Information for patients on common conditions

A lesion is a general term used for things like moles, cysts, skin tags, warts, ulcers and other lumps and bumps you may sometimes get on your skin.

These lesions are usually harmless. They are not cancer. Some benign lesions, such as warts or verrucas, usually clear up on their own. However, if they don’t then your pharmacist can provide useful information on how to manage them.

Advice to help you manage a benign skin lesion

Most benign skin lesions can be left alone and doing nothing is usually the best course of action. Some things that may help include those detailed below:

• Keeping the area clean and dry; gentle cleansing and moisturising can help to reduce dryness or inflammation.
• Limit sun exposure, and apply sunscreen with a sun protection factor (SPF) of 30 or above.
• Avoid jewellery or tight clothing around the area of the skin lesion.
• A simple dry dressing can be applied to avoid irritation.
• Do not scratch, pick or try to remove or shave lesions.

When to seek help

If you are experiencing any of the following symptoms, you should make an appointment at your GP surgery:

• You have a mole that has changed size, shape or colour.
• You have a mole that is painful or itchy.
• You have a mole that is inflamed, bleeding or crusty.
• You have a new or unusual mark on your skin that has not gone away after a few weeks.
• You have a dark area under a nail that has not been caused by an injury.

Your GP may refer you to a specialist if they are concerned about your skin lesion. However, most don’t need referral or treatment. Surgical removal can cause bleeding, pain, infection, scarring and anaesthetic risks, and is not normally funded by the NHS unless there are exceptional clinical circumstances.

View this information in PDF form.

A bunion is a bony lump at the base of the big toe joint. Bunions can cause your big toe to point towards your other toes. You may have hard or swollen skin, and the bunion may look red or darker than the skin around it.

Bunions can cause some discomfort or pain at the toe joint, along the side or on the bottom of your feet, which is usually worse when wearing shoes and walking. Some people may consider them ‘unsightly’, and they can make it harder to find comfortable footwear.

In most cases it is not clear why people develop bunions. Wearing tight or badly fitting shoes tends to make the problem worse as it puts extra pressure on the big toe joint.

Advice to help you manage any issues

You cannot get rid of bunions yourself, but there are things you can do to ease any pain as detailed below:

• Wear wide shoes with a low heel and soft sole.
• Hold an ice pack (or a bag of frozen peas) wrapped in a tea towel to the bunion for up to five minutes at a time.
• Try bunion pads (soft pads you put in shoes to stop them rubbing on a bunion) – you can buy these from pharmacies.
• Take paracetamol or ibuprofen.
• Try to lose weight if you’re overweight.
• Exercises may help maintain or improve foot function, for example raising the big toe and holding for ten seconds five times a day, spreading toes apart and holding for ten seconds five times a day.
• Avoid high heels or tight, pointy shoes.

When to seek help

If you are experiencing any of the following symptoms, you should make an appointment at your GP surgery:

• Pain from a bunion has not improved after trying home treatments for a few weeks.
• Pain is stopping you doing your normal activities.
• You have bunions and diabetes – as foot problems can be more serious if you have diabetes.

Your GP can advise you about things you can do to ease your symptoms, and things you can buy reduce pain such as insoles (orthotics), toe spacers and toe supports. Surgical treatment is not normally funded on the NHS and would only be considered if there are exceptional clinical circumstances.

View this information in PDF form.
 

Ear wax is naturally occuring. It provides protection for your ears by stopping dust, dirt or foreign bodies entering the ear canal. It is slightly acidic, which provides natural protection from infection. The amount of wax an individual has varies from person to person and can depend on environment, diet, and age. Your ears should be self-cleaning so in most cases, ear wax will not cause any problems and should be left alone. 

Advice to help you manage and prevent ear wax blockages

If you have ear wax blockages, there are things you can do to help with any symptoms as detailed below:

• Try to keep your ears dry. When washing hair, showering, or swimming use waterproof ear plugs or cover a piece of cotton wool in Vaseline (to waterproof it) and place it into your ear.
• Avoid putting your head under the water when bathing.
• Do not use cotton buds or any other object to try and remove the wax, as this can push the wax deeper into the canal and cause damage, trauma and potentially an infection. 

