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Fact Sheets

What is B6 toxicity?

Vitamin B6 toxicity (also called vitamin B6 poisoning)

Decolonisation Treatment for MRSA

Super-bug Infection

Genital Warts - Better Health Channel

Mastitis During Breast Feeding

Australian Breast feeding Association

Fact Sheets

What is B6 toxicity?

Vitamin B6 toxicity (also called vitamin B6 poisoning)

Decolonisation Treatment for MRSA

Super-bug Infection

Early detection of Skin Cancer

Skin Cancer

Genital Warts - Better Health Channel

Mastitis During Breast Feeding

Australian Breast feeding Association

Gallery

Cambodia Medical Mission

13 October 2025

Bethany Medical Centre Partners with Light for All Cambodia for 3rd Healthcare Campaign in Kampong Speu

26 June 2025

Vitamin B6 toxicity (also called vitamin B6 poisoning) happens when your body reacts to having too much vitamin B6. It usually occurs from taking high doses of vitamin B6 supplements over time, rather than from food. This is sometimes known as ‘overdose’.

When too much vitamin B6 builds up in the body, it can accumulate in the blood and damage your nerves. This may lead to a condition called peripheral neuropathy, which causes tingling, burning or numbness, usually in your hands and feet.

Not everyone who takes high doses of vitamin B6 develops toxicity. It isn’t clear why it affects some people and not others.

What is vitamin B6?

B6 is an essential vitamin that helps your nervous system function. It is a group of compounds (chemicals) that include many forms, for example pyridoxal, pyridoxine, pyridoxamine and their phosphate forms.

Most people get enough vitamin B6 through their diet.

Eating vitamin B6 from food, even in large amounts, will not cause toxicity, poisoning or overdose.

How much vitamin B6 do I need?

How much B6 you need depends on your age and sex. Most people do not need B6 supplements and can get what they need from food. Vitamin B6 can be found in many foods, including:

meat and chicken
nuts
cereals
bananas

Vitamin B6 supplements come in different forms and doses. Ask your pharmacist, dietitian or doctor if you need them, and if a blood test could help check your levels.

The Australian Dietary Guidelines warn against overdose of B6, which can happen if you take too many vitamin supplements, or foods and drinks with added vitamins.

What are the symptoms of B6 toxicity?

Taking too much B6 can lead to toxicity and cause nerve damage. The symptoms of nerve damage caused by having too much vitamin B6 include:

muscle weakness
numbness
tingling, burning or ‘pins and needles’ sensations
loss of reflexes
nerve pain

Symptoms often start in your extremities (your fingers and toes). They gradually progress to other parts of your body.

If you experience any of these symptoms while taking B6 supplements or multivitamins, see your doctor or pharmacist.

What causes vitamin B6 toxicity?

Vitamin B6 toxicity can be caused by taking too many supplements. Vitamin B6 supplements are usually safe, but people process vitamin B6 at different speeds. A dose that is safe for one person may be too high for someone else.

The recommended upper limit for vitamin B6 is 50 milligrams per day. Taking B6 supplements for a long period of time, even at a safe dose, can still cause toxicity. This is because pyridoxine can stay in your blood for up to a month, so small daily doses can build up over time.

When should I see my doctor?

You should see your doctor if you are taking B6 supplements or multivitamins containing B6 or its different chemical forms and:

feel any numbness, tingling or loss of sensation
have trouble walking or balancing
feel a loss of coordination
have a burning feeling or pain

It’s important to contact your doctor immediately, as continuing to take vitamin B6 can cause the neuropathy (nerve damage) to progress.

How is B6 toxicity diagnosed?

To diagnose vitamin B6 toxicity, your doctor may check the labels of supplements that you are taking or have previously taken. They will ask you questions about your use of supplements, including supplements for other vitamins, sports drinks or other products.

Your vitamin B6 levels can be tested with a blood or urine test.

How is B6 toxicity treated?

There is no specific treatment for pyridoxine or B6 toxicity.

The most effective thing to do is to stop taking all supplements that contain B6. Stopping B6 supplements will help to lower your B6 levels. This can be a gradual process as your body works to process the B6 in your system.

The symptoms of nerve damage may not go away immediately. It can take months to years to recover from this damage to your nervous system, and some people never fully recover.

What are the complications of B6 toxicity?

Consuming too much vitamin B6 in the form of pyridoxine can lead to a type of nerve damage called peripheral neuropathy.

Peripheral neuropathy is when your peripheral nerves are damaged. These are the nerves outside the brain and spinal cord.

More advanced symptoms of peripheral neuropathy include:

loss of balance
difficulty holding small objects
trouble walking

This damage is often temporary and may improve when you stop taking B6 supplements.

https://www.healthdirect.gov.au/vitamin-b6-toxicity

Decolonisation Treatment for MRSA

Decolonisation is the process of eradicating or reducing asymptomatic carriage of Methicillin-Resistant Staphylococcus Aureus (MRSA)

The nares are the primary site of colonisation. Other sites of colonisation include the nasopharynx, skin (especially skin folds), perineum, axillae and the gastrointestinal tract.

Decolonisation should only commence once the infection has cleared.

When an individual has MRSA, contamination of their environment and clothing can occur due to the shedding of skin scales and touching surfaces with contaminated skin or hands.

Indications

The decision to recommend decolonisation should follow an assessment of the individual (and their close contacts) that includes their willingness and capability to comply with the regimen. Decolonisation is generally recommended when individuals or their household contacts:

have recurrent MRSA or staphylococcal-like infections
are at increased risk of infection due to other existing medical conditions
are healthcare workers or careers

–or–

when there are ongoing MRSA infections occurring in a well-defined, closely-associated cohort, for example a dormitory, day-care centre or sports club.

If there are ongoing infections in a household despite treatment, decolonisation of all household members should be considered, even if some members do not have an active infection. All household members should commence decolonisation on the same day. Decolonisation is not always successful on the first attempt, and may need to be repeated.

Decolonisation treatment regimen

Body wash

Daily for 5 days. Use triclosan 1per cent (500ml) or chlorhexidine gluconate 4 per cent (500ml). Both products are available over-the-counter at pharmacies. The estimated cost to the patient $16-$24. Chlorhexidine gluconate is contraindicated in people with a perforated eardrum.

Nasal Ointment

Twice daily for 5 days – use mupirocin 2 per cent (3g bactroban tube). A prescription is required and the estimated cost of private prescriptions is up to $26. This item is on the Pharmaceutical Benefit Scheme (PBS) for Aboriginal or Torres Strait Islander person only, for the purpose of treatment of nasal colonisation with S.aureus.

Denture

Patients with dentures should soak them overnight in a denture cleaning product, for example Steradent or Polident.

Patients with known throat carriage

Gargle twice daily with a 0.2 per cent chlorhexidine-based mouthwash for example, Savacol or Rivacol, which are available over-the-counter at pharmacies.

Post-decolonisation screening for clearance

Post-decolonisation screening to determine clearance is not routinely recommended. However, it can be conducted when the outcome of screening is considered useful for the management of the MRSA, for example when:

individuals are at increased risk for infection due to other existing medical conditions
there are ongoing infections occurring in households or a well-defined, closely-associated cohort, such as a dormitory, sports club or day care centre
individuals request to know their outcome
decolonisation and clearance is requested by the Department of Health.

If clearance screening is indicated, obtain swabs (pre-moisten dry sites with sterile water or saline) from nostrils, throat and any wounds or skin lesions, at week 1 and week 12 post-decolonisation.

Factors contributing to decolonisation failure

Decolonisation is less likely to be successful if the individual has throat carriage, chronic or open wounds or permanent indwelling devices in situ.

There is the potential for failure and/or re-colonisation if there is non-compliance with the requirements for personal hygiene and environmental cleanliness.

Decolonisation should not be commenced on people with scabies or active exfoliative skin conditions, such as eczema or psoriasis, as it is likely to fail and the skin treatments may exacerbate their condition.

Any underlying exfoliative skin condition should be treated first, in consultation with a dermatologist.

Important information

Specific antibiotics may need to be prescribed as part of the decolonisation regimen for people who have recurrent infections following two consecutive decolonisation treatments. This should be in consultation with an infectious diseases physician or clinical microbiologist.

Mupirocin resistance has been associated with widespread, prolonged use and its use should initially be limited to 2 consecutive decolonisation treatments.

If rifampicin is used, it will always be recommended in combination with other antibiotics (never as a single agent).

eRifampicin is an authority required antimicrobial and MRSA treatment is not one of the indications for its use in the PBS

Decolonisation treatment of neonates (< 2 months) should not be commenced in the community unless specifically recommended by an infectious diseases physician or clinical microbiologist.

Decolonisation treatment for MRSA – fact sheet for healthcare provider (PDF 137 KB)

Decolonisation treatment for MRSA – fact sheet for consumer (PDF 1.4MB)

Reference: Decolonisation treatment for MRSA

Genital Warts

Genital warts are one of the most common sexually transmissible infections (STIs). They are caused by the human papillomavirus (HPV). There are over 100 strains of HPV, but only some affect the genitals and not all cause visible warts. Genital warts can appear around the genitals and anus or, sometimes, inside the vagina, rectum or urethra.

Appearance of genital warts

Genital warts appear as painless growths and may be:

flat or raised
single or multiple
clustered together with a cauliflower-like appearance.

Genital warts can be invisible

In many cases, HPV is a ‘subclinical’ infection. This means that you may be carrying HPV on your skin, even though you do not have any visible warts. Subclinical HPV infection is common in both women and men, but is detected more often in women through a cervical screening test.

Risk factors for genital warts

HPV is spread by direct skin-to-skin contact during vaginal or anal sex. It is also possible, but rare, to transmit HPV to the mouth by oral sex. Infection may occur after direct contact with a visible wart or contact with genital skin where the virus is present.

Warts may appear within a few weeks after sex with a person who has HPV, or they may take months to appear, or they may never appear. This can make it hard to know when or from whom you got the virus.

Treatment for genital warts

It is important to remember that treatment does not get rid of the virus. It only treats the visible warts. For most people, the body’s natural immunity will get rid of the virus over time.

Treatment aims to remove visible warts so that the area looks more cosmetically acceptable. Always consult your doctor about any treatments. Over-the-counter wart treatments are not suitable for genital warts.

Treatment options include:

cryotherapy – the warts are frozen off with liquid nitrogen or dry ice. Several treatments may be required
podophyllotoxin – this lotion can be applied at home. It is most effective on multiple warts that are easily accessible. Pregnant women should not use podophyllotoxin
imiquimod cream – this is applied once a day, three times a week for up to three months. This treatment is not recommended for use in pregnancy
laser or diathermy treatment – this is used for larger numbers of warts or when other treatment options have not been effective. Laser or diathermy treatment is administered in hospital under general anesthetic. Remember, this procedure does not get rid of the virus – just the visible warts.

Genital warts can reappear after treatment

After treatment for warts, remember:

The virus may persist on the skin, even though the visible wart has gone. This means that warts may reappear.
If the wart reappears, it does not necessarily mean that you have caught the infection again.
In most cases, the wart will eventually disappear for good. This is due to the body’s natural immune response clearing the virus from the body.

