Common Presentations. Dr J Tomkinson 16/10/13. Around half of consultations in A&E and 20 – 40% of GP consultations are for minor illnesses 57 million GP consultations/ yr OR accounts for over an hour a day for every GP
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Dr J Tomkinson
5% permethrin cream is recommended 1st line as this has the best evidence base.
Patient may not want a prescription
Non phamacological suggestions
(e.g. Anhydrolforte, Driclor, Odaban).
(for hands, feet and axillae).
For more generalised hyperhidrosis, anticholinergics (e.g. oxybutinin) and glycopyrronium can be used, but have significant side-effects.
Endoscopic sympathectomy only if all other therapy fails.
Botulinum toxin very effective for the axillae but often not available on the NHS because of cost (£300–500 per treatment, usually required 3 monthly).
Retrodermal curettage also useful in axillary disease, but again, usually not available on the NHS
The commonest causes are:
Antipyretics (aspirin, NSAIDs)
Hormonal drugs (tamoxifen, GnRH agonists)
Other causes include:
TBPhaeochromocytomaParkinson's diseaseMyeloproliferative HIVCarcinoid syndromeNeuropathiesLymphoma
Hyperhidrosis Support Group
>3y (1 point for each of the following).
Score 1:2–23% chance of having group A b-haemolytic strep (GABHS)
Score 4:25–86% chance of having GABHS
NICE say treat if unwell and score more than ¾
Phenoxymethylpenicillin 500mg qds 10 days (or macrolide)
The British Thoracic Society (BTS) defines pneumonia as:
Cough and at least one other lower respiratory tract symptom
New focal chest signs on examination
EITHER sweating, fevers, shivers, aches and pains or fever >38°C
No other explanation for symptoms.
NICE guidance on respiratory tract infections recommends not prescribing or using a delayed script for acute cough unless:
Co-morbidity or >65y with at least 2 of the following or >80y with at least 1 of the following:
(NICE 2008, CG69)
RCT of over 800 people over the age of 3 with a LRTI (not URTI) showed that:
Often you see a circular bald patch with exclamation hairs (isolated short broken-off hairs in a patch ofbaldness). Lifetime prevalence 1.7%. Alopecia totalis (all of head hair loss) is rarer and alopecia universalis (loss of all body hair) rarer still.
In an initial patch: 33% will have re-grown in 6m, 50% in 12m BUT 33% will never recover. Almost everyone who gets a first patch will do so again, but this may be many years later.
Topical rx : eg ketoconazole shampoo / terbinafine cream
Systemic rx: egterbinafine
How do you explain shingles to a patient?
Aciclovir800mg five times a day if within the first 72 hours
Pain and post herpetic neuralgia
Left untreated, most viral warts will eventually disappear (some pts happy with this info)
Not everyone wants a prescription
Remember reassurance / non-pharmacological treatments
Oral or topical antibiotics?