You can use olive oil or almond oil drops (avoid almond oil if you are allergic to almonds) to encourage the natural movement of wax from the ear canal. You can do this twice a week long term if you have lots of wax build up, to prevent recurrence. The best way to do this is: 

• Warm the drops to room temperature
• Lie on your side with the affected ear upwards
• Pull the outer ear gently backwards and upwards to straighten the ear canal
• Put two to three drops into the affected ear and gently massage the area just in front of the ear. If needed, ask someone to help you put the drops into your ear
• Stay lying on your side for 10 minutes to allow the wax to soak up the drops
• Wipe away any excess oil but do not plug your ear with cotton wool, as this simply absorbs the oil.

You can buy oil drops from the pharmacy or supermarket. An olive oil spray is also available, which avoids the need to lie on your side for ten minutes. This can be helpful if you find it difficult to lie on one side for prolonged periods. 

Your hearing problem may initially worsen after first starting to use the drops, but in most cases, the wax will soften sufficiently to encourage the wax to come out on its own and your symptoms should improve.

DO NOT use olive oil drops if you have been told you have a perforated ear drum or if you have ever had surgery on your ears.

DO NOT put cotton wool in your ear canal after using the olive oil to retain it as this may cause infection.

Other types of ear drops containing bicarbonate or hydrogen peroxide can be purchased to help break down the wax. Prolonged use of these drops can lead to dryness and irritation of the ear canal, so always follow the recommended use on the packaging.

When to seek help

In most cases ear wax will not cause any problems and should be left alone without any attempts to remove it. Ear wax only becomes a problem if a build up is causing symptoms (for example deafness or pain) or a health professional needs a clear view of your ear drum.

If you are experiencing any of the following symptoms, you can make an appointment at your GP surgery:

• Pain.
• Discharge or bleeding from the ear.
• Sudden deafness.
• Dizziness.
• Foreign bodies stuck in the ear (you may be advised to attend your local urgent treatment centre or emergency department). 

Your GP will be able to provide advice. Microsuction, which involves using a small suction tube and probe to gentle remove any excess wax from your ears and clear the blockage, is only offered on the NHS in certain circumstances, for example if you have an infection of the outer ear.  

View this information in PDF form.
 

Loose excess skin is not uncommon after significant weight loss. It can be affected by a number of things including:

• How quickly you have lost weight.
• The percentage of total body weight lost.
• How long you’ve been at your starting weight.
• Genetics.
• Age.

For many people some excess or saggy skin, or stretch marks, are just part of life. However, there may be times when excess skin can cause discomfort.

Advice to help you manage any issues

Things that can help include those detailed below:

• Strength and resistance exercises will help to build lean muscle which will help with any mobility issues, whilst strength training has been shown to improve skin elasticity and thickness.
• Diet can improve skin health. Foods rich in omega-3 fatty acids, such as salmon, tuna, walnuts and almonds can help restore collagen in your skin whilst fruits and vegetables rich in vitamins C and E can help to prevent cell damage. Plant or animal protein can help maintain and repair skin tissue and help build muscle.
• Staying well hydrated is important. Drinking two or more litres of water a day can help to improve skin health.
• Loose skin can form folds that trap moisture, sweat and bacteria, and this may cause a skin rash if moisture collects. Washing between folds with a pH balance liquid soap or cleanser before gently patting skin dry can help. Other things that can help you stay dry include wearing loose clothing made of natural fibres or fabrics that are quick-drying or moisture-wicking, and applying chafing powder or gel.
• Chafing can happen when skin rubs against skin or clothing, which can cause redness, bumps, itching and burning. Keeping the skin dry and clean is important to prevent this.

When to seek help

If you are experiencing any of the following symptoms, you should make an appointment at your GP surgery:

• Skin infections.
• Significant reduction in daily functions and normal activities.

Surgery to manage excess skin such as a tummy tuck (abdominoplasty) is considered a cosmetic surgical procedure and is not normally funded by the NHS. This would only be funded on the NHS if there are exceptional clinical circumstances.

View this information in PDF form.
 

A ganglion or ganglion cyst is a fluid-filled swelling that usually develops near a joint or tendon, most commonly on the wrists, hands and fingers. They can range from the size of a pea to the size of a golf ball. They look and feel like a smooth lump under the skin.