HPV and cervical cancer

Certain types of HPV can infect the cervix and cause cell changes that may, over many years, increase your risk of cervical cancer if the body is not successful in clearing the virus naturally. The types of HPV that cause visible genital warts cannot progress to cervical cancer.

Cervical screening

The National Cervical Screening Program recommends that all women aged between 25 and 70 years who have ever been sexually active should have a cervical screening test every five years, even if they’ve had the HPV vaccine.

The cervical screening test is a screening tool used to detect HPV on the cervix that may lead to cervical cancer.

Most HPV found on the cervix will clear naturally without treatment. However, some high-risk types require closer monitoring and may need treatment to remove them. Your doctor will advise you about this if necessary.

Genital warts and HPV vaccines

There are two HPV vaccine brands available in Australia to help prevent cervical cancer: Cervarix ® and Gardasil®9. Both vaccines work by preventing infection with two types of HPV — types 16 and 18. These two types have been shown to cause 70 per cent of cervical cancers.

Gardasil ®9 provides protection against nine types of HPV. In addition to types 16 and 18, it also protects against HPV types 6 and 11, which cause almost all genital warts, and types 31, 33, 45, 52 and 58, which cause an additional 15 per cent of all cervical cancers. Gardasil&amp®9 replaces the Gardasil® vaccine (which protected against the four types of HPV — types 6, 11, 16 and 18) from 2018.

Immunisation with Gardasil®9 vaccine involves a course of two injections a minimum of six months apart for children aged 12 to 13 years to under 15 years of age as part of the Year 7 secondary school vaccine program, or three injections over a six month period for people from 15 years of age.

Immunocompromised individuals require three doses of the HPV vaccine to attain adequate protection regardless of their age. The doses should be given with a minimum interval of two months between doses one and two and a minimum of four months between doses two and three.

In Victoria, the HPV vaccine is available free of charge under the National Immunisation Program for all adolescents in Year 7 of secondary school (aged 12–13 years). The two-dose course of the vaccine is given at school, or can also be given by a local doctor or at a council immunisation session.

The vaccine provides best protection if it is completed before a person becomes sexually active.

The benefit of the vaccine may be reduced for older men and women who have already had sex. Talk to your doctor about whether or not the vaccine may be beneficial for you and whether you are age eligible for the free vaccine or require a prescription.

Preventing the spread of genital warts

You can help reduce the risk of spreading genital warts by using condoms during anal or vaginal sex. However, condoms only protect the area of skin that they cover. This is because condoms do not cover all the genital skin that is exposed during sexual contact.

Condoms for men can be bought from supermarkets, pharmacists and other outlets. Female condoms are available through Family Planning Victoria and may be available from selected shops. Latex-free condoms are also available from some outlets. Male condoms and lubricant are available free from the Melbourne Sexual Health Centre, along with female condoms on request.

Remember that transmission of genital warts can occur when a wart is present, but may also occur even if there are no genital symptoms.

Genital warts and sexual relationships

The benefits of condoms are less clear if you are in a regular sexual relationship, especially if you and your partner have warts. Discuss this issue with your doctor or with a nurse at an STI clinic.

Where to get help

Your doctor / GP
Your school nurse or school welfare coordinator
Some secondary schools provide access to an adolescent health-trained GP on site
Your local community health service
Family Planning Victoria’s Action Centre Tel. 1800 013 952 or (03)9660 4700 (also is youth friendly)
Family Planning Victoria Tel. 1800 013 952 or (03) 9257 0100
Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619
Thorne Harbour Health (formerly Victorian AIDS Council) Tel. (03) 9865 6700 or 1800 134 840
The Centre Clinic, St Kilda Tel. (03) 9525 5866
Equinox Gender Diverse Health Centre Tel. (03) 9416 2889
PRONTO! Tel. (03) 9416 2889
Ballarat Community Health Sexual Health Clinic Tel. (03) 5338 4500
Bendigo Community Health Sexual Health Clinic Tel. (03) 5434 4300 Or (03) 5448 1600
Gateway Health Clinic 35, Wodonga Tel. (02) 6022 8888 or 1800657 573
Sunraysia Community Health Services Tel. (03) 5022 5444
Barwon Health Sexual Health Clinic Tel. (03) 5226 7489
Victorian Supercare Pharmacies
1800MyOptions Tel:1800 696784 is a statewide phone service for information about sexual health as well as contraception and pregnancy options.

Hand, Foot and Mouth Disease

Hand, foot and mouth disease (HFMD) is a viral infection that causes a rash or blisters on the hands and feet, as well as in or around the mouth. There are two types of viruses that cause HFMD, and the symptoms vary depending on the virus.

HFMD mainly affects children under the age of 10, but can also affect adolescents. It spreads easily from one person to another. It is possible to contract the virus more than once, but the symptoms will be less severe.

HFMD is not related to the foot and mouth disease that is found in animals.

Signs and symptoms of HFMD

Symptoms usually start three to seven days after becoming infected, and can last from seven to 10 days. If your child has HFMD, they may feel tired, have a fever, and have a rash. Depending on which virus your child has, the skin rash can look like:

Small, oval, white blisters on the palms, soles of the feet, as well as in the mouth. Your child may have a sore mouth and throat, leading to poor appetite or risk of dehydration (drinking and eating can be painful because of the mouth blisters).
A red skin rash with a brown scale on it. The rash appears on the outer arms, hands, legs, feet, around the mouth and upper buttocks. The trunk is usually relatively clear. Sometimes there are blisters present, but they are not usually in the mouth and your child can eat and drink as usual.

The blisters should not be itchy like chickenpox blisters. If your child has eczema, the HFMD can cause the eczema to worsen and potentially become infected with bacteria.

How is HFMD spread?

HFMD is most commonly caused by the coxsackie virus. The main way HFMD spreads is through contact with the fluid from inside the blisters, or with the droplets spread from sneezing and coughing. The virus can also be present in bowel movements (poo) for up to several weeks after the person has recovered.

To prevent the spread of HFMD:

Wash your hands thoroughly after touching your child’s bodily fluids. This includes touching their blisters, helping them blow their nose, and changing nappies or helping with toileting.
Make sure your child doesn’t share items such as cutlery, drinking cups, towels, toothbrushes and clothing.
Keep your child home from school, kindergarten or child care until all the fluid in their blisters has dried.

Care at home

HFMD is a viral infection that rarely causes further complications. Antibiotics do not work on viruses and are not given to children with HFMD. HFMD will get better on its own, but there are ways you can care for your child at home:

If your child is in pain or is uncomfortable, give them pain relief, such as paracetamol or ibuprofen. Do not give aspirin. See our fact sheet Pain relief for children.
Give your child frequent sips of water or an oral rehydration solution to stop them becoming dehydrated.
Leave blisters to dry naturally. Do not pierce or squeeze them.
If your child is unwell with a fever and a skin rash (small bright red spots or purple spots or unexplained bruises) that does not turn to skin-colour (blanch) when you press on it, this may be a sign of meningococcal infection (see our fact sheet Meningococcal infection).

Key points to remember

HFMD is a mild illness that will get better on its own.
Two types of viruses cause HFMD, and the rash depends on which virus your child has.
HFMD is spread easily from one person to another.

For more information

- Kids Health Info fact sheet: Pain
  relief for children
- Kids Health Info fact sheet: Dehydration
- Kids Health Info fact sheet: Eczema
- Kids Health Info fact sheet: Fever in children
- Kids Health Info fact sheet: Stopping the spread of germs
- See your GP or Maternal and Child Health Nurse.
- Hand, foot and mouth disease (HFMD)

NSW Health: Hand, foot and mouth disease fact sheet
Better Health Channel: Hand, foot and mouth disease

Common questions our doctors are asked:

Is HFMD dangerous for pregnant women?

HFMD is not known to pose a risk to pregnant women or their unborn babies.

My child still has blisters. Can she return to school?

If the fluid in the blisters has dried, then it is safe for your child to go back to school.

Developed by The Royal Children’s Hospital Emergency and Infection Control departments. We acknowledge the input of RCH consumers and careers.

Reviewed February 2018.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au

Disclaimer

This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children’s Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.

Reference: Hand, foot and mouth disease

Mastitis

What is mastitis?

Mastitis is usually the result of a blocked milk duct that hasn’t cleared. Some of the milk banked up behind the can be forced into nearby breast tissue, causing the tissue to become inflamed. The inflammation is called mastitis. Infection may or may not be present.

If you think you have mastitis, see your doctor.

What are the symptoms?

Early symptoms of mastitis can make you feel as if you are getting the flu. You may begin to get shivers and aches.

Some mothers who do not have any early signs of a blocked duct get mastitis ‘out of the blue’.

The breast will be sore like it is with a blocked duct, only worse. It is usually red and swollen, hot and painful. The skin may be shiny and there may be red streaks. You will feel ill. It is common for the ill feeling to come on very quickly.

What can I do?

Start treatment as soon as you feel a lump or sore spot in your breast.

Drain the breast often, but gently.

This is not the time to wean. More than anything else, your breasts need to be kept as empty as possible. Your baby’s sucking is the best way to do this. The milk is quite safe for your baby to drink.

Feed more often than usual, starting each feed on the sore breast. Let your baby suck long enough on this side to make sure that it is being drained well. However, take care not to let the other breast become too full, as it may cause a similar problem in that breast.

Check that your baby is getting the milk – that is, the let-down reflex is working soon after s/he begins to suck. When your let-down happens, you may notice tingling feelings in your breasts, a sudden feeling of fullness or milk leaking from your other breast. Your baby’s sucking pattern will change and s/he will start to gulp or swallow more often. Make sure your baby is attached well and that you are relaxed and comfortable to help the let-down reflex work.

There are ways of helping the breast to ’empty’ or drain more easily:

Make sure your bra is very loose or take it off.
Relax while you feed to help your milk flow.
Make a special effort to relax your arms, legs, back, shoulders and neck.
Breathe deeply and evenly.
Listen to soothing music and think about your baby to help start the let-down reflex.
Changing feeding positions might help to clear the blockage.
Gently massage the breast by stroking toward the nipple while your baby feeds.
Hand express to ’empty’ the breast if your baby won’t suck. If you have mastitis, your milk may taste salty. This won’t harm your baby, but may cause him to refuse the breast.

Apply warmth and cold

Using COLD packs on the affected breast can help reduce swelling and relieve pain.

Use WARMTH only sparingly and just before a feed (for up to a few minutes) can help trigger your let-down to help clear the blockage and may relieve pain.

Some sources of warmth:

Have a warm shower.
Use a heat pack (wheat packs that you heat in the microwave oven work well), well-covered hot water bottle, warm hand towel or a face washer wrung out in hot water.

Rest

Getting rest when you have mastitis is vital. Stay in bed if you can, or at least put your feet up for most of the day. If you do go to bed, take your baby, supplies for changing nappies and your own food and drinks with you, so you don’t have to keep getting up. If you have other children, it may be better to lie down in your living area.

Seek medical help

See a doctor after a few hours if you don’t start to feel better or straight away if you feel very unwell. If you are prescribed antibiotics, make sure you finish the course. Some mothers may get a thrush infection after a course of antibiotics, so if you have had thrush in the past, discuss this with your doctor. When mastitis is not treated promptly, a breast abscess breast abscess may form, although this is uncommon.

