A cure for everything: your medical handbook

What's the best way to treat headaches, veruccas, acne or heartburn? Now you can find out, from a website that gives you access to the latest research. Jeremy Laurance reports
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Indy Lifestyle Online

They are among the commonest afflictions known to medicine. Almost everyone will have suffered from one and millions will at some time have had experience of them all. Now the British Medical Journal has put together a database telling us which treatments really work and which don't, based on the best and most up-to-date medical research. Here, we present a selection.

ACNE

What is it?

Spots, in a word. On your face, back, or chest. Eight out of 10 teenagers suffer some degree of acne, and in about a third it is severe enough to require treatment. Increasingly, it is also affecting adults over 25.

What causes it?

Blocked pores caused by the overproduction of sebum, an oily substance that stops the skin drying out. Sebum builds up behind the blockage, causing a swelling.

What treatments work?

There are many over-the-counter creams and gels and anything that contains benzoyl peroxide is worth trying. However, it may take up to eight weeks to work. The cream helps stop new spots forming so it needs to be applied to the whole of the face or affected area. If this does not work, your doctor may suggest clindamycin or erythromycin gel. These are antibiotics available only on prescription. Tretinoin lotion, a retinoid which is a form of Vitamin A, helps unblock the pores in severe cases of acne. Isotretinoin tablets, which are sold under the brand name Roaccutane, are available for very severe acne and have been proved effective but can have serious side effects. It should only be prescribed by a consultant dermatologist.

ATHLETE'S FOOT

What is it?

A skin infection caused by a fungus, which usually first occurs between the toes. It makes the skin itch and peel and is easy to catch in shared changing rooms.

What causes it?

The fungus that causes athlete's foot lives in damp, warm places, and feeds on keratin, a protein in skin. Men get it more than women.

What treatments work?

It is important to treat it promptly as it can spread and will be harder to treat. Creams and gels are just as effective as tablets but have fewer side effects. Terbinafine cream or spray (Lamisil) can be bought over the counter or obtained on prescription. It clears up the condition in seven out of 10 cases and may work faster than treatments containing an azole drug (Canesten, Daktarin).

BAD BREATH

What is it?

Almost everyone has it first thing in the morning because the saliva that keeps your mouth clean has dried up overnight. It is worse in people who breathe through their mouths. Those with persistent bad breath mostly have gum disease or bacteria that grow on the tongue.

What causes it?

Bacteria growing on the tongue give off gasses that can make your breath smell bad. The problem is worse if you smoke, don't brush your teeth every day and don't produce enough saliva. Drinking plenty of water, eating regularly and avoiding breathing through the mouth all aid production of saliva. Gum disease occurs because of plaque, which is mostly made up of bacteria, growing on the teeth.

What treatments work?

Antibacterial mouthwashes, and those that contain cetylpyridinium chloride and chlorhexidine gluconate can be effective. Common brands are Corsodyl, and Dentyl PH. Dentists sometimes recommend mouthwashes containing hydrogen peroxide such as Peroxyl. Some brands such as Listerine contain an antiseptic, usually alcohol, but there isn't any research to show whether this works or not.

COLD SORES

What are they?

Blisters that appear around the mouth and lips. They can be passed on to others via kissing or sharing cups, cutlery and towels. A first infection in children can cause quite a serious illness, with fever, swollen glands and pain on swallowing.

What causes them?

The herpes virus, which is transmitted in saliva. Type 1 herpes mostly causes cold sores; type 2 is a sexually transmitted virus that causes sores on the genitals. Once you are infected with type 1, the virus remains in the nerves in your face and can cause further episodes at any time. New attacks may be triggered by throat infections, tiredness, stress and sunlight.

What treatments work?

Very little, but they usually clear up within seven to 10 days without treatment. Over-the-counter antiviral creams such as Zovirax and Vetavir have only a limited effect, reducing pain for just a few hours. For those whose cold sores are triggered by sunlight, a sunscreen applied to the lips and mouth may be worth trying.