They are not a cancer. Ganglion cysts are harmless and may disappear without treatment, although this can take a number of years. They do not spread to other areas of the body.

It's not clear why ganglion cysts form. They seem to happen when the synovial fluid that surrounds a joint or tendon leaks out and collects in a sac.

Advice to help you manage a ganglion cyst

If a ganglion cyst does not cause symptoms or pain, it is best just to leave it alone. Some things that may help include those detailed below:

• Avoid repetitive joint motions.
• Protective braces may support joint movement and ease irritation.
• Take paracetamol or ibuprofen for occasional pain.
• Hold an ice pack wrapped in a tea towel to the ganglion cyst for up to five minutes at a time to reduce pain or inflammation.
• Never attempt to puncture or rupture the ganglion cyst yourself.
• Avoid the ‘traditional cure’ of smashing the ganglion cyst with a heavy book to burst it under the skin as it is only very occasionally successful. There is a high chance of it coming back and there is a risk of damage to other parts of the hand.

When to seek help

If you are experiencing pain that is stopping you doing your normal activities, or which has not improved after trying home treatments for a few weeks you may want to make an appointment at your GP surgery.

Your GP will look at your joint and ask you about your symptoms. The two main treatment options for a ganglion cyst are:

• Aspiration – draining fluid out of the cyst with a needle and syringe; about half of all ganglion cysts treated using aspiration return at some point.
• Cutting the ganglion cyst out during surgery.

Surgical treatments are not normally funded on the NHS and would only be considered if there are exceptional clinical circumstances.

View this information in PDF form.

Hyperhidrosis is a condition in which a person sweats excessively. It may affect the whole of your body, or just certain areas. The most common areas affected are armpits, palms of your hands, soles of your feet, face, chest and groin.

The exact cause is not known, but this is a common condition that affects between one and three in every 100 people. It can happen because of another condition you have, or as a side effect of medicine you are taking, or for no obvious reason.

There are no guidelines to determine what ‘normal sweating’ is. It’s normal to sweat if you get hot or do exercise, but if you are sweating when your body does not need to cool down, you may have hyperhidrosis.

There is no single cure for excessive sweating. Sometimes it gets better with age, but there are things you can do that can help.

Advice to help you manage excessive sweating

Things that can help include those detailed below:

• Use anti-perspirant frequently, rather than deodorant.
• Wear loose-fitting clothes to minimise signs of sweating. White or black clothing can also minimise signs.
• Wear socks that absorb moisture and change your socks at least twice a day if possible.
• Ideally wear shoes made of leather or natural materials, and try to alternate between different pairs of shoes every day.
• Mindfulness, breathing exercises and cognitive behavioral therapy may help reduce anxiety, which can worsen sweating.
• Avoid triggers that can make sweating worse such as spicy foods, alcohol and caffeine.
• Avoid wearing tight fitting clothes or synthetic fabrics, such as nylon.
• Avoid wearing enclosed boots or sports shoes that may cause your feet to sweat more.

When to seek help

A pharmacist can help with excessive sweating. You can buy things without a prescription such as:

• Stronger antiperspirants containing aluminum chloride, which you apply at night and wash off in the morning.
• Armpit or sweat shields to absorb excess sweat and protect clothing
• Foot powders for sweaty feet.
• Soap substitutes that are more gentle on your skin.

If you are experiencing any of the following symptoms, you may want to make an appointment at your GP surgery:

• Symptoms have not improved after trying home treatments for at least six months.
• It stops you from doing your daily activities.
• It happens at night (you are having night sweats).
• You have a family history of excessive sweating.
• You are taking medicine for another condition.

Your GP may refer you for tests if they think another condition may be causing your sweating. They may recommend other treatments that you can try such as taking tablets (anticholinergics).

Other possible treatments such as Botox injections and surgery to remove sweat glands are not normally funded on the NHS. These would only be funded on the NHS if there are exceptional clinical circumstances.

View this information in PDF form.
 

A keloid or keloid scar is a scar that overgrows and becomes larger than the original wound. It can spread upwards, giving a raised scar. They are usually hard, smooth and shiny.

We do not fully understand why some people develop keloid scars after an injury, but they are caused by an over production of collagen (the skin’s structural protein). They are not contagious. They are most likely to develop following burns, acne scars and wounds that become infected or tight whilst healing. They can also happen after a cut or piercing.