A summary of things to do to help relieve mastitis

START TREATMENT STRAIGHT AWAY

Rest as much as you can
Keep the sore breast as empty as possible by feeding your baby often
Apply warmth to the sore breast for up to a few minutes before a feed
Feed from the sore breast first, when your baby’s sucking is stronger
Massage the breast gently while your baby feeds
Talk to an Australian Breastfeeding Association counsellor for ideas on other feeding positions
Hand express if needed, before, after and between feeds
Cold packs after a feed may help relieve pain and reduce swelling
Breastfeed often. Hand express if your breast feels full and your baby won’t feed often

Early treatment will mean you get better faster, you will feel less ill and you will be at less risk of a breast abscess.

Prevention

Ensure your baby is attaching well to your breasts and feeding well
Breastfeed your baby as often as your baby wants to feed
Avoid missing or putting off feeds
If a breast becomes uncomfortably full, wake your baby for a feed. If your baby is not interested in feeding, you may like to express a small amount for comfort
Avoid putting pressure on your breasts eg with clothing or with your fingers while feeding
Rest as much as you can
Alternate from which breast you begin each feed. This can help ensure at least one breast gets drained well at every second feed
Avoid giving your baby any other fluids except your breastmilk, unless medically advised to.

Further resources

See the Royal Women’s Hospital mastitis clinical guideline the Academy of Breastfeeding Medicine mastitis protocol and page 43 of the National Health and Medical Research Council’s Infant Feeding Guidelines

Telephone counselling is available on the 24-hour national ABA Breastfeeding Helpline on 1800 686 268. We also offer email counselling to our members. See the full range of benefits you get with ABA membership.

The information in this website article has been taken from the ABA booklet Breastfeeding: breast and nipple care and does not replace advice from your health care providers.

Musculoskeletal Health

It is estimated that 30% of the Australian population suffer from some form of pain related to musculoskeletal conditions.

The most common causes of musculoskeletal pain are:

Arthritis
Osteoporosis

Arthritis

Arthritis is an inflammation of the joints. Itcauses pain, stiffness and disability and is very common. It affects both adults and children, and can cause chronic pain.

About Your Joints

A joint is situated where two bones meet. Joints allow movement and flexibility of various parts of the body.

The movement of the bones is caused by muscles which pull on tendons that are attached to bone. Cartilage covers the end of bones. Between the cartilage of two bones that form a joint there is a small amount of thick fluid called synovial fluid. This lubricates the joint, which allows smooth movement between the bones.

The synovium is the tissue that surrounds a joint. Synovial fluid is made by cells of the synovium. The outer part of the synovium is called the capsule. This is tough membrane that gives the joint stability and stops the bones from moving out of joint. Surrounding ligaments and muscles also help to give support and stability to joints.

How Does Arthritis Affect You?

Arthritis may affect just one joint (knee, hip, spine, shoulder, elbow, hands or feet), a few joints, or many joints.

Types Of Arthritis

The two most common types of arthritis are:

Osteoarthritis,
Rheumatoid arthritis.

Causes Of Arthritis

However, there are many different causes of arthritis including:

Age and wear and tear on joints,
Septic arthritis,
Ankylosing spondylitis,
Gout,
Calcium pyrophosphate deposition,
Psoriatic arthritis,
Reactive arthritis, and
Juvenile idiopathic arthritis.

Symptoms Of Arthritis

The symptoms of arthritis vary depending on the nature and severity of the underlying cause. Symptoms can include:

Joint pain, tenderness and stiffness,
Restricted movement of the joints,
Warmth and red skin over the affected joint, and
Weakness and muscle wasting around the joint.

Diagnostic Of Arthritis

X-rays can reveal if osteoarthritis from degenerative changes is causing your knee hip or joint pain. The diagnosis of osteoarthritis is made from your:

Medical history,
Physical examination, and
Radiology studies (xray).

There is no blood test to diagnose Osteoarthritis.

Conservative Treatment Options

Conservative treatment options refer to management of the problem without surgery.

Some conservative treatment measures for knee osteoarthritis include:

Activity Modification and Limitations,
Weight Reduction,
Anti-inflammatory Medications,
Physical Therapy,
Orthotics such as canes, braces or insoles, and
Injection of steroid and analgesic into the knee joint eg: Platelet Rich Plasma (PRP).

Osteoporosis

Osteoporosis is a condition that affects bone strength (the word osteoporosis literally means “porous bones”).

Bone is made of tough, elastic fibres (collagen fibres) and gritty, hard material (minerals). It is a living tissue and contains cells that make, mould and take back up (resorb) bone.

Initially, as you grow, bone forms faster than it is resorbed. But, as you get older, this reverses. As a result, from about the age of 35, you start to lose a certain amount of bone material overall.

Your bones become less dense and less strong. The amount of bone loss can vary. If you have a lot of bone density loss, then you have ‘thinning’ of the bones (osteoporosis).

If you have osteoporosis, your bones can break more easily than normal, especially if you have an accident such as a fall. If you have a milder degree of bone loss, this is known as osteopenia.

Causes Or Risk Factors For Osteoporosis

The exact cause of osteoporosis is not clear. The major risk factors associated with an increase in the incidence of osteoporosis include:

Age and gender: After the age of 35 years, the body gradually loses bone mass. Hence, the greater the age, the higher the risk for osteoporosis. Moreover, women are four times more prone to osteoporosis when compared to men. Thus older women over 50 are at a higher risk for osteoporosis.
Family history and ethnicity: Caucasians, Hispanics and Asians are at an increased risk to developing osteoporosis.This risk is further increased by a small, thin body frame and a family history of fractures. Hence heredity plays an important role in the development of osteoporosis.
Endocrine disorders: Endocrine disorders such as hyperparathyroidism and thyroid problems increase the risk of osteoporosis by adversely affecting the process of bone formation.
Medications: Hormone replacement therapy for prostate cancer or breast cancer, long term corticosteroid therapy (more than 3 months) and some anti-epileptic drugs increase the risk for osteoporosis.
Nutrition and lifestyle: A sedentary lifestyle, smoking, excessive alcohol intake and poor nutrition with a calcium deficient diet make an individual highly prone to develop osteoporosis.
Eating disorders: These may lead to a deficiency of essential nutrients required for healthy bone and thereby increase the risk for osteoporosis.

Diagnosis Of Osteoporosis

At present, there is no national screening programme in Australia for osteoporosis. However, if you have a risk factor, our practice may ask questions to see how many other risk factors for osteoporosis (listed above) apply to you.

If you are found to be at increased risk, or your risk is uncertain, you may be referred for a DEXA scan. DEXA stands for dual-energy X-ray absorptiometry. It is a scan that uses special X-ray machines to check your bone density.

A DEXA scan can confirm osteoporosis.

Treatment For Osteoporosis

Treatment of osteoporosis aims to strengthen the existing bones, while stopping the disease progression.

Medications: such as calcium and vitamin D supplements, oestrogen for postmenopausal women, testosterone for men, parathyroid hormone shots and bisphosphonates can be prescribed to patients.
Simple lifestyle changes: such as a healthy, well balanced diet rich in protein, calcium and vitamin D, regular exercise such as walking and jogging, along with abstinence from smoking and alcohol improve overall bone health and prevent the development of osteoporosis. In patients with osteoporosis these lifestyle changes may delay the progression of the disease.

Speak to our doctors about your osteoporosis.

Vaginitis

What is vaginitis?

Vaginitis is an inflammation of the vagina. As many as one third of women will have symptoms of vaginitis sometime during their lives. Vaginitis affects women of all ages but is most common during the reproductive years.

What can cause vaginitis?

A change in the balance of the yeast and bacteria that normally live in the vagina can result in vaginitis. This causes the lining of the vagina to become inflamed. Factors that can change the normal balance of the vagina include the following:

Use of antibiotics
Changes in hormone levels due to pregnancy, breastfeeding, or menopause
Douching
Spermicides
Sexual intercourse
Infection

How is vaginitis diagnosed?

To diagnose vaginitis, your health care professional will take a sample of the discharge from your vagina and look at it under a microscope. Your health care professional also may suggest other tests.

How is vaginitis treated?

Treatment will depend on the cause of the vaginitis. Treatment may be either with a pill or a cream or gel that is applied to the vagina.

What is a yeast infection?

Yeast infection also is known as candidiasis. It is one of the most common types of vaginal infection.

What causes yeast infections?

A yeast infection is caused by a fungus called Candida. It is found in small numbers in the normal vagina. However, when the balance of bacteria and yeast in the vagina is altered, the yeast may overgrow and cause symptoms.

What factors increase the risk of getting a yeast infection?

Use of some types of antibiotics increase your risk of a yeast infection. The antibiotics kill normal vaginal bacteria, which keep yeast in check. The yeast can then overgrow. A woman is more likely to get yeast infections if she is pregnant or has diabetes. Overgrowth of yeast also can occur if the body’s immune system, which protects the body from disease, is not working well.

What are the symptoms of a yeast infection?

The most common symptoms of a yeast infection are itching and burning of the area outside the vagina called the vulva. The vulva may be red and swollen. The vaginal discharge usually is white, lumpy, and has no odor. Some women with yeast infections notice an increase or change in discharge.

What treatments are available for vaginal yeast infection?

Yeast infections can be treated either by placing medication into the vagina or by taking a pill.

Should I use an over-the-counter medication to treat a yeast infection?

Over-the-counter treatments are safe and often effective in treating yeast infections. But many women think that they have a yeast infection when they actually have another problem. In these cases, a medication for a yeast infection will not work and may cause a delay in proper diagnosis and treatment of the actual problem.

Even if you have had a yeast infection before, it may be a good idea to call your health care professional before using an over-the-counter medication to treat your symptoms. If this is the first time you have had vaginal symptoms, you should see your health care professional. If you have used an over-the-counter medication and your symptoms do not go away, see your health care professional.

What is bacterial vaginosis?

Bacterial vaginosis is caused by overgrowth of the bacteria that occur naturally in the vagina.

What are the symptoms of bacterial vaginosis?

The main symptom is increased discharge with a strong fishy odor. The discharge usually is thin and dark or dull gray, but may have a greenish color. Itching is not common, but may be present if there is a lot of discharge.

How is bacterial vaginosis treated?

Several different antibiotics can be used to treat bacterial vaginosis. They can be taken by mouth or inserted into the vagina as a cream or gel.

What is trichomoniasis?

Trichomoniasis is a condition caused by the microscopic parasite Trichomonas vaginalis. It is spread through sex. Women who have trichomoniasis are at an increased risk of infection with other sexually transmitted infections (STIs).

What are the symptoms of trichomoniasis?

Signs of trichomoniasis may include a yellow-gray or green vaginal discharge. The discharge may have a fishy odor. There may be burning, irritation, redness, and swelling of the vulva. Sometimes there is pain during urination.

How is trichomoniasis treated?

Trichomoniasis usually is treated with a single dose of an antibiotic by mouth. Sexual partners must be treated to prevent the infection from recurring.

What is atrophic vaginitis?

Atrophic vaginitis is not caused by an infection but can cause vaginal discharge and irritation, such as dryness, itching, and burning. This condition may occur any time when female hormone levels are low, such as during breastfeeding and after menopause. Atrophic vaginitis is treated with estrogen, which can be applied as a vaginal cream, ring, or tablet. A water-soluble lubricant also may be helpful during intercourse.

