Enhancing Self-Care Medicines Use

Commissioning Support Enhancing Self-Care Medicines use

This is an interactive PDF. To navigate, use the arrow buttons on each page or locate a specific section using the tabs and buttons within the document. ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Contents

03 Introduction 22 Probiotics Indigestion and Heartburn Infrequent Constipation 04 How to use this Interactive PDF 23 Vitamins and Minerals Infrequent Migraine 05 Background to Self-care Insect Bites and Stings 07 Further Reading 24 Self-limiting Conditions Mild Acne 25 Overview 08 Key Contacts Mild Dry Skin 26 Self-limiting Conditions Sunburn Sun Protection 09 GP Guidance Acute Sore Throat Infrequent Cold Sores of the Lip Hay Fever/Seasonal Rhinitis 10 Overview Conjunctivitis Minor Burns and Scalds 11 Guidance for Clinicians Coughs, Colds and Nasal Mild General Aches and Pains Congestion Mouth Ulcers 12 Exceptions to Guidance Cradle Cap (Seborrhoeic Nappy Rash 14 Adult Care Providers Dermatitis – Infants) Oral Thrush Haemorrhoids Prevention of Dental Caries 15 Care Homes Infant Colic Ringworm/Athlete’s Foot/ 16 Patients Receiving Social Care Mild Cystitis Fungal Nail Infection in Community Teething/Mild Toothache 17 OTC Medicines in Schools 50 Self-care Conditions Threadworms and Nurseries 51 Overview Travel Sickness 18 Further Reading Warts and Verrucae 52 Self-care Conditions Mild Irritant Dermatitis 19 Pharmacy Guidance Dandruff 133 Further Support Diarrhoea (Adults) 20 Overview Materials Dry Eyes/Sore (Tired) Eyes 134 National Materials and Earwax Shared Learning 21 Items of Limited Clinical Excessive Sweating (Hyperhidrosis) Effectiveness Head Lice 136 Acknowledgements

ENHANCING SELF-CARE MEDICINES USE 2 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

How to use this Interactive PDF Background to Self-care Introduction Further Reading

Key Contacts

ENHANCING SELF-CARE MEDICINES USE INTRODUCTION 3 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

This implementation tool has been How to use this How to use this developed to aid GPs, pharmacists, other Interactive PDF healthcare professionals and supporting organisations to implement the national Interactive PDF guidance for conditions that can be treated Background to Self-care over-the-counter. • The tool aims to provide a shared perspective and Conditions for which over-the-counter support for the implementation of NHS England’s Further Reading (OTC) items should not routinely be prescribed national self-care agenda and accelerate uptake, enabling commissioners, healthcare professionals in primary care and patients to understand and apply national advice Key Contacts The 2018 NHS England national guidance aims to reduce the routine • The tool has been designed to guide clinicians and prescribing of products for conditions that: organisations through the decisions that need to be made and provide easy access to a variety of • Are considered to be self-limiting, and therefore do not need treatment support materials to increase the uptake of self- as they will get better on their own accord care treatments and strategies by patients, enabling • Lend themselves to self-care i.e. the person suffering does not normally improved use of NHS resources need to seek medical advice and can simply and effectively • Over-the-counter medicines are those that can manage the condition by purchasing over-the-counter items from be sold by local pharmacies, some but not all can their local pharmacy be sold by local supermarkets and other shops. • Can be treated with over-the-counter products in a more cost effective We promote the use of local pharmacies as a manner than via a NHS prescription wider range of products are avaailable and this is • Have little evidence of clinical effectiveness. supported by professional advice • Some of the information contained has been gathered from organisations where previous introduction of self-care strategies has gone well to Each section contains… share learning and reduce duplication across the NHS

✓✓ Guidance • This tool should be read in conjunction with the national guidance ✓✓ Contacts for individuals requiring further advice or information • Any information contained within this tool should be used as a guide and tailored to local practice and ✓✓ Resources and further reading for those who want to patient needs as required. expand their knowledge and understanding

ENHANCING SELF-CARE MEDICINES USE INTRODUCTION 4 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

How to use this Interactive PDF Background to Self-care

Background to Self-care Why is the NHS promoting self- care? NHS England Chief Executive Simon Stevens said: In the 12 months prior to June 2017, the NHS spent approximately £569 million1 on prescriptions for Across the NHS our aim is to: Further Reading medicines, which could be purchased over-the-counter ‘Think like a patient, act like a (OTC) from a pharmacy and/or other outlets such as taxpayer’. The NHS is probably the petrol stations or supermarkets. most efficient health service in the Key Contacts By reducing spend on treating conditions that are self-limiting, world, but we’re determined to manageable with self-care or for which there is little evidence keep pushing further. Every pound we of clinical effectiveness, resources can be used for other higher save from cutting waste is another priority areas that have a greater impact on patient care and pound we can then invest in better ensure the long-term sustainability of the NHS. A&E care, new cancer treatments and much better mental health services.

1 Refined BSA data to June 2017

ENHANCING SELF-CARE MEDICINES USE INTRODUCTION 5 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

How to use this Interactive PDF Background to Self-care

Background to Self-care Key facts about the treatment of self-care conditions in the NHS. The NHS each year spends: What is self-care and why does it matter? Further Reading £22.8m People can play a central role to protect themselves from ill on treating constipation health, by improving or maintaining Key Contacts - enough to fund around healthy lifestyles, choosing the 900 community nurses most appropriate treatment and best managing their long-term £3m conditions. on athlete's foot The term self-care is defined and other fungal as ‘Empowering people with the £5.5m confidence and information to infections – look after themselves when they on mouth ulcers enough to fund can, and visit the GP when they 810 hip operations need to, which gives people greater control of their own health and encourages healthy behaviours that help prevent ill health in the £4.5m on long term’. dandruff shampoos Self-Care Forum

£2.8m on £7.5m diarrhoea - enough on indigestion and to fund 2912 heartburn cataract operations

ENHANCING SELF-CARE MEDICINES USE INTRODUCTION 6 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

How to use this Interactive PDF Further reading

Background to Self-care Key NHS England resources Guidance on conditions for which over the counter items should not routinely be Further Reading prescribed in primary care Conditions for which over the counter items should not be routinely prescribed in primary Key Contacts care: Consultation report of findings Quick ref guide FAQs Other documents Self Care Forum NHS Choices

ENHANCING SELF-CARE MEDICINES USE INTRODUCTION 7 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

How to use this Interactive PDF Key contacts

Background to Self-care For any enquiries, comments or suggestions regarding this tool please contact:

Further Reading Midlands and Lancashire Commissioning Support Unit Paula Wilson Key Contacts [email protected] Daya Singh [email protected] Medicines Management Team [email protected]

Clarity Consulting Associates Ltd Shoshana Bloom [email protected]