Keloid scars usually start to develop a few weeks after the original skin injury, but they can occur years later. While keloid scars are growing, they may feel itchy, prickly or sore. Once they have stopped growing there is usually no discomfort.

Advice to help you manage any issues

There is no cure for keloid scars and you cannot get rid of a keloid scar, but there are things you can do to help improve how it looks and reduce irritation as detailed below:

• Silicone dressings or gels can be bought from a pharmacist without a prescription. Over time, they can reduce the thickness and make the keloid paler.
• Applying non-scented moisturisers can help to reduce dryness and discomfort.
• Massaging your scar with a cream a few times a day for ten minutes each time may help. You should start scar massage when the wound is completely healed and continue until the scar has fully matured.
• Try to keep your scar covered when you are in the sun for at least one year after the keloid scar forms by wearing clothing that covers it or putting a dressing over it.
• Use sun screen with a sun protection factor (SPF) of 30 or above on the scar and surrounding skin.
• Compression with bandages, clips or splints may sometimes help, particularly on the earlobe or torso.
• Do not scratch the scar as this may make it worse.
• Avoid tight fitting clothes or clothes with straps over the scar.
• Do not attempt to cut or shave down keloid scars.
• Avoid skin trauma where possible, for example tattooing, body piercing and unnecessary surgical procedures.

When to seek help

If you are experiencing any of the following symptoms, you should make an appointment at your GP surgery:

• Signs of infection such as pain, swelling, warmth or pus.
• If the scar restricts movement, particularly over a joint, or it is stopping you from doing your daily activities.

Treatment options may include steroid injections or creams. Surgically removing or cutting out a keloid scar is rarely a success as this can cause a larger wound, and the keloid scar is likely to regrow in it. Surgical treatment is not normally funded on the NHS and would only be considered if there are exceptional clinical circumstances.

View this information in PDF form.

Nasal congestion is the blockage of the passages in your nose, usually due to membranes (skin) lining the nose becoming swollen or inflamed. This is also known as having a blocked nose. This can be caused by allergies or the common cold.

Nasal congestion can also result from a deviated septum. The septum is a thin piece of cartilage and bone in the middle of the nose between the left and right sides. A deviation can cause restricted airflow on either side (unilateral) or both sides (bilateral) of the nose.

Most people have a degree of deviation in their nose, with one side narrower than the other. This can be made worse by injury.

Advice to help you manage nasal blockage

In most cases, nasal blockage does not require any NHS treatment. If you have a nasal blockage or congestion, there are things you can do to help with any symptoms as detailed below:

• Try over-the-counter medication such as decongestant nasal sprays. These should not be used for more than a week at a time because using them for too long can make your congestion worse.
• Breathing in steam or vapours such as menthol or eucalyptus may be soothing.
• Saline drops or sprays, or other nasal washes or douches may help wash away any mucus in your nose.
• If your symptoms are caused or worsened by seasonal allergies, antihistamine tablets may help.
• It may be useful to wear an adhesive dilating strip or an internal nasal dilator, particularly at night.
• Using an extra pillow at night may help reduce congestion.
• Do not use nasal decongestant sprays regularly over the long term.

When to seek help

If you are experiencing any of the following symptoms, you can make an appointment at your GP surgery:

• Significant and persistent nasal blockage.
• Pain that stops you doing your normal activities.

Your GP may recommend sprays or drops to manage your symptoms, such as steroid sprays. In some cases, you may need to take the medication for several weeks before you see an improvement in your symptoms.

Surgical treatment such as septoplasty (to straighten the nasal septum), or rhinoplasty (to straighten the outside of the nose, often called a ‘nose job’) is not normally funded on the NHS unless there are exceptional clinical circumstances.

View this information in PDF form.
 

Ptosis is the drooping of your upper eyelid. It can be present from birth (congenital) or develop later in life. It is usually due to a weak levator muscle (the muscle that raises the eyelid). Ptosis is usually harmless and largely cosmetic, but in some cases vision on the affected side may be reduced.

Dermatochalasis is the medical term used to describe excess skin of the eyelid, often referred to as ‘hooding’. It is commonly caused by aging, which leads to a loss of skin elasticity. It is not a serious condition but may reduce vision if the excess skin droops over the eyelid.