Glossary

Antibiotics: Drugs that treat certain types of infections.

Bacterial Vaginosis: A type of vaginal infection caused by the overgrowth of a number of organisms that are normally found in the vagina.

Candidiasis: Also called yeast infection or moniliasis, a type of vaginitis caused by the overgrowth of a fungus.

Estrogen: A female hormone produced by the ovaries.

Hormones: Substances made in the body by cells or organs that control the function of cells or organs. An example is estrogen, which controls the function of female reproductive organs.

Menopause: The time in a woman’s life when menstruation stops; defined as the absence of menstrual periods for 1 year.

Sexually Transmitted Infection (STI): An infection that is spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Spermicides: Chemicals (creams, gels, foams) that inactivate sperm.

Trichomoniasis: A type of vaginal infection caused by a one-celled organism that is usually transmitted through sex.

Vulva: The external female genital area.

If you have further questions, contact your obstetrician – gynecologist.

FAQ028: Designed as an aid to patients, this document sets forth current information and opinions related to women’s health. The information does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations, taking into account the needs of the individual patient, resources, and limitations unique to institution or type of practice, may be appropriate.

Vulvodynia (FAQ127)

Patient Education FAQs

Reference: Vaginitis

Vulvovaginitis

What is vulvovaginitis?

Vulvovaginitis is an inflammation of the vulva and sometimes the vagina. Girls with vulvovaginitis may have itching, redness and tenderness in the genital area. They may sometimes also have discharge from the vagina. This can stain underwear and have a strong smell.

What causes it?

Vulvovaginitis starts when the skin of the vulva or vagina gets irritated. There are many things that can cause this irritation, like:

tight clothing rubbing against the genital area
dampness
strong soap or detergent
bacteria from the anus
germs from a cold
skin problems (eczema or psoriasis)
constipation
sexual abuse

Why do children get vulvovaginitis?

Young girls have a greater risk for vulvovaginitis because:

they have thin and delicate skin in the genital area, which is easily irritated.
the opening of the vagina is closer to the anus.
they may wipe from back to front, bringing germs from the anus to the vulva and vagina.
they can irritate the skin of their genitals (playing in sand, on slides, teeter-totters, wearing tight.
leotards or wet bathing suits)

How is it treated?

It’s important to keep your child’s genital area clean and dry. You’ll also need to remove any causes of irritation. It can help to:

Give your a child sitz bath (a bath where the person sits in water up to their hips) twice a day in warm water to soothe the skin. You can add non-prescription bath powder for dry, itchy skin.
Wipe your child after they have a bowel movement (poop) with cotton balls dabbed with mineral oil instead of toilet paper. Remember to wipe from front to back.
Apply a thin layer of ointment (Vaseline®, Desitin® or Zincofax®) to the vulva 2-3 times a day.
Treat constipation.
Try to stop your child from scratching.

Can vulvovaginitis come back?

Yes. About half of young girls who get vulvovaginitis will have it more than once. These episodes happen less often as girls get older. Good hygiene and removing irritants will make it less likely that the vulvovaginitis will come back.

Preventing vulvovaginitis

Clothing dos

Wash underwear with a mild detergent and rinse well.
Have your child wear cotton underwear only.
Have your child sleep in loose pajamas or a nightgown (no underwear!)

Bathing dos

Give your child a bath every day with hypoallergenic soap for the body. For example: Dove®, Petro-Phillic®, Aveeno®, Johnson & Johnson®.
After a bath, pat the genital area dry with a towel. You can also use a hair dryer on a cool setting.

Toilet routine dos

Wipe from front to back. Make sure your child wipes from front to back after a bowel movement or after passing urine (peeing). Some children find it’s easier to do a good job with wet wipes (alcohol and perfume free). They can bring these to school or day care in a backpack.
Wash hands! Help your child to wash her hands well after using the toilet.
Prevent constipation. Make sure your child gets plenty of physical activity, fluids, fruits and vegetables. Stools (poop) should be shaped like a sausage. Stool that has cracks or comes out as small pebbles means your child has constipation. Visit www.cheo.on.ca to learn more about constipation.

Toilet routine don’ts

use coloured toilet paper.
use diapers at night if possible. Try to start toilet training as soon as you can

For girls that have urinary incontinence (can’t control the bladder):

Keep underwear dry. Change your child into dry underwear often. Don’t use panty liners as these make irritation worse.
Have your child sit on the toilet to pee at least four times a day. This is most important before bed and after getting up each morning. Emptying the bladder regularly can help incontinence.

Reference: VULVOVAGINITIS

Acne Vulgaris

Who gets acne vulgaris?

Nearly all of us have acne at some time or another. It mainly affects adolescents (and can start as young as 8 years old), but acne may persist, begin or become more severe in adulthood.

Find out more about the causes of acne…

What are the clinical features of acne vulgaris?

Acne most often affects the face, but it may spread to involve the neck, chest and back, and sometimes even more extensively over the body.

Superficial lesions

Open and closed comedones (blackheads and whiteheads)
Papules (small, tender red bumps)
Pustules (white or yellow “squeezable” spots)

Deeper lesions

Nodules (large painful red lumps)
Pseudocysts (cyst -like fluctuant swellings)

Secondary lesions

Excoriations (picked or scratched spots)
Erythematous macules (red marks from recently healed spots, best seen in in fair skin)
Pigmented macules (dark marks from old spots, mostly affecting those with dark skin)
Scars or various types

Individual acne lesions usually last less than 2 weeks but the deeper papules and nodules may persist for months. Many acne patients also have oily skin (seborrhoea).

More images of acne…

Acne grading

Acne may be classified as mild, moderate or severe. Comedones and inflammatory lesions are usually considered separately.

Mild acne

20 comedones
15 inflammatory lesions
Or, total lesion count 30

Moderate acne

20 – 100 comedones
15 – 50 inflammatory lesions
Or, total lesion count 30 – 125

Severe acne

5 pseudocysts
Total comedo count 100
Total inflammatory count 50
Or total lesion count 125

Classification of acne

Some dermatologists assess the severity of a patient’s acne more precisely by using a grading scale. The inflammatory lesions are compared with a set of standard photographs to determine the grade, which may be 1 (very mild) to 12 (exceptionally severe) for example.

In clinical trials evaluating acne treatment, the numbers of uninflamed and inflamed lesions are carefully counted at regular intervals. It is remarkably difficult to count consistently.

What is the treatment for acne vulgaris?

Treatment for acne depends on the patient’s age and sex, the extent and the severity of the acne, how long it has been present, and response to previous treatments.

Treatment for mild acne includes topical anti-acne preparations, lasers and lights
Treatment for moderate acne adds acne antibiotics such as tetracyclines and/or antiandrogens such as birth control pill
Treatment for severe acne may require a course of oral isotretinoin.

Reference: DermNet NZ

Helicobacter Pylori

What is Helicobacter pylori?

The bacteria H. pylori lives in the lining of the stomach. It is the most common infection in the world and is more common in developing countries. It causes inflammation of the stomach’s lining and increased production of gastric acid, which can cause gastritis, ulcers and some stomach cancers.

How is Helicobacter pylori transmitted?

It’s not fully understood how people get infected with H. pylori. It’s thought to be spread though contact with the saliva or faecal matter (poo) of an infected person, or by consuming contaminated water or food. With the improvement in basic hygiene there has been a decrease in H. pylori in the developed world.

It is likely that people become infected as children, but you can also be infected as an adult.

What conditions does Helicobacter pylori cause?

Most people who are infected with H. pylori eventually develop gastritis (inflammation of the lining of the stomach) but they may not show any symptoms.

If you are infected with H. pylori, you are more likely than other people to develop ulcers in the stomach or duodenum (the first part of the small intestine).

It also increases the risk of cancer of the stomach, but this is very rare in Australia.

How is Heliobacter pylori diagnosed?

There are several ways H.Pylori can be detected in people with symptoms, such as ulcers or gastrointestinal pain. Your doctor will request the right tests for your case, which might include:

breath test
blood test
stool (poo) sample
endoscopy

How is Helicobacter pylori treated?

Some people with H.pylori won’t need any treatment, particularly if they don’t have any symptoms.

If you’re diagnosed with a stomach ulcer caused by H. pylori, your doctor will most likely treat it with a mix of antibiotics and acid-suppressing medicine. This will also speed up ulcer healing and help prevent more ulcers from developing because the antibiotics will kill the bacteria.

Once H.pylori has been successfully eradicated, your risk of being infected again is very low.

Can Helicobacter pylori be prevented?

You can reduce your chances of getting H. pylori in the same way you protect yourself from other bacteria, for example by:

washing your hands after you use the bathroom, and before preparing and eating food
avoiding food or water that’s not clean
eating food that is cooked thoroughly (especially when travelling)
avoiding food served by people who haven’t washed their hands

Resources and support

Speak to your doctor. If you need to find a GP or health service, use the healthdirect Service Finder.
If you’re experiencing symptoms and want advice on what to do next, call healthdirect on 1800 022 222 to speak with a registered nurse, 24 hours, 7 days a week.

To know more about the breath test click here.

Triglycerides

Triglycerides are a common type of fat that accounts for about 95 per cent of all dietary fats. Both animal and vegetable fats contain triglycerides. Once digested, triglycerides circulate in the bloodstream to be used as energy by the cells. Any leftovers are stored in body fat to fuel the body between meals. If you regularly eat more kilojoules than you burn, you will be overweight or obese and may have raised triglyceride levels circulating in your blood. High blood triglycerides are linked with an increased risk of health conditions including heart disease. High triglycerides are also known as hypertriglyceridemia. Metabolic syndrome – risk factors.

High triglyceride levels are associated with a collection of disorders known as ‘metabolic syndrome’. A person with metabolic syndrome has an increased risk of developing diabetes, stroke or heart disease.

A person is classed as having metabolic syndrome when they have any three of the following factors:

Central (abdominal) obesity – excess fat in and around the stomach (abdomen)
High blood pressure (hypertension)
Higher than normal blood glucose levels
Low HDL (high density lipoprotein) cholesterol
High blood triglycerides.

Triglycerides and cholesterol

Like triglycerides, cholesterol is a fatty substance that circulates in the blood. However, the body uses triglycerides and cholesterol differently. Triglycerides are a type of fuel, while cholesterol is needed for various metabolic processes such as making particular hormones and building cells. The two types of cholesterol are high density lipoprotein (HDL) and low density lipoprotein (LDL). Over time, raised LDL causes fatty plaques to form on blood vessel walls. This process is called atherosclerosis. Blood flow is restricted through these narrowed blood vessels. A complete blockage can cause life-threatening conditions including heart attack or stroke. High triglycerides contribute to the development of atherosclerosis. Studies show that many people with high triglycerides have low levels of HDL – the ‘good’ cholesterol that helps remove fat from the artery. Low HDL levels are a known risk factor in the development of heart disease.

Causes of high triglycerides

In many cases, habitual overeating causes high triglycerides. Occasionally, the trigger is an underlying condition such as:

Excessive alcohol consumption
Adverse side effect of particular medications
Poorly managed diabetes
Hypothyroidism (insufficient production of thyroid hormones)
Some types of liver disease
Some types of kidney disease
Some genetic disorders, including the inherited disease familial hypertriglyceridemia and familial combined hyperlipidemia (triglyceride and LDL are both elevated).