ENHANCING SELF-CARE MEDICINES USE INTRODUCTION 8 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Guidance for Clinicians GP Guidance Exceptions to Guidance

Adult Care Providers

Care Homes

Patients Receiving Social Care in Community

OTC Medicines in Schools and Nurseries

Further Reading

ENHANCING SELF-CARE MEDICINES USE GP GUIDANCE 18 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Pharmacy Guidance

ENHANCING SELF-CARE MEDICINES USE PRESCRIBING DATA AND MONITORING SUCCESS 19 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Overview

The following points should be considered by community pharmacists when supporting patients to self-care though over-the-counter medication. • Establish a good communication system between the pharmacy • Promote non-drug options where appropriate and available and the GP practice especially if a supply cannot • Where patients are purchasing medication, recommend evidence be given for whatever reason based products and ensure that the patient is aware of the least • Be aware of patients repeatedly purchasing medication for the costly option same condition. They may require a referral to their GP. Check • Check the licence indications for OTC drugs to ensure you as a patient for red flag symptoms and signpost as appropriate pharmacist are providing a legal supply • Always provide safety netting advice, making sure patients • If patients are referred to pharmacy to self-care, but the understand when to seek further medical advice pharmacist believes this is inappropriate, liaise directly • Ensure all community pharmacy staff are aware of this guidance with the referring healthcare professional to ensure patient and promote self-care strategies where possible and appropriate. needs are addressed Only refer patients to their GP where it is clinically indicated, • Pharmacy staff need to check for red flags when assessing the without raising patient expectations regarding obtaining a patient. All staff undertaking this activity should be properly prescription trained and aware of what the red flags are for each condition • Reassure patients with long-term chronic conditions • Where a patient is housebound, and poses concerns over their that their doctor will continue to prescribe medication ability to self-care, the pharmacist should liaise with the patient’s for their condition GP and agree the best approach for that patient. • Advise patients that they should keep commonly used over-the- counter products such as painkillers, at home to help deal with most minor ailments. Refer patients to the NHS list compiled by the Royal Pharmaceutical Society

ENHANCING SELF-CARE MEDICINES USE PRESCRIBING DATA AND MONITORING SUCCESS 20 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Items of Limited Clinical Effectiveness Items of Limited Clinical Effectiveness

ENHANCING SELF-CARE MEDICINES USE ITEMS OF LIMITED CLINICAL EFFECTIVENESS 21 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Items of Limited Clinical Effectiveness Items of Limited Clinical Effectiveness

Probiotics Some medicines available on prescription are not considered to be clinically effective due to a lack of evidence. Vitamins and Minerals These products are no longer recommended for use within the NHS.

Probiotics

Rationale: There is currently insufficient clinical evidence to support prescribing of probiotics within the NHS for the treatment or prevention of diarrhoea of any cause.

Example products that could be restricted: Probiotics e.g. sachets, liquid, acidophilus, (Yakult®).

Supporting guidance: Public Health England’s ‘C.difficile in adults’ guidance NICE CG 84: Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management

ENHANCING SELF-CARE MEDICINES USE ITEMS OF LIMITED CLINICAL EFFECTIVENESS 22 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Items of Limited Clinical Effectiveness Items of Limited Clinical Effectiveness

Vitamins and Minerals

Rationale: Exceptions: There is insufficient high quality evidence to demonstrate the • Medically diagnosed deficiency, including for those patients who clinical effectiveness of vitamins and minerals supplementation. may have a lifelong or chronic condition or have undergone Vitamins and minerals are essential nutrients which most people surgery that results in malabsorption. Continuing need should, can and should get from eating a healthy, varied and balanced however, be reviewed on a regular basis. Note: maintenance or diet. In most cases, dietary supplementation is unnecessary. preventative treatment is not an exception Many vitamin and mineral supplements are classified as foods • Calcium and/or vitamin D for osteoporosis and not medicines; they therefore do not have to go through the • Malnutrition including alcoholism strict criteria laid down by the Medicines and Health Regulatory Authority (MHRA) to confirm their quality, safety and efficacy • Patients suitable to receive Healthy Start vitamins for pregnancy before reaching the market. or children aged from 6 months to their fourth birthday. (NB: this is not on prescription but commissioned separately). Prescribing not in line with recognised exceptions should be discontinued. This guidance does not apply to prescription-only Supporting guidance: vitamin D analogues such as alfacalcidol and these should continue to be prescribed. NHS Choices: Supplements, Who Needs Them? A behind the Headlines Report, June 2011 Example products that are restricted: NHS Choices: Do I need vitamin supplements? Supplements and vitamins with minerals e.g. maintenance dose Healthy Start Vitamins vitamin D, vitamin C, multivitamins, zinc, cod liver oil, (I-Caps®, Berocca®, Sanatogen®, Seven Seas®).

ENHANCING SELF-CARE MEDICINES USE ITEMS OF LIMITED CLINICAL EFFECTIVENESS 23 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview

Self-limiting Conditions Self-limiting Conditions

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 24 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Overview

Self-limiting Conditions A number of common conditions are considered to be self-limiting and so do not need treatment as they Please note: will heal of their own accord. OTC restrictions = over-the-counter These conditions include: products that cannot be purchased if the patient meets any of the criteria. Further Acute Sore Throat Cradle Cap (Seborrhoeic Dermatitis information can be found from the product - Infants) Infrequent Cold Sores of the Lip information leaflet. Haemorrhoids For further advice on over-the-counter Conjunctivitis medications, click here. Infant Colic Coughs, Colds and The brands listed are not exhaustive and Nasal Congestion Mild Cystitis other brands may be available which the community pharmacist may recommend to the patient. Prices listed in this tool are correct at the time of writing and are subject to change.

GPs should issue a ‘non- prescription’ sheet’ to patients being referred to purchase over-the-counter medication at end of each consultation.