Advice to help you manage ptosis or dermatochalasis

If you have ptosis or dermatochalasis, there are things you can do to help with any symptoms as detailed below:

• Use cool compresses or cucumber slices for tired or puffy eyes.
• Try to get enough sleep.
• Stay hydrated to reduce eyelid swelling or puffiness.
• Avoid rubbing your eyes, as this can stretch skin and weaken eyelid muscles.

When to seek help

If you are experiencing any of the following symptoms, you can see a pharmacist or make an appointment at your GP surgery where you:

• Have a swollen eyelid that is red, hot or painful.
• Cannot open your eye or keep it open.
• Are sensitive to light.
• Have eyesight changes.

If you have sudden onset ptosis or painful ptosis then you should contact your GP as soon as possible. If it happens outside of working hours, call 111 or get help from 111 online.

Most people with ptosis or dermatochalasis do not need any treatment – and treatment may not be effective. Surgical treatment is not funded on the NHS unless there are exceptional clinical circumstances.

View this information in PDF form.

Tinnitus is a sensation or awareness of sound that is not caused by a real external sound source. It can be perceived in one or both ears, inside the head or in the person's immediate environment. Although it is commonly assumed to be a ringing noise, tinnitus can take almost any form, including hissing, whistling, humming, or buzzing. Some people hear a single sound whereas others hear multiple noises. For some, the sound is constant; for others it is constantly changing.

Tinnitus is extremely common. Approximately 1 in 8 of the UK population have some degree of tinnitus. The number of people who are significantly affected by tinnitus is much smaller – probably around 1 in 200. For most people, the symptom is mild and does not interfere greatly with their lives. Many people think that tinnitus will never go away. Actually, with time, many people report that their tinnitus lessens or even disappears. Tinnitus is rarely a sign of a serious underlying condition. Knowledge of these simple facts can help many people to cope with it.

It’s not always clear what causes tinnitus, but it can be linked to some form of hearing loss, Ménière's disease, conditions such as diabetes, thyroid disorders or multiple sclerosis, anxiety or depression, or side effect of some medications.

Advice to help you manage tinnitus

If you have tinnitus, there are things you can do to help with any symptoms as detailed below:

• Try to relax - deep breathing or yoga might help.
• Improve your sleep by having a consistent bedtime routine or cutting down on caffeine.
• Avoid things that can make tinnitus worse, such as stress or loud background noises. 
• Join a support group - talking to other people with tinnitus may help you cope.
• Do not have total silence - listening to soft music or sounds may distract you from the tinnitus.
• Do not focus on it as this can make it worse - hobbies and activities may often take your mind off it. 

When to seek help

Ask for an urgent GP appointment if:

• You have tinnitus that beats in time with your pulse (pulsatile).

Call 999 if you have:

• Tinnitus after a head injury.
• Tinnitus with sudden hearing loss, weakness in the muscles of your face, or a spinning sensation (vertigo). 

Most people with tinnitus do not need any specific treatment. A GP may recommend a referral for a type of talking therapy such as cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT).

Up-to-date advice on all aspects of tinnitus is available from the British Tinnitus Association at www.tinnitus.org.uk (helpline 0800 018 0527, Mon-Fri, 9am-5pm; Text/SMS: 07537 416841; web chat via chat icon on the website).

View this information in PDF form.

Varicose veins are veins that look swollen and twisted under the skin. They may feel lumpy and bulge out. They are most common on the legs but you can get them on other parts of your body.

Varicose veins are very common. About 10 to 20% of men and 25 to 33% of women develop them at some time in their lives. They are not caused by an underlying disease and often occur for no apparent reason, although pregnancy, age and being overweight may make them more likely.

Varicose veins do not cause symptoms or issues in most cases. They can sometimes cause discomfort, such as aching, itching, dry or scaly skin, and swollen ankles or legs.

Advice to help you manage varicose veins

If you have varicose veins, there are things you can do to help with any symptoms as detailed below:

• Try to keep to a healthy weight.
• Put your legs up when possible, for example lie down with your legs on cushions.
• Exercise regularly – running or walking can improve blood flow.
• Use a moisturising cream or lotion if you have dry, flaky or itchy skin.
• Try not to injure your legs.
• Try to avoid standing for long periods.
• Try not to sit still for long periods unless your feet are raised.
• Do not smoke, as it damages your veins.