Diagnosis of high triglycerides

A blood test can reveal whether or not you have high triglycerides. You may need to have two (or more) blood tests for accurate results. Don’t eat anything for at least 12 hours before each blood test because food – particularly fatty food – can temporarily boost triglyceride levels in the blood and skew your test results. Triglycerides are measured in mmol/L.

The range includes:

Very high – over 6 mmol/L
High – between2 and 6 mmol/L
Borderline high – between 1.7 and 2 mmol/L
Normal – below 1.7 mmol/L

The doctor may also test your cholesterol levels. In many cases, high triglycerides and high cholesterol go hand in hand. This condition is sometimes known as combined hyperlipidemia.

Treatment of high triglycerides

In most cases, high triglycerides are managed by making lifestyle changes. You may be advised to:

Exercise for at least 30 minutes every day.
Eat less, particularly high fat foods.
Increase the amount of fibre in your diet.
Avoid high sugar foods such as lollies. Choose foods with a low glycaemic index (GI) such as legumes and wholegrain products.
Eat more fish. Choose fish rich in omega-3 fatty acids such as salmon, mackerel, tuna and trout. Omega-3 in high doses can reduce triglyceride levels.
Cut back on alcohol. The kilojoules and sugar in alcoholic drinks can raise triglyceride levels.
Lose excess body fat using a combination of healthy eating and regular exercise.
Don’t smoke.
Manage coexisting health conditions such as diabetes or hypertension effectively.

Medications may be needed for high triglyceride levels

Sometimes, healthy eating and regular exercise can’t lower high triglyceride levels. This may be the case, for example, if you have familial hypertriglyceridemia or if you already have heart disease. Your doctor may prescribe medication such as fibrates or nicotinic acids. Drugs to help lower high blood cholesterol may also be prescribed, if necessary.

Suggestions for managing high triglyceride levels with medication include:

Always take prescription medications exactly as instructed.
See your doctor if you are having side effects from the medication. Known medication side effects may include indigestion, diarrhea, fever or muscle problems.
Don’t assume that medications will somehow overcome the hazards of an unhealthy lifestyle. A healthy diet, regular exercise and maintaining an appropriate weight for your height are the most important management strategies for high triglycerides.

Where to get help

Your doctor
Dietitians Association of Australia Tel. 1800 812 942
Cardiovascular specialist (your doctor can refer you)

Things to remember

About 95 per cent of all dietary fats are triglycerides.
Once digested, triglycerides circulate in the bloodstream to be used as energy by the cells.
If you habitually eat more kilojoules than you burn, you may have raised triglyceride levels in the blood. This is linked with an increased risk of health conditions including heart disease.
Lifestyle choices can keep triglyceride levels within the normal range. Aim to exercise regularly, eat a healthy diet and maintain an appropriate weight.

References: Triglycerides | Better Health Channel

Bronchiectasis

Bronchiectasis is an irreversible widening (dilation) of portions of the breathing tubes or airways (bronchi) resulting from damage to the airway wall.

The most common cause is severe or repeated respiratory infections, often in people who have an underlying problem with their lungs or immune system.
Most people develop a chronic cough, and some also cough up blood and have chest pain and recurrent episodes of pneumonia.
Chest x-rays, computed tomography, and breathing tests are usually done to determine the extent and severity of the disorder.
People often are given inhaled drugs, antibiotics, and other measures to suppress and clear the buildup of mucus.

Bronchiectasis can result when conditions directly injure the bronchial wall or indirectly lead to injury by interfering with normal airway defenses. Airway defenses include the mucus layer and tiny projections (cilia) on the cells that line the airways. These cilia beat back and forth, moving the thin liquid layer of mucus that normally coats the airways. Harmful particles and bacteria trapped in this mucus layer are moved up to the throat and coughed out or swallowed.

Whether airway injury is direct or indirect, areas of the bronchial wall are damaged and become chronically inflamed. The inflamed bronchial wall becomes less elastic, resulting in the affected airways becoming widened (dilated) and developing small outpouchings, or sacs, that resemble tiny balloons. Inflammation also increases secretions (mucus). Because cells with cilia are damaged or destroyed, these secretions accumulate in the widened airways and serve as a breeding ground for bacteria. The bacteria further damage the bronchial wall, leading to a vicious cycle of infection and airway damage.

Understanding Bronchiectasis

In bronchiectasis, mucus production increases, the cilia are destroyed or damaged, and areas of the bronchial wall become chronically inflamed and enlarged.

Bronchiectasis may affect many areas of the lung (diffuse bronchiectasis), or it may appear in only one or two areas (focal bronchiectasis). Typically, bronchiectasis causes widening of medium-sized airways, but often smaller airways become scarred and destroyed.

Complications

The inflammation and infection can extend to the small air sacs of the lungs (alveoli) and cause pneumonia, scarring, and a loss of functioning lung tissue (see also Overview of the Respiratory System). Severe scarring and loss of lung tissue can ultimately strain the right side of the heart as it tries to pump blood through the altered lung tissue. The right-sided heart strain can lead to a form of heart failure called cor pulmonale.

Very severe (advanced) cases of bronchiectasis, which occur more commonly in underdeveloped countries and in people who have advanced cystic fibrosis, may impair breathing enough to cause abnormally low levels of oxygen and/or high levels of carbon dioxide in the blood, a condition called chronic respiratory failure.

Causes

The most common cause is severe or repeated respiratory infections, which are particularly likely in people who have one or more of the following:

Cystic fibrosis
Other hereditary disorders, such as primary ciliary dyskinesia, in which the ability to clear the airways is impaired
Immunodeficiency disorders
Certain autoimmune disorders, such as rheumatoid arthritis, ulcerative colitis, or Sj gren syndrome
Mechanical factors, such as airway blockage caused by an inhaled object, chronically enlarged lymph nodes, changes after lung surgery, or a lung tumor
Inhaling toxic substances that injure the airways, such as noxious fumes, gases, smoke (including tobacco smoke), and injurious dust (for example, silica and coal dust)

Allergic bronchopulmonary aspergillosis, which affects the larger airways, can cause mucus plugs that block the airways and lead to bronchiectasis. It is an allergic reaction to the fungus Aspergillus and occurs most commonly in people with asthma or cystic fibrosis.

In developing nations, severe or repeated infections that cause bronchiectasis are more often caused by tuberculosis. Poor nutrition and unavailability of vaccines can also contribute.

In many people with bronchiectasis, a cause cannot be determined despite a thorough evaluation.

Symptoms

Bronchiectasis can develop at any age. In most people, symptoms begin gradually, usually after a respiratory infection, and tend to worsen over the years. Most people develop a chronic cough that produces thick sputum. The amount and type of sputum depend on the extent of the disease and whether there is a complicating infection (often called a disease flare). Often, people have coughing spells only early in the morning and late in the day.

Coughing up of blood (hemoptysis) is common because the damaged airway walls are fragile and have increased numbers of blood vessels. Hemoptysis may be the first or only symptom.

Recurrent fever or chest pain, with or without frequent bouts of pneumonia, may also occur. People with widespread bronchiectasis may develop wheezing or shortness of breath. People whose bronchiectasis progresses to cor pulmonale or chronic respiratory failure also have fatigue, lethargy, and worsening shortness of breath, particularly during exertion. If bronchiectasis is severe and chronic, people commonly lose weight.

People may have flares (exacerbations) of disease. Exacerbations may result from a new or worsening infection. When an exacerbation occurs, people may have more severe cough, increased sputum production, or worsening of breathing difficulties.

Some Causes of Bronchiectasis

Bacterial infections, such as those caused by Staphylococcus or Pseudomonas
Mycobacterial infections, such as tuberculosis
Viral infections caused by influenza, respiratory syncytial virus, or adenoviruses

Bronchial blockage

Inhaled object
Enlarged lymph nodes
Lung tumor
Lung surgery
Mucus plugs (for example, due to allergic bronchopulmonary aspergillosis)

Inhalation injuries

Injury from noxious fumes, gases, or particle
Inhalation of stomach acid and food particles (for example, as a result of severe gastroesophageal reflux disease or a swallowing disorder)

Hereditary disorders

Cystic fibrosis
Primary ciliary dyskinesia, including Kartagener syndrome
Alpha-1 antitrypsin deficiency
Marfan syndrome

Immunologic abnormalities

Immunoglobulin deficiency syndromes
White blood cell dysfunction
Complement deficiencies
Certain autoimmune disorders, such as rheumatoid arthritis, Sj gren syndrome, and ulcerative colitis

Other conditions

Human immunodeficiency virus (HIV) infection
Diffuse panbronchiolitis (characterized by inflammation of the bronchioles throughout the lungs and chronic sinusitis)

Diagnosis

Chest x-ray
Computed tomography
Pulmonary function tests
Specific tests for suspected causes

Doctors may suspect bronchiectasis because of a person’s symptoms or the presence (currently or in the past) of a condition thought to cause bronchiectasis.

Tests are done to

Confirm the diagnosis
Assess the extent of the disease
Identify the cause of the disease

Chest x-rays can often detect the lung changes caused by bronchiectasis. However, occasionally, x-ray results are normal. Computed tomography (CT) is the most accurate test to identify and confirm the diagnosis and to determine the extent and severity of the disease.

Pulmonary function tests are done to assess how well the lungs are working. These tests measure how well the lungs are able to hold air, to move air in and out, and to exchange oxygen and carbon dioxide. Pulmonary function tests do not diagnose bronchiectasis but do help doctors determine how severe the lung disorder.

After bronchiectasis is diagnosed, tests are often done to check for disorders that may be causing or contributing to it. Such tests may include the following:

Testing for human immunodeficiency virus (HIV) infection and other immune system and autoimmune disorders
Measuring the salt level in sweat (which is abnormal in people with cystic fibrosis)
Examining nasal, bronchial, or sputum specimens with a special microscope
Doing other tests to determine if the cilia are structurally or functionally defective
Testing for allergic bronchopulmonary aspergillosis, tuberculosis, and alpha-1 antitrypsin deficiency

When bronchiectasis is limited to one area – for example, a lung lobe or segment – doctors may do a bronchoscopy to determine whether an inhaled foreign object or lung tumor is the cause.

Genetic testing for cystic fibrosis may be needed when there is a family history, repeated respiratory infections, or other unusual findings in a child or adult, even when other typical features of cystic fibrosis are absent.

Doctors may take a sample of sputum and send it to a laboratory to grow (culture) the bacteria to determine which bacteria are present and what antibiotics are most effective against these bacteria. This testing can help determine the best antibiotics to use during flares.

Prevention

Early identification and treatment of conditions that tend to cause bronchiectasis may prevent its development or reduce its severity. More than half the cases of bronchiectasis in children can be accurately diagnosed and promptly treated.

Childhood immunizations against measles and pertussis (whooping cough), improved living conditions, and better nutrition have markedly reduced the number of people who develop bronchiectasis. Annual influenza vaccination, pneumococcal vaccination, and use of appropriate antibiotics early in the course of lung infections help to prevent bronchiectasis or reduce its severity.