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 25 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Acute Sore Throat

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores A prescription for treatment of Self-care measures of the lip acute sore throat should not Conjunctivitis routinely be offered to patients • Take simple analgesia e.g. paracetamol or ibuprofen. See OTC restrictions Coughs, Colds and as in most cases, the condition • Drink adequate fluids Nasal Congestion is self-limiting and will clear up • Salt water gargling may help Cradle Cap (Seborrhoeic on its own without the need • There is some evidence that medicated lozenges (containing a local anesthetic and Dermatitis – Infants) for further treatment. NSAID or an antiseptic agent) can help reduce pain in adults. No evidence was found Haemorrhoids for non-medicated lozenges, mouthwashes, or local anesthetic mouth spray on its Infant Colic own. NICE NG 84 Mild Cystitis Supporting • Hot drinks should be avoided as these can exacerbate pain resources • Ice or ice lollies can be cooling and soothing NHS Choices • In the exceptional cases where antibiotics have been prescribed, children can return to school or daycare 24hours after starting treatment if they no longer feel unwell. NICE CKS Self-care forum GP handout

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 26 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Acute Sore Throat

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores Exceptions ‘Red flag’ symptoms of the lip Conjunctivitis • Most sore throats are caused by a virus and most people • People with severe recurrent tonsillitis should be referred get better on their own supported by self-care measures. to an ear, nose, and throat specialist Coughs, Colds and Nasal Congestion However, where the sore throat is caused by bacterial • Persistent sore throat for > 6 weeks infecton, antibiotics may be required and careful Cradle Cap (Seborrhoeic consideration should be made to avoid overuse of • Excessive drooling Dermatitis – Infants) antibiotics and promote self-care where appropriate • Trismus Haemorrhoids • ‘Red flag’ symptoms. • Unilateral facial swelling Infant Colic • Dysphagia Mild Cystitis • Dyspnoea • Immunosuppressant medication such as carbimazole • Persistent unilateral tonsillar enlargement • Neck stiffness • Photophobia • Non-blanching rash.

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 27 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Acute Sore Throat

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores Products listed in table are licensed to treat this condition. Please note there may be limited clinical evidence available to support use of some products. of the lip We recommend patients speak to a pharmacist for individual advice. Exceptions included are not an exhaustive list, please check product licences. Prices correct at time of writing and are subject to change. Conjunctivitis Example OTC medications (generic) Brand Price OTC restrictions Coughs, Colds and Nasal Congestion Benzydamine 0.15% mouthwash • Difllam® Oral rinse • Children under 12 years (oral rinse) ® • Pregnancy, breastfeeding Cradle Cap (Seborrhoeic Benzydamine oromucosal spray • Difflam Spray Dermatitis – Infants) Benzocaine 0.71% throat spray • Ultra Chloraseptic® • Children under 6 years • Methaemoglobinaemia Haemorrhoids • Epiglottitis • Pregnancy, breastfeeding 2,4-dichlorobenzyl alcohol, • Strepsils® • Diabetes • Pregnancy, breastfeeding Infant Colic amylmetacresol lozenges • Children under 6 years • Fructose intolerance, glucose- ® Mild Cystitis Benzocaine, tyrothricin lozenges • Tyrozets® (Strepsils ) galactose malabsorption or • Children under 3 years sucrose-isomaltose insufficiency (Tyrozets®) Paracetamol 500mg tablets and • Anadin paracetamol® • Long-term conditions requiring regular pain relief capsules (25p / 16 tablets) • Children under 12 years Paracetamol 500mg soluble tablets • Severe renal or severe hepatic impairment Ibuprofen 200mg, 400mg capsules • Anadin® Ibuprofen • Stomach ulcer, • Long-term conditions requiring and tablets ( / 16 tablets) • Nurofen® perforation or bleeding regular pain relief • Calprofen® (active or history of) • Asthma • Cuprofen® • Renal impairment • Unstable high blood pressure • Hepatic impairment • Taking anticoagulants Ibuprofen 100mg/5ml liquid/ • Nurofen® for Children suspension sugar free 3 months to 12 years • Cardiac impairment • Pregnancy, breastfeeding Paracetamol liquid 120mg/5ml • Calpol® /100ml • Children under 2 months (infant suspension +2months) /80ml Paracetamol liquid 250mg/5ml (six plus suspension)

Pharmacy only medication Less than £1 £1 - £5 More than £5

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 28 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Infrequent Cold Sores of the Lip

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores A prescription for treatment of Self-care measures of the lip cold sores should not routinely Conjunctivitis be offered to patients as the • Apply an anti-viral cream at first sign >> Avoid kissing and oral sex until of symptoms and before appearance all lesions have fully healed Coughs, Colds and condition is self-limiting and of cold sore Nasal Congestion will clear up on its own without >> Do not share items that come Cradle Cap (Seborrhoeic the need for treatment. The • Topical anaesthetics or analgesics, into contact with lesions (for Dermatitis – Infants) patient should be reassured mouthwash and lip barrier preparations example lipstick) are available over-the-counter, which Haemorrhoids that oral herpes simplex >> Avoid touching the lesions, other some people may find helpful than when applying topical Infant Colic infections are usually self- • Paracetamol and/or ibuprofen preparations, which should be Mild Cystitis limiting, and that lesions should heal without scarring. should be taken to relieve pain and dabbed on rather than rubbed fever, if required and there are no in to minimize mechanical trauma contraindications to the lesions • Ensure adequate fluid intake to reduce >> Wash hands with soap and water Supporting the risk of dehydration immediately after touching lesions resources • Take care if using contact lenses, as • Patients should try to avoid triggers, NHS Choices there is a risk of transmission to the if possible. If sunlight is a trigger, eye if lenses become contaminated advise the use of sunscreen or NICE CKS • Defer elective dental treatment until sunblock lip balm (sun protection Self-care forum all lesions have fully healed factor 15 or greater) GP handout • Herpes simplex virus is easily • Patients should seek further medical transmitted to other people and advice if their symptoms worsen patients should be advised how to or no significant improvement is seen reduce the risk of transmission: after 5–7 days.

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 29 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Infrequent Cold Sores of the Lip

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores Exceptions ‘Red flag’ symptoms of the lip Conjunctivitis • Immunocompromised patients Assess for any red flags that may suggest more serious underlying disease such as oral cancer, including: Coughs, Colds and • Consider seeking specialist advice or referral if the person: Nasal Congestion >> Is pregnant (particularly near term) • Unexplained ulceration in the oral cavity lasting for more than 3 weeks Cradle Cap (Seborrhoeic >> Has frequent or persistent and/or severe episodes of Dermatitis – Infants) recurrent oral herpes simplex infection • A suspicious lump on the lip or in the oral cavity Haemorrhoids • ‘Red flag’ symptoms. • A red, or red and white, patch in the oral cavity consistent Infant Colic with erythroplakia or erythroleukoplakia Mild Cystitis • Patient is unable to swallow due to pain and is at risk of dehydration (especially in children).