When to seek help

If you are experiencing any of the following symptoms, you can make an appointment at your GP surgery:

• Pain or swelling in your legs.
• A sore on your leg that has not healed after two weeks.

Bleeding from varicose veins happens only rarely. If a varicose vein does bleed, you should try to stop the bleeding by:

• Raising the leg – lie down flat and raise your leg high to ensure it is above the rest of the body, for example, resting it on a chair or lots of pillows.
• Pressure – put a clean cloth or dressing on the bleeding area and put firm pressure on it, for at least ten minutes.
• If it does not stop or is bleeding heavily call 111 or get help from 111 online.

Most people with varicose veins do not need any treatment. A GP may recommend the use of compression stockings or provide advice about dressings if you have any issues such as ulcers on your legs. Surgical treatment for varicose veins is not normally funded on the NHS, unless there are exceptional clinical circumstances.

View this information in PDF form.

Vertigo feels like you or everything around you is spinning – enough to affect your balance. It’s more than just feeling dizzy and can last from a few seconds to hours. Many different factors can affect the inner ear and cause vertigo. One way to distinguish them is by the duration of the dizziness.

Short-lived episodes of dizziness (few seconds to minutes)
An extremely common type of vertigo is benign positional vertigo. This is typically a very sudden onset of dizziness, which settles rapidly after a few seconds or at most a couple of minutes. It is often started off by the person suddenly looking upwards or sideways, and some people get it when they turn over in bed. In between attacks, the sufferer feels entirely normal. Sometimes the attacks start following a whiplash injury or other head injury, but often there appears to be no reason that they should have started. The attacks usually disappear with time. Medicines do not help, but a manoeuvre known as Epley's Manoeuvre can be extremely effective in some patients.

Medium length episodes of dizziness (half-hour to several hours)
These types of vertigo are rarer and are thought to be due to an increase in pressure of the fluid in the inner ear, although nobody really knows for sure. Ménière's disease or endolymphatic hydrops result in episodes of severe vertigo that can last up to several hours. The dizzy episodes are usually linked with vomiting, a reduction in their hearing, a feeling of fullness in the ear and some tinnitus. The hearing recovers once the vertigo has settled but may gradually deteriorate with time. Treatment of Ménière's disease can involve medicines available from your GP.

Longer episodes of dizziness (days to weeks)
An infection of the inner ear (labyrinthitis) or an inflammation of the balance nerve (vestibular neuronitis) can give rise to severe rotatory dizziness for up to two to three weeks, with a slow return to normal balance which can take a further few weeks.

Vertigo often gets better without treatment however there are things you can do to ease symptoms when they’re happening and to reduce how often it happens.

Advice to help you manage vertigo

If you have vertigo, there are things you can do to help with any symptoms as detailed below:

• Lie still in a quiet, dark room to reduce the spinning feeling.
• Move your head carefully and slowly during daily activites.
• Sit down as soon as you feel dizzy.
• Turn on the lights if you get up at night.
• Use a walking stick if you are at risk of falling.
• Sleep with your head slightly raised on two or more pillows.
• Get out of bed slowly and sit on the edge of the bed for a while before standing up.
• Try to relax as anxiety can make vertigo worse.
• Do not bend over to pick things up - squat to lower yourself instead.
• Do not stretch your neck, for example while reaching up to a high shelf.

When to seek help

If you are experiencing any of the following symptoms, you can make a appointment at your GP surgery:

• Regular or constant vertigo.
• Worsening vertigo. 

Ask for an urgent GP appointment or call 111 if you have vertigo and:

• A severe headache.
• Are being sick or feel very sick.
• Have a very high temperature or feel hot and shivery.

Call 999 if you have vertigo and:

• Double vision or loss of vision.
• Hearing loss.
• Trouble speaking.
• Leg or arm weakness, numbness or tingling.

Most people with vertigo do not need any treatment. a GP might prescribe antibiotics if it's caused by an infection. You could also be given exercise to do try to correct your balance.

Further information

ENT UK has information on exercises you can try:

Cawthorne-Cooksey excercises

BPPV and Home Epley manoeuvre