Other specific steps that can be taken include the following:

Receiving immunoglobulin for an immunoglobulin deficiency syndrome may prevent recurring infections.
In people who have allergic bronchopulmonary aspergillosis, using corticosteroids appropriately – and sometimes an antifungal drug (such as itraconazole) – may reduce the bronchial damage that results in bronchiectasis.
Giving the enzyme alpha-1 antitrypsin to people with alpha-1 antitrypsin deficiency may help prevent the disorder from becoming more severe.
Avoiding toxic fumes, gases, smoke, and injurious dusts also helps prevent bronchiectasis or reduce its severity.
Watching what children put in their mouth can help prevent them from inhaling foreign objects into the airways.
Avoiding oversedation due to drugs or alcohol and seeking medical care for neurologic symptoms (such as impaired consciousness) or gastrointestinal symptoms (such as difficulty in swallowing and regurgitation or coughing after eating) may help to prevent aspiration.
Avoiding use of mineral oil or petroleum jelly in the nose may prevent accidental inhalation of these substances into the lungs.

Treatment

Vaccination to prevent infections that cause or worsen bronchiectasis
Antibiotics to treat infections that cause or worsen bronchiectasis
Drainage of airway secretions with chest physical therapy, regular exercise, and other techniques
Inhaled bronchodilators and sometimes inhaled corticosteroids
Rarely, surgical removal of part of lung
Oxygen therapy, if needed

Treatment of bronchiectasis is directed toward reducing the frequency of infections when possible, preventing certain infections with vaccines, decreasing the buildup of mucus, decreasing inflammation, and relieving airway blockage. Early, effective treatment can reduce complications such as hemoptysis, low oxygen levels in the blood, respiratory failure, and cor pulmonale. Treatment of underlying conditions that cause or contribute to flares is also needed.

Flares (exacerbations) are treated with antibiotics, bronchodilators, and chest physiotherapy to promote drainage of secretions and mucus. Chest physiotherapy includes such techniques as postural drainage and chest percussion. Sometimes antibiotics are given for a long period to prevent recurring infections, especially in people who have frequent flares or cystic fibrosis. Some patients with cystic fibrosis may benefit from gene therapy targeting CFTR, which can decrease exacerbations.

Did You Know…

Bronchiectasis was first identified in 1819 by the same man who invented the stethoscope.

Inflammation and the buildup of mucus may be helped by humidification of the air and inhaling a salt water solution. Drugs that thin the thick sputum (mucolytics) may also be given to people who have cystic fibrosis. In other people, the effectiveness of mucolytics is uncertain.

Bronchial blockage can be detected and treated by bronchoscopy before severe damage occurs.

Significant bleeding with cough is sometimes treated with a technique called embolization instead of surgery. In embolization, doctors use a catheter to inject a substance that blocks the vessel that is bleeding.

Low blood oxygen levels are treated with oxygen therapy. Appropriate use of oxygen may help prevent complications such as cor pulmonale. If people have wheezing or shortness of breath, bronchodilators and sometimes inhaled corticosteroids often help. If a person has a flare, usually these drugs and an antibiotic are given, and oral corticosteroids are added in severe cases. Respiratory failure, if present, should be treated.

Rarely, part of a lung needs to be surgically removed. Such surgery usually is an option only if the disease is confined to one lung or, preferably, to one lung lobe or segment. Surgery may be considered for people who have recurrent infections despite treatment or who cough up large amounts of blood.

Advanced bronchiectasis in some people – mostly those who also have advanced cystic fibrosis – can be treated with lung transplantation. Five-year survival rates as high as 65 to 75% have been reported when a heart-lung transplantation or a double lung transplantation is used. Pulmonary function (as measured by the amount of air in the lungs and the rate and amount of air moving in and out of the lungs with each breath) usually improves within 6 months, and the improvement may be sustained for at least 5 years.

Prognosis for people with bronchiectasis depends on its cause and on how well infections and other complications are prevented or controlled. People with coexisting conditions, such as chronic bronchitis or emphysema, and people who have complications, such as pulmonary hypertension or cor pulmonale, tend to have a worse prognosis.

Atelectasis

Atelectasis is a condition in which all or part of a lung becomes airless and collapses.

Blockage of the bronchial tubes is a common cause of atelectasis.
Shortness of breath can develop if oxygen levels are low or pneumonia occurs.
Chest x-ray is used to confirm the diagnosis.
Treatment may involve making sure deep breathing occurs, relieving airway blockages, or both.

The main function of the lungs is to absorb oxygen into the bloodstream from the atmosphere and to expel carbon dioxide from the blood into the exhaled breath (gas exchange – see figure Gas Exchange Between Alveolar Spaces and Capillaries). For gas exchange to occur, the small air sacs within the lungs (alveoli) must remain open and filled with air. Alveoli are kept open by the elastic structure of the lung and by a liquid lining called surfactant. Surfactant counters the natural tendency of the alveoli to close (collapse). Periodic deep breaths, which people take unconsciously, and coughing also help keep alveoli open. Coughing expels any mucus or other secretions that could block the airways leading to the alveoli.

If the alveoli are closed for any reason, they cannot participate in gas exchange. The more alveoli that are closed, the less gas exchange occurs. Accordingly, atelectasis can decrease the level of oxygen in the blood. The body compensates for a small amount of atelectasis by closing off (constricting) the blood vessels in the affected area. This constriction redirects blood flow to alveoli that are open so that gas exchange can continue.

Causes

Common causes of atelectasis usually involve one of the following:

Blockage of one of the tubes (bronchi) that branch off from the trachea (windpipe) and lead to the lung tissue
Conditions that decrease deep breathing or suppress a person’s ability to cough

The blockage may be caused by something inside the bronchus, such as a plug of mucus, a tumor, or an inhaled foreign object (such as a pill, a piece of food, or a toy). Alternatively, the bronchus may be blocked by something pressing from the outside, such as a tumor or an enlarged lymph node. Blockage from the outside can also occur if the pleural space (the space outside of the lung but inside of the chest) contains a large amount of fluid (pleural effusion) or air (pneumothorax).

When a bronchus or a smaller airway (bronchiole) becomes blocked, the air in the alveoli beyond the blockage is absorbed into the bloodstream, causing the alveoli to shrink and collapse. The area of collapsed lungs may become infected because bacteria and white blood cells can build up behind (to the inside of) the blockage. Infection is particularly likely if atelectasis persists for several days or more. If atelectasis persists for months, the lung may not easily re-expand.

Any condition that decreases deep breathing or suppresses a person’s ability to cough can cause or contribute to atelectasis. Large doses of opioids or sedatives can decrease deep breathing. Atelectasis is common after general anesthesia, which temporarily suppresses a person’s cough and drive to breathe. Atelectasis is particularly common after chest or abdominal surgery because the effects of receiving general anesthesia may be added to the pain of deep breathing, so people take only shallow breaths. Chest or abdominal pain due to other causes (for example, injury or pneumonia) also makes taking a deep breath painful.

Certain neurological conditions, immobility, and chest deformities can limit chest movement and thus decrease deep breathing, as can abdominal swelling. People who are very overweight or obese are also at greater risk of developing atelectasis.

Did You Know?

People who smoke can decrease their risk of atelectasis after surgery by stopping smoking, ideally 6 to 8 weeks before the surgery.

Symptoms

Atelectasis itself does not cause any symptoms except sometimes shortness of breath. The presence and severity of shortness of breath depend on how rapidly atelectasis develops and how much of the lung is affected. If atelectasis involves a limited portion of the lung or develops slowly, symptoms may be mild or not even noticed. If a large number of alveoli are affected, particularly if atelectasis occurs rapidly, shortness of breath may be severe.

The heart rate and breathing rate may increase, and sometimes the person may look bluish (a condition called cyanosis) because oxygen levels in the blood are low.

Symptoms may also reflect the disorder that caused atelectasis (for example, chest pain due to an injury) or a disorder that results from atelectasis (for example, chest pain with deep breathing, due to pneumonia).

Diagnosis

Chest x-ray

Doctors suspect atelectasis based on a person’s symptoms, the physical examination findings, and the setting in which the symptoms occurred. A chest x-ray that shows the airless area confirms the diagnosis. Sometimes computed tomography (CT), bronchoscopy (inserting a viewing tube into the bronchus), or both may be done to find the cause.

Prevention

People who smoke can decrease their risk of atelectasis after surgery by stopping smoking, ideally 6 to 8 weeks before surgery. After surgery, people are encouraged to breathe deeply, cough regularly, and move about as soon as possible. The use of devices to encourage voluntary deep breathing, called incentive spirometry, and certain exercises, including changing position to increase the drainage of lung mucus and other secretions, may help prevent atelectasis.

Atelectasis may be prevented by making sure deep breathing occurs. Whenever possible, conditions that cause shallow breathing for long periods should be treated.

Treatment

Deep breathing and coughing
Relief of airway blockages by suctioning or bronchoscopy

Treatment of atelectasis may involve making sure deep breathing occurs, relieving airway blockages, or both.

Sometimes blockages can be relieved when a patient’s airway is suctioned by a health care practitioner. A blockage that cannot be removed by suctioning may require removal by bronchoscopy. Sometimes other methods are necessary. For example, if a tumor is blocking an airway, the blockage can sometimes be relieved by surgery, radiation therapy, chemotherapy, or laser treatment. If mucus is plugging the airways, doctors sometimes give drugs to try to thin the mucus or open the airways.

Treatment of complications

Symptoms and complications of atelectasis may require treatment. People may require.

Supplemental oxygen
Antibiotics, if bacterial infection is suspected
Rarely, insertion of a breathing tube (endotracheal intubation) and mechanical ventilation

Antidepressants

There is a lot of misinformation about antidepressant medication and there is no simple explanation as to how it works. Medication can be important in the treatment of moderate to severe depression and in some anxiety conditions. This fact sheet looks at what antidepressants do, how they work and where to get more information and help.

How do antidepressants work?

Research shows that more severe forms of depression are associated with specific changes in the brain, including changes to some hormones and chemical message systems. In these forms of depression, there are alterations in the activity of the brain in areas which may cause a major depressive episode. This is associated with the symptoms and disability seen with depression. Antidepressant medication is thought to influence the activity of serotonin and noradrenaline in some areas of the brain. However, depression is not simply a deficiency of these chemicals. Different types of antidepressants work in slightly different ways, but they all have an influence on parts of the brain related to emotions and motivation.

When is antidepressant medication used?

Antidepressant medication may be prescribed, along with psychological treatments, when a person experiences a moderate to severe episode of depression. Sometimes, antidepressants are prescribed when other treatments have not been successful or when psychological treatments are not possible due to the severity of the illness or a lack of access to the treatment. People with more severe forms of depression (bipolar disorder and depression with psychosis) do generally need to be treated with medication. This may include one or a combination of mood stabilisers, anti-psychotic drugs and antidepressants.

Which antidepressants are the most useful?

Making a decision about which antidepressant is best for a person can be complex. The decision is made in consultation with a doctor, after careful assessment and consideration. People can help the doctor’s assessment by providing as much information as possible about themselves and their medical history. Important factors include the person’s age, symptoms, other medications and, if female, whether they are pregnant or breastfeeding. There are many different types of antidepressant medication which have been shown to work, but their effectiveness differs from person to person. Your doctor may wish to prescribe a particular antidepressant to tailor it to your particular symptoms. Antidepressants take at least two weeks before they start to help, and it may also take some time for the doctor to find the most suitable medication and dosage.