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 30 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Infrequent Cold Sores of the Lip

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Coughs, Colds and Example OTC medications (generic) Brand Price OTC restrictions Nasal Congestion Cradle Cap (Seborrhoeic Aciclovir cream 5% ( ) • Zovirax® • Immunocompromised and terminally ill Dermatitis – Infants) • Only for face and lips Haemorrhoids Docosanol 10% • Blistex® Cold Sore • If you are allergic to the • If blister has already formed Infant Colic Cream ingredients • Only for face and lips Mild Cystitis • Immunocompromised • Children under 12 years

Paracetamol 500mg tablets and • Anadin paracetamol® • Long-term conditions requiring regular pain relief capsules ( / 16 tablets) • Mandanol® • Children under 12 years Paracetamol 500mg soluble tablets • Panadol® • Severe renal or severe hepatic impairment

Ibuprofen 200mg, 400mg capsules • Anadin® Ibuprofen • Long-term conditions • Pregnancy, breastfeeding and tablets ( / 16 tablets) • Nurofen® requiring regular pain • Stomach ulcer, relief • Calprofen® perforation or bleeding • Asthma (active or history of) • Cuprofen® • Unstable high blood • Renal impairment pressure • Hepatic impairment • Taking anticoagulants • Cardiac impairment

Pharmacy only medication Less than £1 £1 - £5 More than £5

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 31 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Conjunctivitis

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores A prescription for treatment Self-care measures of the lip of conjunctivitis should not Conjunctivitis routinely be offered to patients Viral conjunctivitis usually resolves within one to two weeks and bacterial conjunctivitis usually resolves within 5-7 days without the use of antimicrobials. Coughs, Colds and as the condition is frequently Nasal Congestion due to viral infections, is self- • Bathing/cleaning the eyelids with cotton wool soaked in sterile saline or boiled and Cradle Cap (Seborrhoeic limiting and will clear up on cooled water to remove any discharge Dermatitis – Infants) its own without the need for • Cool compresses applied gently around the eye area Haemorrhoids antimicrobial treatment. • Use of lubricating drops or artificial tears Infant Colic • Avoid wearing contact lenses Mild Cystitis • Inform the person that infective conjunctivitis is contagious and they should try to prevent spread of infection to their other eye and other people by: Supporting >> Washing hands frequently with soap and water resources >> Using separate towels and flannels >> Avoiding close contact with others especially if they are a healthcare professional NHS Choices or child care provider – they may be infectious for up to 14 days from onset. Public Health England does not recommend an exclusion period from school, nursery or NICE CKS - Conjunctivitis childminders except if an outbreak or cluster of cases occurs. NICE CKS - Dry eye syndrome Self-care forum GP handout

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 32 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Conjunctivitis

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores Exceptions ‘Red flag’ symptoms of the lip Conjunctivitis • Severe cases of bacterial conjunctivitis may require • Reduced visual acuity topical antibiotics Coughs, Colds and • Marked eye pain, headache or photophobia Nasal Congestion • ‘Red flag’ symptoms. • Red sticky eye in a neonate (within 30 days of birth) Cradle Cap (Seborrhoeic • History of trauma or possible foreign body Dermatitis – Infants) Haemorrhoids • Copious rapidly progressive discharge Infant Colic • Infection with a herpes virus Mild Cystitis • Soft contact lens use with corneal symptoms (such as photophobia and watering).

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 33 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Conjunctivitis

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Cradle Cap (Seborrhoeic Chloramphenicol 0.5% eye drops • Optrex® • Children under 2 years Dermatitis – Infants) • Pregnancy, breastfeeding Haemorrhoids • Please check eye drops are suitable if you wear Infant Colic contact lenses Mild Cystitis Sodium cromoglicate 2% eye drops • Opticrom® • Children under 6 years (mast cell stabiliser) • Pregnancy, breastfeeding • Please check eye drops are suitable if you wear contact lenses

Chloramphenicol 1% eye ointment • Golden eye® • Children under 2 years • Pregnancy, breastfeeding

Pharmacy only medication Less than £1 £1 - £5 More than £5

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 34 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Coughs, Colds and Nasal Congestion

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores A prescription for treatment Self-care measures of the lip of coughs, colds and nasal Conjunctivitis congestion should not routinely • Symptom relief and rest are the most • For adults and children over 6 years appropriate management. During the of age various products that combine Coughs, Colds and be offered to patients as the course of the illness ensure the patient analgesics with other drugs, such as Nasal Congestion condition is self-limiting and has adequate fluid intake, eats healthy decongestants, are available through Cradle Cap (Seborrhoeic will clear up on its own without food and gets adequate rest a pharmacy. While these may relieve Dermatitis – Infants) the need for treatment. • Paracetamol or ibuprofen should be some symptoms, people should be Haemorrhoids Antibiotics and antihistamines taken if needed to relieve symptoms aware of their limited benefit and are ineffective and may cause Infant Colic as follows: potential for adverse effects before adverse effects. using them. For example: Mild Cystitis >> Adults and children aged 5 years and over, if the person has a headache, >> Intranasal or oral decongestants muscle pain, or fever may relieve nasal congestion in the short term Supporting >> Children aged under 5 years, if resources the child has a fever and appears >> Cough medicines have limited distressed benefit on cold symptoms in general, NHS Choices but may be useful in children over • Vapour rubs may soothe respiratory 6 years of age and adults NICE CKS symptoms in infants and small children when applied to the chest and back • A major route of transmission of the Self-care forum common cold is direct bodily contact. • Gargling with salt water or sucking GP handout Hand washing should be promoted to menthol sweets may help to relieve reduce the risk of transmission. sore throat or nasal congestion • Nasal saline drops may help relieve nasal congestion

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 35 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Coughs, Colds and Nasal Congestion

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores Exceptions ‘Red flag’ symptoms of the lip Conjunctivitis • ‘Red flag’ and sepsis symptoms. • Where symptoms are worsening Sinus and Nasal Congestion (for example after 3–5 days) or where Coughs, Colds and • Nasopharyngeal cancer is rare – 460 symptoms are persisting (for example Nasal Congestion cases diagnosed per year in the UK. after 7–14 days) Cradle Cap (Seborrhoeic Symptoms include: • Young children and babies with Dermatitis – Infants) >> Unilateral symptoms of obstruction symptoms of dehydration, laboured Haemorrhoids with blood stained discharge breathing, or prolonged fever Infant Colic >> Persistent (>3weeks) unilateral • Persistent cough for more than symptoms of obstruction Mild Cystitis three weeks >> Unilateral or bleeding polyps • Pleuritic chest pain >> Polyps in children • Dyspnoea >> Objective facial swelling • Haemoptysis >> Paraesthesia of cheek • Persistent nocturnal cough >> Persistent unexplained epistaxis • Wheeze >> Loosening of teeth • Recurrent chest infections >> Orbital pathology e.g. proptosis • Coughing up phlegm every morning for more than three months of the year • Unintentional weight loss • History of night sweats • Persistent, palpable neck lumps

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 36 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Coughs, Colds and Nasal Congestion

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Coughs, Colds and Example OTC medications (generic) Brand Price OTC restrictions Nasal Congestion

Cradle Cap (Seborrhoeic Paracetamol 1000mg/ Pholcodine • Day Nurse® • Children under 16 years Dermatitis – Infants) 10mg/ Pseudoephedrine HCL 60mg in Oral Solution • Pregnancy, breastfeeding 30ml oral solution Haemorrhoids • High blood pressure Infant Colic • Heart disease Paracetamol 500mg/ Pholcodine 5mg/ • Day Nurse® Mild Cystitis Pseudoephedrine HCL 30mg capsules Capsules • Kidney disease