EAR WAX

What is it?

All ears produce wax, which helps to prevent infections. Normally it moves steadily to the outside where it is washed away, but sometimes it builds up over the ear drum, affecting hearing.

What causes it?

People who have narrow ear canals are more likely to suffer from blocked ears. Men are more susceptible than women, as is anyone who wears ear plugs, such as musicians. Using cotton buds can make it worse, by pushing the wax down into the ear.

What treatments work?

The standard treatment is to use ear drops to soften the wax, followed by syringing carried out by a doctor or nurse. The procedure is painless and involves squirting warm water into the ear canal to wash out the wax. There is limited research to prove that it works but most doctors think it is effective.

HEARTBURN

What is it?

A burning feeling that starts in the chest and moves upwards to the neck and throat. There may also be a sour or bitter taste. People who have heartburn two or three times a week may be suffering from gastro-oesophageal reflux disease.

What causes it?

Acid from the stomach splashing back into the oesophagus (gullet). This is normally prevented by a ring of muscle at the base of the oesophagus that only opens to allow food to pass. In some people, however, the muscle fails to work properly.

What treatments work?

Drugs containing proton pump inhibitors such as Losec and Zoton are the best but are only available on prescription. They won't cure reflux but should relieve the symptoms. Over-the-counter products such as Zantac and Axid also work, but not as well. Antacids - indigestion tablets - may work for mild symptoms. If treatment is stopped the symptoms may return. The only permanent cure is surgery.

TENSION HEADACHES

What are they?

Headaches that occur when you are feeling stressed, tired and angry. If you get them on more than 15 days a month, doctors classify the problem as chronic (long lasting). They are more common among women, the young and people who take little exercise.

What causes them?

Tension in the muscles of your face, neck and scalp and bad posture, especially if you are desk-bound. But some doctors think this sort of tension has nothing to do with it. They prefer to call them tension-type headaches.

What treatments work?

Everyone gets occasional tension headaches that may be cured with paracetamol. But chronic tension headaches may be made worse by painkillers if they are taken more than two or three times a week. In these cases, antidepressants such as amitryptiline and mirtazapine have been shown to be effective. Cognitive behaviour therapy has been proved effective in helping people cope with stress.

WARTS AND VERRUCAS

What are they?

Growths on your skin, which may be uncomfortable and unsightly.

What causes them?

A virus that infects the skin. There are dozens of types of virus and the type you get determines the type of wart. Older children and teenagers are most prone to warts, which tend to spread in shared washing areas. As people age they develop an immunity to the virus, which is why warts mostly clear up on their own.

What treatments work?

Salicylic acid is a treatment painted on the wart every day which slowly destroys the hard skin. But it may take three months. Warts can be frozen off by your doctor, but it may need repeating and doesn't work for everyone. Over-the-counter freezing treatments don't get as cold as the liquid nitrogen the doctor uses and there is little research to show if they work. One folk remedy is sticking duct tape over the wart; this may work if the tape is kept in place and replaced each week for eight weeks.

www.besttreatments.co.uk has been set up by the BMJ to rate thousands of health-related treatments

Patient, heal thyself...

* PERIOD PAIN

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen work. Also try regular magnesium supplements and heat from a bath or hot-water bottle.

* JET LAG

The hormone melatonin is likely to work, but is not usually prescribed in the UK. Taking sleeping pills for your first few nights after travelling is likely to work, but with side effects. Avoid alcohol and caffeine and try to eat and sleep in accordance with your new time zone.

* LEG CRAMPS

Quinine from your doctor is likely to help. Taking magnesium salts may be effective.

* PANIC ATTACKS

Cognitive behaviour therapy and SSRI antidepressants are effective. Some relaxation therapies, and other talking cures, might help.

* BACK PAIN

Staying as active as possible and taking NSAIDs are both effective. Spinal manipulation may be effective. Specific back exercises are unlikely to work.

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