Age

Depression is common and can affect people of all ages, however, generally medication is not recommended as the first choice for the treatment of depression in children and young people.

The Therapeutic Goods Administration (Australia’s regulatory agency for medical drugs) and manufacturers of antidepressants do not recommend antidepressant use for depression in young people under the age of 18. There are, however, no government (i.e. Pharmaceutical Benefits Scheme) restrictions placed on the prescription of antidepressants and doctors are not prevented from prescribing them if they feel they are needed.

There is concern that a small percentage of young people up to the age of 24 years taking Selective Serotonin Reuptake Inhibitors (SSRIs) for the treatment of depression may experience an increase in suicidal thoughts and behaviour. Research shows the risk to be roughly 4 per cent compared to 2 per cent for those taking a placebo dummy pill).

A young person will require close medical supervision and monitoring in the early stages of treatment if an antidepressant is prescribed.

Chronic Illness

Like any medication, antidepressants can produce side-effects. In some cases, taking antidepressants can affect existing symptoms or treatments for other illnesses. It is important for people to let doctors know about any illness they may have and any medication they are taking.

Pregnancy and breastfeeding

The decision to take medication while pregnant or breastfeeding is an individual one. It should be made in consultation with a doctor after considering the risks and benefits to both the mother and baby. The lowest effective dose should be used.

If a woman is breastfeeding, generally specific types of medications are preferred. While a number of factors will influence the choice of antidepressant, a group of antidepressants called tricyclics, as well as sertraline, citalopram and fluvoxamine are most commonly prescribed for women who are breastfeeding.

Studies show that paroxetine is generally not recommended at this time.

Antidepressants and bipolar disorder

People who have bipolar disorder and experience an episode of depression will often be given a mood stabiliser alone. It can take time for mood stabilisers to work. Sometimes antidepressants are used along with mood stabilisers to help ease the symptoms.

“I resisted medication for years; inaccurately believing it was ‘weak’ or I would turn into a ‘vegetable’. Many misconceptions exist regarding medication. In my case, medication propelled my recovery and helped me to utilise psychological treatments effectively.” April, 25

Types of antidepressants

There are many different types of antidepressant medication. Your doctor may need to find the medication and dose which is most effective for you. Keep in mind antidepressants take time before they start to help (at least two weeks). Below is a description of the different classes of antidepressants. Please note, this list only includes the generic medication names and not the pharmaceutical brand names. Please look on your medication packaging to find the name of the medication you are taking (this is usually written in lowercase).

There are differences in effects and side-effects of the antidepressants listed below, which can be discussed with your prescribing health professional.

Selective Serotonin Reuptake Inhibitors (SSRIs)

This class includes sertraline; citalopram; escitalopram; paroxetine; fluoxetine; fluvoxamine. SSRIs are:

the most commonly prescribed antidepressants in Australia
often a doctors’ first choice for most types of depression
generally well tolerated by most people
generally non-sedating.

Serotonin and Noradrenalin Reuptake Inhibitors (SNRIs)

This class includes venlafaxine; desvenlafaxine; duloxetine. SNRIs:

have fewer side-effects compared to the older antidepressants (such as TriCyclic Antidepressants)
are often prescribed for severe depression
are safer if a person overdoses.

Reversible Inhibitors of MonoAmine oxidase (RIMAs)

The class includes moclobemide. RIMAs:

have fewer side-effects
are non-sedating
may be less effective in treating more severe forms of depression than other antidepressants
are helpful for people who are experiencing anxiety or sleeping difficulties.

TriCyclic Antidepressants (TCAs)

The class includes nortriptyline; clomipramine; dothiepin; imipramine; amitriptyline. TCAs are:

effective, but have more harmful side-effects than newer drugs (i.e. SSRIs)
more likely to cause low blood pressure – so this should be monitored by a doctor
more risky if a person were to overdose.

Noradrenaline-Serotonin Specific Antidepressants (NaSSAs)

This class includes mirtazapine. NaSSAs are:

helpful when there are problems with anxiety, sleeping or poor appetite
generally low in sexual side-effects, but may cause weight gain.

Noradrenalin Reuptake Inhibitors (NARIs)

This class includes reboxetine. NARIs are:

designed to act selectively on one type of brain chemical – noradrenalin
less likely to cause sleepiness or drowsiness than some other antidepressants

more likely to:

make it difficult for people to sleep
cause increased sweating after the initial doses
cause sexual difficulties after the initial doses
cause difficulty urinating after the initial doses
cause increased heart rate after the initial doses.

“Medication is not an instant fix. It takes time and often works alongside other strategies/treatments. In addition, you should be aware you will probably have side-effects, but they do ease over time and eventually, you will feel like you again.” Gina, 38

Things to note

All of these drugs have been shown to have effect as antidepressants for more severe depression however their effectiveness differs from person to person.

When symptoms are directly due to depression, the person is likely to begin to improve after 4-6 weeks of effective therapy. For example, although SSRIs commonly make sleep difficulties or insomnia worse initially, they are associated with improved sleep 4-6 weeks later.

TCAs are commonly prescribed for their wide range of general benefits, but are also the most toxic antidepressants if taken in large quantities.

SSRIs or clomipramie (TCA) would be the first choice if obsessive compulsive disorder symptoms were prominent.

Monoamine Oxidase Inhibitors (MAOIs)

This class includes tranylcypromine. MAOIs are prescribed only under exceptional circumstances as they require a special diet and have adverse effects.

Tetracyclics

This class includes Mianserin. Tetracyclics:

operate via noradrenaline and serotonin neurotransmitters systems
include side-effects such as sedation and dizziness
can cause a rare side-effect to arise, so occasional blood tests are necessary.

What are the side effects?

Antidepressants can make people feel better, but they won’t change their personality or make them feel happy all the time. They will not improve unhappiness due to a predicament or an event. Like taking any other medication, some people will experience some sideeffects. Common side-effects, depending on which medication is taken, include nausea, headaches, anxiety, sweating, dizziness, agitation, weight gain, dry mouth and sexual difficulties (e.g. difficulty becoming/staying aroused).

Some of the side-effects can be short-lived, but people who experience such symptoms should tell their doctor, as there may be ways of minimising them. The likelihood of a particular side-effect happening varies between individuals and medications.

It is not uncommon for people with depression to have suicidal thoughts. Treating the depression effectively will reduce the likelihood of a person hurting him or herself. In the period of time between the person starting antidepressant medication and responding to treatment – which can be more than two weeks – the person should still be monitored by the doctor and his or her progress reviewed, as the risk of suicidal behaviour may even be slightly increased.

How long are antidepressants usually needed?

Like any medication, the length of time a person needs to take antidepressants for depends on how severe the illness is and how they respond to treatment. Some people only need to take them for a short time (usually 6-12 months) with psychological treatments and self-help techniques being sufficient in stopping its return. Others may need to take them over the long term to prevent recurrence.

People often want to stop taking antidepressants quickly because they are concerned they are addictive. This may be because they confuse them with sedatives, a group of medications that are used to help a person feel relaxed and, in some cases, fall/stay asleep. Sedatives are designed to be used only for a short time. If used for long periods of time, sedatives may cause withdrawal insomnia and anxiety and be needed in higher doses in order for them to have the same effect. Sedatives may be craved and become addictive. This is not the case with antidepressants.

Stopping some antidepressants quickly (e.g. some SSRIs and SNRIs) can lead to a discontinuation syndrome, which consists of flu-like symptoms. For many people, this will last for several days and can be avoided if the medications likely to do this are stopped gradually, on a doctor’s recommendation and under supervision. However, in some cases these symptoms can last for weeks, months or even years. Sometimes discontinuation symptoms are severe, including irritability, agitation, dizziness and confusion.

Stopping medication should only be done gradually, on a doctor’s recommendation and under supervision.

“No one treatment has been helpful by itself for me. It’s been a combination of medication with talk therapy, as well as lifestyle changes such as getting regular exercise and modifying my diet (i.e. cutting down on alcohol and carbohydrate intake).” Greg, 42

Everyone needs to find the treatment that’s right for them. Just because a treatment has been shown to work scientifically, doesn’t mean it will work equally well for every individual. Some people will have complications, side-effects or find that the treatment does not fit in with their lifestyle. It can take time, strength and patience to find a treatment that works.

After seeking appropriate advice, the best approach is to try a treatment you’re comfortable with and one that works for most people. If you do not recover quickly enough, or experience problems with the treatment, discuss this with your health professional and consider trying another.

References

Reference: Beyond Blue (2011). Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals. Melbourne: Beyond Blue http:// www.nps.org.au/publications/health-professional/ health-news-evidence/2013/ssris-pregnancy
NPS MedicineWise (2013). Is it safe to use SSRIs during pregnancy?. [online] Available at: http://www.nps.org. au/publications/health-professional/health-newsevidence/2013/ssris-pregnancy [Accessed 22 Dec. 2014].

This fact sheet was reviewed and updated in December 2016. Clinical information might change after this date. This fact sheet is not a substitution for medical advice from your doctor.

Early Detection of Skin Cancer

Most skin cancer can be successfully treated if it is found early. But without treatment, skin cancer can be deadly. Get to know your skin and what looks normal for you to help you find changes earlier. Don’t rely on an annual skin check to detect suspicious spots. Check all of your skin − not just sunexposed areas. If you notice any new spots or changes in the colour, size or shape of existing spots, see your general practitioner (GP) as soon as possible.

What is skin cancer?

Skin cancer is the uncontrolled growth of abnormal cells in the skin. These abnormal cells usually form as a result of ultraviolet (UV) radiation damage.

There are three main types of skin cancer:

Basal cell carcinoma (BCC)

This is the most common, least dangerous form of skin cancer. BCCs grow slowly, usually on the head, neck and upper torso. A BCC may:

appear as a lump or dry, scaly area.
be red, pale or pearly in colour.
ulcerate as it grows, or appear as a sore that fails to heal completely or heals but then breaks down again.

Squamous cell carcinoma (SCC)

These are less common than BCCs but may spread to other parts of the body if untreated. SCCs grow over some months and appear on skin most often exposed to the sun. An SCC may:

be a thickened, red, scaly spot.
bleed easily, crust and ulcerate.

Melanoma

Melanoma may be life-threatening in as little as six weeks and, if left untreated, it can spread to other parts of the body. Melanoma can also appear on skin not typically exposed to the sun, such as the inner thigh or underarm.

Use the ABCD rule as a guide while examining your skin:

A = Asymmetry, look for spots that are asymmetrical (one half of the spot doesn’t match the other).
B = Border irregularity, look for spots with uneven borders. Melanoma is often flat with an uneven, smudgy outline.
C = Colour, look for spots with an unusual or uneven colour. May be blotchy and more than one colour – brown, black, blue, grey or red.
D = Diameter, look for spots that are larger than 7mm.

Nodular melanoma is a fast growing and aggressive melanoma that does not follow the ABCD criteria above. It is often red, pink, brown or black and feels firm to touch. Nodular melanoma grows very quickly and needs to be treated as soon as possible.