Pharmacy only medication Less than £1 £1 - £5 More than £5

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 37 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Cradle Cap (Seborrhoeic Dermatitis – Infants)

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores A prescription for treatment of Self-care measures of the lip cradle cap should not routinely Conjunctivitis be offered to patients as the • Regular washing of the scalp with a baby shampoo, followed by gentle brushing with a soft brush to loosen scales and improve the condition of the skin Coughs, Colds and condition is self-limiting and will Nasal Congestion clear up on its own without the • Soaking the crusts overnight with white petroleum jelly or a slightly warmed vegetable Cradle Cap (Seborrhoeic need for treatment. The parent/ or olive oil, and shampooing in the morning. If these methods do not achieve Dermatitis – Infants) carer of the patient should be softening, a greasy emollient or soap substitute, such as emulsifying ointment, can be used, which helps to remove the scales more easily Haemorrhoids reassured that the condition is • Cradle cap shampoos are widely available to purchase. Infant Colic not serious, does not usually Mild Cystitis trouble the infant and typically resolves spontaneously within a few months.

Supporting resources NHS Choices NICE CKS Self-care forum GP handout

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 38 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Cradle Cap (Seborrhoeic Dermatitis – Infants)

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores Exceptions ‘Red flag’ symptoms of the lip Conjunctivitis • If the condition is causing distress to the infant • Consider referral to a dermatologist/paediatrician if there is: and is not improving Coughs, Colds and >> Severe or widespread seborrhoeic dermatitis. Nasal Congestion • ‘Red flag’ symptoms. Consider possible serious underlying conditions Cradle Cap (Seborrhoeic such as immunodeficiency Dermatitis – Infants) >> Failure to respond to routine treatment Haemorrhoids >> Worsening of symptoms despite treatment Infant Colic >> Signs of infection (for example crusting, Mild Cystitis oozing, and bleeding).

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 39 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Cradle Cap (Seborrhoeic Dermatitis – Infants)

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Coughs, Colds and Example OTC medications (generic) Brand Price OTC restrictions Nasal Congestion

Cradle Cap (Seborrhoeic Sodium lauryl ether sulfate, sodium • Dentinox® Cradle Cap • If the cradle cap has spread to the face Dermatitis – Infants) lauryl ether sulfo-succinate Treatment Shampoo • Do not use on broken skin or infected skin Haemorrhoids Infant Colic White soft paraffin, olive oil ( ) • Hydromol® (125g) or greasy emollients ® Mild Cystitis • Vaseline (100ml)

Pharmacy only medication Less than £1 £1 - £5 More than £5

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 40 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Haemorrhoids

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores A prescription for treatment of Self-care measures of the lip minor haemorrhoids should not Conjunctivitis routinely be offered to patients • Gradually increase the amount of fibre in your diet Coughs, Colds and as the condition is self-limiting • Drink plenty of fluid Nasal Congestion and will clear up on its own • Take simple analgesia e.g. paracetamol or ibuprofen for pain relief Cradle Cap (Seborrhoeic without the need for treatment. (see OTC restrictions). Avoid non-steroidal anti-inflammatory drugs Dermatitis – Infants) Self-care treatment and lifestyle (NSAIDS) if rectal bleeding is present Haemorrhoids advice is to aid healing of minor • Ensure good hygiene and keep anal region clean and dry to reduce irritation Infant Colic symptoms. Clinical judgment is and aid healing required to assess if severity Mild Cystitis • Avoid stool withholding and undue strain during bowel movements of symptoms warrants further investigation or referral. • Avoid medication that causes constipation – such as painkillers that contain codeine • Exercise regularly – this can help prevent constipation • Use creams, ointments or suppositories for symptomatic relief Supporting • Dietary and lifestyle measures can reduce the risk of recurrence. resources NHS Choices NICE CKS Self-care forum GP handout

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 41 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Haemorrhoids

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores Exceptions ‘Red flag’ symptoms of the lip Conjunctivitis • People who do not respond to conservative treatment • Consider the need for admission or onward referral for: Coughs, Colds and • People with recurrent symptoms who do not respond to >> Extremely painful, large thrombosed internal or external Nasal Congestion primary care management haemorrhoids Cradle Cap (Seborrhoeic • ‘Red flag’ symptoms. >>Suspected perianal sepsis (a rare but life-threatening Dermatitis – Infants) complication) Haemorrhoids >>Suspected anal or colorectal cancer. Gastrointestinal tract Infant Colic (lower) cancers - recognition and referral Mild Cystitis >>When another serious pathology, such as inflammatory bowel disease or a sexually transmitted infection, is suspected • Weight loss • Change in bowel habit, especially diarrhoea and/or increased frequency • Iron-deficiency anaemia • Abdominal mass • Rectal/anal mass • Faecal occult blood.

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 42 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Haemorrhoids

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Coughs, Colds and Example OTC medications (generic) Brand Price OTC restrictions Nasal Congestion

Cradle Cap (Seborrhoeic balsam peru, bismuth oxide, zinc oxide • Anusol® cream • Not recommended for children (Anusol®) Dermatitis – Infants) • Children under 12 years (Germoloids®) ® Haemorrhoids balsam peru, bismuth oxide, bismuth • Anusol ointment • Pregnancy, breastfeeding subgallate, zinc oxide Infant Colic • Rectal bleeding or blood in stools

Mild Cystitis balsam peru, benzyl benzoate, • Anusol® HC bismuth oxide, bismuth subgallate, Ointment hydrocortisone acetate, zinc oxide

balsam peru, benzyl benzoate, • Anusol® Plus HC bismuth oxide, bismuth subgallate, Suppositories hydrocortisone acetate, zinc oxide

lidocaine hydrochloride, zinc oxide • Germoloids® Cream, • Germoloids® Ointment, • Germoloids® Suppositories

Pharmacy only medication Less than £1 £1 - £5 More than £5

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 43 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Infant Colic

