel and is usually applied twice a day (or once a day if your skin is particularly sensitive).

The medicine does not make your skin sensitive to sunlight, so you do not have to avoid exposure to the sun.

You'll usually need to use azelaic acid for a month before your acne improves.

The side effects of azelaic acid are usually mild and include:

  • burning or stinging skin
  • itchiness
  • dry skin
  • redness of the skin

Antibiotic tablets

Antibiotic tablets (oral antibiotics) are usually used in combination with a topical treatment to treat more severe acne.

In most cases, a class of antibiotics called tetracyclines is prescribed, unless you're pregnant or breastfeeding.

Pregnant or breastfeeding women are usually advised to take an antibiotic called erythromycin, which is known to be safer to use.

It usually takes about 6 weeks before you notice an improvement in your acne.

Depending on how well you react to the treatment, a course of oral antibiotics can last 4 to 6 months.

Tetracyclines can make your skin sensitive to sunlight and UV light, and can also make the oral contraceptive pill less effective during the first few weeks of treatment.

You'll need to use an alternative method of contraception, such as condoms, during this time.

Hormonal therapies

Hormonal therapies can often benefit women with acne, especially if the acne flares up around periods or is associated with hormonal conditions such as polycystic ovary syndrome.

If you do not already use it, a GP may recommend the combined oral contraceptive pill, even if you're not sexually active.

This combined pill can often help improve acne in women, but may take up to a year before the full benefits are seen.

Co-cyprindiol

Co-cyprindiol is a hormonal treatment that can be used for more severe acne that does not respond to antibiotics. It helps to reduce the production of sebum.

You'll probably have to use co-cyprindiol for 2 to 6 months before you notice a significant improvement in your acne.

There's a small risk that women taking co-cyprindiol may develop breast cancer in later life.

For example, out of a group of 10,000 women who have not taken co-cyprindiol, you'd expect 16 of them to develop breast cancer by the time they were 35.

This figure rises to 17 or 18 for women who were treated with co-cyprindiol for at least 5 years in their early 20s.

There's also a very small chance of co-cyprindiol causing a blood clot. The risk is estimated to be around 1 in 2,500 in any given year.

It's not thought to be safe to take co-cyprindiol if you're pregnant or breastfeeding. Women may need to have a pregnancy test before treatment can begin.

Other side effects of co-cyprindiol include:

  • bleeding and spotting between your periods, which can sometimes occur for the first few months
  • headaches
  • sore breasts
  • mood changes
  • loss of interest in sex
  • weight gain or weight loss

Isotretinoin

Isotretinoin is a treatment for severe acne that comes in capsules. It has a number of beneficial effects:

  • it helps normalise sebum and reduce how much is produced
  • it helps prevent follicles becoming clogged
  • it decreases the amount of bacteria on the skin
  • it reduces redness and swelling in and around spots

But the drug can also cause a wide range of side effects. It's only recommended for severe cases of acne that have not responded to other treatments.

Because of the risk of side effects, isotretinoin can only be prescribed by a specialist doctor.

Read all about isotretinoin, including who can take it, side effects and the risks in pregnancy.

Non-pharmaceutical treatments

Several treatments for acne do not involve medicine.

These include:

  • comedone extractor – a small pen-shaped instrument that can be used to clean out blackheads and whiteheads
  • chemical peels – where a chemical solution is applied to the face, causing the skin to peel off and new skin to replace it
  • photodynamic therapy – where light is applied to the skin in an attempt to improve symptoms of acne

But these treatments may not work and cannot be routinely recommended.

Acne and toothpaste

A claim found on many websites is that toothpaste can dry up individual spots.

While toothpaste does contain antibacterial substances, it also contains substances that can irritate and damage your skin.

Using toothpaste in this way is not recommended. There are far more effective and safer treatments available from pharmacists or GPs.

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