Self-examination

Most skin cancers are found by people checking their own skin or are noticed by a loved one. Cancer Council recommends that all adults, particularly those aged 40 and over, should:

get to know their skin.
check all areas of their skin regularly, including skin not normally exposed to the sun.
look for changes in the shape, colour or size of a spot, or a new spot – if you notice anything unusual, see your doctor straight away.
ask others to check difficult-to-see areas, such as the back.

Photographs of any suspicious spots can be useful to record any changes over time. If you are worried about any skin changes, talk to your GP.

Who can diagnose and treat skin cancer?

Cancer Council recommends that you first visit a GP to assess your skin. Although suspicious spots should be treated appropriately, harmless spots should not be removed unnecessarily.

GPs

GPs an examine your skin and advise you of appropriate care. GPs are trained in diagnosing and treating skin cancers, which may include minor procedures.

If you are at higher risk of skin cancer, speak with your GP about developing a surveillance program, which may include regular skin checks.

Your GP can also refer you to a dermatologist.

Dermatologists

Dermatologists are doctors who have completed additional training to specialise in diagnosing and treating skin diseases, including skin cancer.

To see a dermatologist you should get a referral from a GP. You can see a dermatologist without a GP referral but your Medicare rebate may be smaller.

Book your appointment as soon as you can. It may be some weeks before you can get an appointment. If your case is urgent, your GP should be able to arrange an early appointment. If you live in regional Victoria, there may not be a dermatologist in the area; however, many regional areas have visiting dermatologists. Your GP should be able to advise you.

Skin cancer clinics

There are many skin cancer clinics offering a variety of services and fee arrangements. General practitioners – not dermatologists – are more likely to operate skin cancer clinics. If you wish to see a dermatologist or get a second opinion, you may ask for a referral.

Cancer Council Victoria does not operate or endorse any skin check service providers or skin cancer clinics.

Questions to ask

Whoever you decide to see, here are some questions you should ask.

What are the qualifications, skills and experience of the person examining my skin?

If you are told you have skin cancer, ask:

What type of skin cancer do I have (is it a common BCC or SCC or is it a potentially serious melanoma)?
How advanced is the skin cancer?
Do I need treatment immediately?
What are the treatment options and the benefits and risks of the treatment options?
What sun protection is required? Ask about skin cancer prevention.
What follow-up is required?
What costs are involved?

Ask how much each procedure will cost and how much you will get back through Medicare. If you are in a private health fund, check first if any of these procedures are covered by your plan.

More information and resources

Consumer Guide to Skin Clinics and other information is available from sunsmart.com.au.
Melanoma and Common Skin Cancers patient booklets are available from the Cancer Council on 13 11 20 or cancervic.org.au.
UV-protective clothing and accessories can be purchased at Cancer Council Victoria’s shop or online at www.cancercouncilshop.org.au.
This information is based on available evidence at the time of review. It can be photocopied for distribution.
Updated: August 2017

Reference: Early detection of skin cancer

Eczema

Eczema is a common skin condition that usually begins before your child is one year old. The affected skin is dry, red and itchy. Sometimes these areas of skin can become cracked, weepy and then scab over.

Unfortunately there is no cure for eczema. However, there are many ways to keep eczema under control and help your child feel more comfortable. Eczema is not contagious.

Signs and symptoms of eczema

Babies with eczema usually have a red, dry rash on their face. The rash may be on their scalp, body, arms and legs or behind their ears. The rash is very itchy and may keep them awake at night.

In toddlers and older children, the eczema rash is often in the skin creases around the knees, wrists, elbows and ankles.

In some children the rash can cover their entire body.

It is common for the severity of the eczema to change, and you will notice that sometimes your child’s eczema is mild, while at other times it gets worse. It is important to effectively manage the eczema and control it as soon as it flares up.

Secondary bacterial or viral skin infections are also common in children with eczema, especially when the eczema is not well controlled. Do not allow anyone with a cold sore to kiss your child, as the eczema may become infected with the cold sore virus. The signs of a secondary infection are weepy, crusted and broken areas of eczema.

What causes eczema?

The cause of eczema is not known. If a member of your family has eczema, asthma or hay fever, then it is more likely that your child will have eczema. Some children with eczema may also develop asthma or hay fever.

Eczema can be triggered by a number of things, such as:

becoming overheated with clothing, blankets, heaters
dryness of the skin
irritation from soaps, detergents, fabrics or other chemicals
food allergies or intolerances
allergies to environmental allergens, such as dust mites, plant pollens or animal fur
viruses and other common infections.

Care at home

Eczema can be well controlled at home in most children by identifying and avoiding triggers. Using the following strategies will help control the eczema and make your child more comfortable.

Avoid things that irritate the skin

Each child may react to different things, and it may take a while to work out what is irritating your child’s skin. Some common things that can irritate the skin include:

dummies, dribbling or food around the mouth – apply thick moisturiser around the mouth, wash the skin with a soft, wet towel after eating and then reapply the moisturiser
prickly materials, such as woollen or acrylic clothing, bedding and car seat covers
detergents, soaps, bubble baths, antiseptic washes
toothpaste – use a product without SLS as an ingredient
environmental allergens, such as pet fur, pollen and house dust mites – if you think your child may be allergic to one of these allergens, take them to see an allergist.

Keep the skin moisturised

A thick, plain moisturiser with no fragrance should be used as often as necessary on your child, even when the skin is clear of eczema. Some children will require moisturiser application once or twice a day, while others will need it more often. Thicker creams are more effective than lotions.

Fragrance-free moisturisers, bath oils or soap-free body wash (not plant-based) should be used in the bath and shower.

Keep your child cool

Heat is the most common trigger for eczema. You can keep your child cool by:

dressing your child in one or two thin layers of cotton clothing
removing doonas and woollen blankets from your child’s bed and using a cotton blanket or sheet instead
keeping your house below 20°C during the day
keep your child’s room at or below 15°C overnight
telling teachers at your childcare centre, kindergarten or school how to dress your child appropriately.

It is a good idea to bathe your child at least once a day in a cool bath. The bath should be no hotter than 30°C, and have one to two capfuls of plain, non-perfumed bath oil added.

Control your child’s itching

Scratching makes the eczema worse and can cause infection. Try these ideas to help them stop scratching:

Apply a soft, cool, wet towel to the itchy area for immediate relief, and leave on for 5 – 10 minutes. Remove the towel and apply a thick layer of moisturiser.
Apply wet dressings at bedtime, particularly if the eczema is not controlled within 24 – 48 hours of starting cortisone treatment (if prescribed – see below). Wet dressings should be stopped when the eczema has cleared and then used again if it flares up. Wet dressings are very effective and are usually only needed for three to five nights. (See Wet dressing instructions)
A wet T-shirt or singlet underneath a thin layer of cotton clothing is a good way to reduce the itch and redness on your child’s body. You can repeat this throughout the day and night until the itch and redness subside.
Use a mineral salt spray (available at pharmacies) for immediate relief of itch.
Distract your child when they are scratching.
Keep your child’s fingernails short and clean.

Eczema and diet

Most children with eczema do not have any reactions to food. However, in some children, food allergy may be a trigger.

Food allergy needs to be considered in babies with very widespread eczema who are not responding to eczema treatment.

Sometimes older children can be intolerant to acidic foods and preservatives, leading to eczema breakouts around the mouth. This is not an allergy.

All foods should be considered ‘innocent until proven guilty’. It is important not to restrict your child’s diet unless you have been advised to do so by a doctor, allergist or dietitian. An allergist may choose to test your child to confirm any food allergies.

When to see a doctor

Take your child to the GP if:

your child ‘s eczema is not getting better after two days of regular treatment
your child is showing signs of infection: weepy, crusted and broken areas of eczema
you are concerned about your child’s health or skin for any reason.

If your child’s eczema has developed a bacterial infection, they may need antibiotics. Very occasionally, if your child has a severely infected rash, they may need to be treated in hospital.

Bleach baths may be recommended if your child’s eczema is infected and difficult to control. See Formula for an eczema bath.

If your child’s eczema is complicated or difficult to treat, a doctor or dermatology nurse practitioner will prepare an eczema treatment plan for your child.

Cortisone treatment

Your doctor may prescribe a cortisone-based cream or ointment. Cortisone is a natural hormone that is produced by the body. Cortisones are very effective in controlling eczema, and are safe if used as directed.

Weaker cortisones are used on your child’s face, and stronger cortisones are used on their body. It is important to apply the correct cortisone to all areas of eczema, even if the skin is open. Any medicines, creams and ointments should be used as prescribed by the doctor.

Even though weak cortisone creams are available over the counter from the pharmacy, it is important to get a cream or lotion that is suitable for your child, and that you know how to apply it properly. Seek medical advice before using over-the-counter cortisone treatments on your child.

Removing your child’s scabs

If the eczema becomes crusted or scabs over, it is important to remove the scabs. The eczema treatment won’t reach the skin if scabs are in the way. To remove scabs, give your child a cool bath for 30 minutes to soften the scabs. Then before getting them out of the bath, wipe the crusts off with a soft, wet towel. Once the scabs are removed, your child’s eczema treatment plan should be followed again, with creams applied on the open skin.

Key points to remember

There is no cure for eczema but it can be well controlled.
It is common for the severity of the eczema to change, and it is important to control the eczema as soon as it flares up.
To control eczema, keep your child cool, moisturise them frequently, and keep them away from things that irritate their skin.
For eczema that’s difficult to manage, ask your doctor to complete an eczema treatment plan for your child.

For more information

Dr Margie: Top tips to help you manage your child’s eczema
The Royal Children’s Hospital Dermatology Department: Eczema resources
The Royal Children’s Hospital Dermatology Department: Wet dressing instructions
The Royal Children’s Hospital Dermatology Department: Formula for an eczema bath
The Royal Children’s Hospital: Eczema workshops run by the Dermatology Nurse Practitioners. At these three-hour workshops, your child will receive assessment, education and management plans. Your doctor needs to send a referral for you to attend this workshop.
Eczema Association of Australasia Inc
ASCIA

Common questions our doctors are asked:

Will the treatments cure eczema?

No. Eczema can be well controlled in most children by looking after the skin as suggested. This does not mean the eczema is cured. For many children, adequate skin care including cortisone treatment will need to be continued for many years. Your child may grow out of their eczema, especially with a good treatment plan. However, they will always have sensitive and dry skin.

Can my child have all the usual vaccinations?

Nearly all children with eczema can have all their vaccinations (including measles) in the normal way. This includes children who have egg allergy. Occasionally, the eczema may flare up after immunisations.

Can my child go swimming?

Yes, if the eczema is not flaring up. Before swimming, apply a layer of moisturiser from top-to-toe. Soon after swimming, wash the skin thoroughly in a cool shower or bathe your child with some bath oil, then reapply the moisturiser. If the eczema flares that night, apply a wet dressing just before your child goes to bed.

I’ve heard that cortisone is dangerous to use on children because it is a steroid, and steroids can have bad side effects. Is this right?

Cortisone treatments are very effective in controlling eczema, and as long as they are used as directed they are safe for children to use. Weak cortisone treatments won’t have any negative effects on a child’s growth and development.

Developed by The Royal Children’s Hospital General Medicine and Dermatology departments, and Centre for Community Child Health. We acknowledge the input of RCH consumers and careers.

Reviewed March 2018.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.

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Reference: Eczema

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