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores A prescription for treatment of Self-care measures • There is insufficient good-quality of the lip infant colic should not routinely evidence to recommend the use of Conjunctivitis be offered to patients as the • Strategies that may help to soothe a the following: crying infant, such as: ® Coughs, Colds and condition is self-limiting and >> Simeticone (such as Infacol ) or Nasal Congestion will clear up on its own without >> Hold and rock baby gently over the lactase (such as Colief®) drops shoulder during a crying episode Cradle Cap (Seborrhoeic the need for treatment. Parents >> Maternal diet modification if Dermatitis – Infants) or carers should be reassured >> Gentle motion (such as pushing the breastfeeding, or changing the infant Haemorrhoids that infantile colic is a common pram or rocking the crib) milk formula preparation >> ‘White noise’ (for example from a Infant Colic problem that should resolve by >> Probiotic supplements or herbal vacuum cleaner or hairdryer) supplements Mild Cystitis 6 months of age. >> Bathing the infant in a warm bath >> Manipulative strategies, such as >> Ensuring an optimal winding spinal manipulation or cranial Supporting technique is used during and after osteopathy feeds, if needed • Seek information and support from: resources • Keep feeding the baby as usual. If > The self-help support group Cry-sis NHS Choices breastfeeding, continue wherever for families with excessively crying possible. Hold the baby upright during or sleepless children. Telephone NICE CKS feeding to stop them swallowing air Helpline (0845 122 8669) Self-care forum • Ensure you get sufficient rest when the > Your local pharmacist, health visitor or nursery nurse GP handout baby is asleep • Put the baby down in a safe place, > Family and friends, if possible such as their cot, if you feel unable to > Meeting other parents/carers with cope with the crying for a few minutes, babies of the same age, to share to allow ‘time out’ experiences and access peer support.

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 44 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Infant Colic

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores Exceptions of the lip Conjunctivitis • Consider seeking specialist advice from a paediatrician, if: Coughs, Colds and >> Parents/carers feel unable to cope with the infant’s Nasal Congestion symptoms despite reassurance and advice in primary care Cradle Cap (Seborrhoeic >> Symptoms are severe or persist after 4 months Dermatitis – Infants) >> The infant is not thriving, or symptoms are not starting to Haemorrhoids improve or are worsening after 4 months of age Infant Colic >> There is a suspected underlying cause for symptoms which Mild Cystitis cannot be managed in primary care.

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 45 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Infant Colic

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores Please note there may be limited clinical evidence available to support use of some products. We recommend patients speak to a pharmacist for of the lip individual advice. Conjunctivitis Coughs, Colds and Nasal Congestion Cradle Cap (Seborrhoeic Dermatitis – Infants) Haemorrhoids Infant Colic Mild Cystitis

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 46 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild Cystitis

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores A prescription for treatment Self-care measures of the lip of mild cystitis should not Conjunctivitis routinely be offered to patients • Take over-the-counter painkillers, such as paracetamol or ibuprofen Coughs, Colds and as the condition is self-limiting (see OTC restrictions) Nasal Congestion and will clear up on its own Cradle Cap (Seborrhoeic without the need for treatment. • Drink enough fluid to avoid dehydration Dermatitis – Infants) • No evidence found for cranberry Haemorrhoids products or urine alkalinising agents to treat lower UTI. Infant Colic Supporting Mild Cystitis resources NHS Choices NICE CKS Self-care forum GP handout Treating your infection – Urinary tract infection (UTI) Leaflet Urinary tract infections: A leaflet for older adults and carers

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 47 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild Cystitis

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Acute Sore Throat Infrequent Cold Sores Exceptions ‘Red flag’ symptoms of the lip Conjunctivitis • Consider the need for antibiotics depending on • Seek urgent medical review if: severity of symptoms, risk of complications, and Coughs, Colds and >> Symptoms worsen rapidly or significantly at any Nasal Congestion previous urine culture results time or fail to improve within 48 hours. Consider Cradle Cap (Seborrhoeic • ‘Red flag’ and sepsis symptoms. alternative treatment or a more serious diagnosis Dermatitis – Infants) such as pyelonephritis or sepsis Haemorrhoids • Cystitis in men. Infant Colic Mild Cystitis

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 48 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild Cystitis

Self-limiting Conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-LIMITING CONDITIONS 49 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview

Self-care Conditions Self-care Conditions

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 50 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Overview

Self-care Conditions Minor conditions suitable for self-care Please note: Mild Irritant Dermatitis Hay Fever/Seasonal Rhinitis OTC restrictions = over-the-counter Dandruff Minor Burns and Scalds products that cannot be purchased if the patient meets any of the criteria. Further Diarrhoea (Adults) Mild General Aches and Pains information can be found from the product Dry Eyes/Sore (Tired) Eyes Mouth Ulcers information leaflet. For further advice on over-the-counter Earwax Nappy Rash medications, click here. Excessive Sweating Oral Thrush The brands listed are not exhaustive and (Hyperhidrosis) Prevention of Dental Caries other brands may be available which the Head Lice community pharmacist may recommend Ringworm/Athletes Foot/ to the patient. Prices listed in this tool are Indigestion and Heartburn Fungal Nail Infection correct at the time of writing and are subject to change. Infrequent Constipation Teething/Mild Toothache

Infrequent Migraine Threadworms

Insect Bites and Stings Travel Sickness

Mild Acne Warts and Verrucae

Mild Dry Skin

Sunburn

Sun Protection GPs should issue a ‘non- prescription’ sheet to patients being referred to purchase over-the-counter medication at end of each consultation.

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 51 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild Irritant Dermatitis

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of mild irritant dermatitis Dry Eyes/Sore (Tired) Eyes should not be routinely offered • Use emollients frequently and apply liberally Earwax • Use of aqueous cream is not recommended as it is thought to cause a Excessive Sweating to patients as the condition is (Hyperhidrosis) appropriate for self-care. disproportionate amount of skin reaction Head Lice • Use soap substitutes wherever possible Indigestion and Heartburn • Avoidance of known irritants is required to support treatment and prevent recurrent Infrequent Constipation Supporting episodes of contact dermatitis. If contact is made with a known irritant, wash the Infrequent Migraine area with warm water and an emollient. Use gloves to protect hands when in contact Insect Bites and Stings resources with irritants, but remove them occasionally as sweating can make symptoms worse. Mild Acne Cotton gloves under rubber gloves may be helpful if rubber gloves irritate the skin Mild Dry Skin NHS Choices Sunburn NICE CKS • Check the ingredients on make-up and soap to make sure they do not contain any Sun Protection irritants or allergens; in some cases, you may need to contact the manufacturer or Self-care forum Hay Fever/Seasonal Rhinitis check online to get this information. Minor Burns and Scalds GP handout Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 52 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild Irritant Dermatitis

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • If the dermatitis is severe, chronic, recurring or persistent • Infected dermatitis. Earwax and not responding to primary care treatments Excessive Sweating (Hyperhidrosis) • Previously stable dermatitis has become difficult or impossible Head Lice to control with standard treatments Indigestion and Heartburn • Allergy to prescribed or over-the-counter topical Infrequent Constipation treatments is suspected Infrequent Migraine • More serious conditions such as eczema and Insect Bites and Stings psoriasis may require topical corticosteroids as part Mild Acne of the treatment strategy Mild Dry Skin Sunburn • ‘Red flag’ symptoms Sun Protection • See earlier for general exceptions. Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 53 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild Irritant Dermatitis

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 54 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Dandruff

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment of Self-care measures Diarrhoea (Adults) dandruff will not be routinely Dry Eyes/Sore (Tired) Eyes offered to patients as the • Remove thick crusts or scales on the scalp before using an antifungal shampoo. Earwax Removal of crusts can be achieved by: Excessive Sweating condition is appropriate for (Hyperhidrosis) self-care. >> Applying warm mineral or olive oil to the scalp for several hours Head Lice • Shampoo with a keratolytic preparation (for example salicylic acid) or coal tar– Indigestion and Heartburn keratolytic preparation Infrequent Constipation Supporting • Selenium sulphide shampoo may be used as an alternative Infrequent Migraine Insect Bites and Stings resources • Shampoos should be used twice a week for at least one month Mild Acne • Shampoos should be left on for at least 5 minutes before rinsing off Mild Dry Skin NHS Choices • Shampoos can also be applied to the beard area Sunburn NICE CKS Sun Protection • Once symptoms are under control, the frequency of shampooing may be reduced, for Self-care forum Hay Fever/Seasonal Rhinitis example to once a week or once every 2 weeks Minor Burns and Scalds GP handout • Symptoms may return if stopped completely Mild General Aches and Pains • Topical corticosteroids are not appropriate for continuous long-term use, and their use Mouth Ulcers as maintenance treatment is not recommended. Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 55 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Dandruff

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Seek specialist advice if symptoms have not resolved after 4 Earwax weeks, or sooner if response to treatment is poor Excessive Sweating (Hyperhidrosis) • See earlier for general exceptions. Head Lice Indigestion and Heartburn Infrequent Constipation Infrequent Migraine Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 56 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Dandruff

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 57 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Diarrhoea (Adults)

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment of Self-care measures Diarrhoea (Adults) diarrhoea will not be routinely Dry Eyes/Sore (Tired) Eyes offered to patients as the • Stay at home and get plenty of rest Earwax • It's important to drink plenty of fluids to avoid dehydration, particularly if you're also Excessive Sweating condition is appropriate for (Hyperhidrosis) self-care. Diarrhoea will usually vomiting. Take small, frequent sips of water Head Lice clear up without treatment • Ideally, adults should drink a lot of liquids that contain water, salt, and sugar. Examples Indigestion and Heartburn in 3-7 days, particularly if it's are water mixed with juice, and soup broth. If you're drinking enough fluid, your urine Infrequent Constipation caused by an infection. will be light yellow or almost clear Infrequent Migraine NB: This recommendation does • Consider using an oral rehydration solution (ORS) to treat or prevent dehydration if Insect Bites and Stings not apply to children you're at risk – for example, if you're frail or elderly. They are dissolved in water and Mild Acne replace salt, glucose, and other important minerals that are lost if you are dehydrated Mild Dry Skin Sunburn • Most experts agree you should eat solid food as soon as you feel able to. Eat small, Sun Protection Supporting light meals and avoid fatty or spicy foods. Good examples are potatoes, rice, bananas, Hay Fever/Seasonal Rhinitis resources soup, and boiled vegetables. Salty foods help the most Minor Burns and Scalds • You don't need to eat if you've lost your appetite, but you should continue to drink Mild General Aches NHS Choices fluids and eat as soon as you feel able to. and Pains Mouth Ulcers NICE CKS Nappy Rash Self-care forum Oral Thrush Prevention of Dental Caries GP handout Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 58 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Diarrhoea (Adults)

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • The person is systemically unwell and may require hospital • Symptoms >4 weeks Earwax admission and/or antibiotics • Fever Excessive Sweating (Hyperhidrosis) • Patients over 60 years with symptoms lasting over 48 hours • Abdominal pain and tenderness Head Lice • Presence of blood or pus • Blood in the stool Indigestion and Heartburn • Recent travel abroad to a high risk area Infrequent Constipation • Weight loss Infrequent Migraine • History of Clostridium difficile • Iron-deficiency anaemia Insect Bites and Stings • Acute diarrhoea is an extremely common • Change in bowel habit Mild Acne presentation in primary care, so it is important Mild Dry Skin not to miss more serious pathology • Inability to retain oral fluids Sunburn • ‘Red flag’ symptoms • Evidence of dehydration, severe dehydration or shock Sun Protection • Nocturnal symptoms — organic cause more likely Hay Fever/Seasonal Rhinitis • See earlier for general exceptions. Minor Burns and Scalds • Coexisting medical conditions: immunodeficiency, lack of Mild General Aches stomach acid, inflammatory bowel disease, valvular heart and Pains disease, diabetes mellitus, renal impairment, rheumatoid Mouth Ulcers disease, systemic lupus erythematosus Nappy Rash • The patient is taking medication such as immunosuppressants Oral Thrush or systemic steroids, proton pump inhibitors, angiotensin- Prevention of Dental Caries converting enzyme inhibitors, diuretics. Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 59 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Diarrhoea (Adults)

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Products listed in table are licensed to treat this condition. Please note there may be limited clinical evidence available to support use of some products. Diarrhoea (Adults) We recommend patients speak to a pharmacist for individual advice. Exceptions included are not an exhaustive list, please check product licences. Prices Dry Eyes/Sore (Tired) Eyes correct at time of writing and are subject to change. Earwax Excessive Sweating Example OTC medications (generic) Brand Price OTC restrictions (Hyperhidrosis) Head Lice Oral rehydration sachets • Dioralyte Relief® oral • Not licensed under the age of 1 year Indigestion and Heartburn powder sachets • Liver or renal disease Infrequent Constipation ® • Dioralyte oral powder • Low potassium/sodium diets Infrequent Migraine sachets Insect Bites and Stings Mild Acne Loperamide 2mg capsules • Imodium® • Children under age of 12 Mild Dry Skin ( ) • Dioraleze® • Inflammatory bowel disease Sunburn • Entrocalm® • Post bowel surgery Sun Protection • Post pelvic radiation Hay Fever/Seasonal Rhinitis Minor Burns and Scalds • Colorectal cancer Mild General Aches and Pains Bismuth subsalicylate syspension • Pepto-bismol® • Not licensed for under 16 years Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Pharmacy only medication Less than £1 £1 - £5 More than £5 Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 60 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Dry Eyes/Sore (Tired) Eyes

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of dry eyes/sore (tired) eyes Dry Eyes/Sore (Tired) Eyes will not be routinely offered • Avoid alcohol and exposure to cigarette smoke Earwax • Protect eyes from environmental factors such as wind, hot air, smoke and dust by Excessive Sweating to patients as the condition is (Hyperhidrosis) appropriate for self-care. wearing wrap around glasses Head Lice • Minimise time spent using computers and avoid prolonged periods of computer use, Indigestion and Heartburn lower computer screens to below eye level, take regular breaks, and increase blink Infrequent Constipation Supporting frequency with computer use and reading Infrequent Migraine • Increase humidity and reduce time spent in air conditioned environments, if possible Insect Bites and Stings resources Mild Acne • Keep eyes clean – use wipes, warm compresses and eyelid massages NHS Choices Mild Dry Skin • Contact lens wearers should reduce time wearing lenses, remove lenses when Sunburn NICE CKS experiencing symptoms and see an optician if symptoms persist. Changing lens type Sun Protection Self-care forum or solution may help Hay Fever/Seasonal Rhinitis • Tear supplements can be used if lifestyle measures do not relieve symptoms. Drops Minor Burns and Scalds GP handout are best for daytime use with ointments or gels reserved for use before bed. Mild General Aches and Pains Consider preservative free formulations if the person is intolerant of preservative in Mouth Ulcers tear supplements. Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 61 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Dry Eyes/Sore (Tired) Eyes

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Chronic dry eye is an exception • Sjorgen syndrome Earwax • ‘Red flag’ symptoms • History of other conditions such as acute glaucoma, Excessive Sweating (Hyperhidrosis) • See earlier for general exceptions. keratitis, iritis or corneal ulcer Head Lice • Children with any corneal change Indigestion and Heartburn • Patient is suspected of having an underlying systemic Infrequent Constipation condition such as Sjogren’s syndrome Infrequent Migraine Insect Bites and Stings • Persistent symptoms that do not respond after 12 weeks Mild Acne • Abnormal lid anatomy or function Mild Dry Skin • Pain or blurred vision. Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 62 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Dry Eyes/Sore (Tired) Eyes

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 63 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Earwax

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of earwax will not be routinely Dry Eyes/Sore (Tired) Eyes offered to patients as the • Earwax usually falls out on its own Earwax • If wax doesn’t fall out or blocks the ear, ear drops can be used to loosen wax Excessive Sweating condition is appropriate for (Hyperhidrosis) self-care. • Advise patient that instilling ear drops may cause transient hearing loss, discomfort, Head Lice dizziness and irritation of the skin Indigestion and Heartburn • Do not remove earwax by inserting cotton buds into the ear canal. Nice NG 98 Infrequent Constipation Supporting Infrequent Migraine • Ear candling should never be used. Insect Bites and Stings resources Mild Acne Mild Dry Skin NHS Choices Sunburn NICE CKS Sun Protection Self-care forum Hay Fever/Seasonal Rhinitis Minor Burns and Scalds GP handout Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 64 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Earwax

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • No routine exceptions have been identified • Suspected perforated tympanic membrane Earwax • See earlier for general exceptions. • A past history of ear surgery Excessive Sweating (Hyperhidrosis) • A foreign body, including vegetable matter, in the ear canal Head Lice • A visible tympanic membrane perforation Indigestion and Heartburn Infrequent Constipation • Ear drops have been unsuccessful Infrequent Migraine • Badly blocked and can't hear Insect Bites and Stings • Not cleared after 5 days. Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 65 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Earwax

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Products listed in table are licensed to treat this condition. Please note there may be limited clinical evidence available to support use of some products. Diarrhoea (Adults) We recommend patients speak to a pharmacist for individual advice. Exceptions included are not an exhaustive list, please check product licences. Prices Dry Eyes/Sore (Tired) Eyes correct at time of writing and are subject to change. Earwax Excessive Sweating Example OTC medications (generic) Brand Price OTC restrictions (Hyperhidrosis) Head Lice Olive oil • Do not use if: earwax removal took place in the previous Indigestion and Heartburn 2 or 3 days, swelling, pain or discharge present or there is Infrequent Constipation Arachis oil/chlorobutanol hemihydrate • Cerumol® a history of ear problems Infrequent Migraine drops • Please check age restrictions for each individual product Insect Bites and Stings Mild Acne Sodium bicarbonate ear drops Mild Dry Skin Sunburn Acetic acid 2% • Earcalm® Sun Protection Hay Fever/Seasonal Rhinitis Urea Hydrogen Peroxide 5.0% • Otex® Minor Burns and Scalds Mild General Aches Cleansing wash • Audiclean® cleansing • Adults and children above 6 months. and Pains wash • Do not use if history of ear problems or pain or Mouth Ulcers discharge from ears Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Pharmacy only medication Less than £1 £1 - £5 More than £5 Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 66 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Excessive Sweating (Hyperhidrosis)

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment of Self-care measures Diarrhoea (Adults) excessive sweating will not be Dry Eyes/Sore (Tired) Eyes routinely offered to patients as • Use a commercial antiperspirant (as opposed to a deodorant) frequently e.g. Earwax the condition is appropriate for 20% aluminium chloride hexahydrate preparations such as roll-on antiperspirants Excessive Sweating and sprays, which are available over-the-counter (Hyperhidrosis) self-care. Head Lice • Modify behaviour to avoid identified triggers (such as crowded rooms, alcohol, Indigestion and Heartburn caffeine, or spicy foods), where possible Infrequent Constipation Supporting • Avoid: tight clothing and man-made fabrics e.g. nylon and enclosed boots Infrequent Migraine or sports shoes Insect Bites and Stings resources • Wear white or black clothing to minimize the signs of sweating Mild Acne Mild Dry Skin NHS Choices • Consider using dress shields (also known as armpit or sweat shields) to absorb Sunburn NICE CKS excess sweat and protect delicate or expensive clothing Sun Protection Self-care forum • Wear moisture-wicking socks, changing them at least twice daily Hay Fever/Seasonal Rhinitis • Use absorbent soles, and use absorbent foot powder twice daily Minor Burns and Scalds GP handout Mild General Aches • If skin irritation occurs with the application of topical aluminum salt preparations, use and Pains topical emollients and soap substitutes to reduce irritation and reduce the frequency Mouth Ulcers of topical aluminum salt application until symptoms resolve. Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 67 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Excessive Sweating (Hyperhidrosis)

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • No routine exceptions have been identified Earwax • See earlier for general exceptions. Excessive Sweating (Hyperhidrosis) Head Lice Indigestion and Heartburn Infrequent Constipation Infrequent Migraine Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 68 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Excessive Sweating (Hyperhidrosis)

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 69 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Head Lice

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures • People should be advised that: Diarrhoea (Adults) of head lice will not be >> Children being treated for head lice Dry Eyes/Sore (Tired) Eyes No treatment can guarantee success, routinely offered to patients can still attend school Earwax but a treatment has the best chance of as the condition is appropriate Excessive Sweating success if it is performed correctly and >> There is no evidence that head lice (Hyperhidrosis) for self-care. if all affected household members are have a preference for either clean or Head Lice dirty hair A diagnosis of active head lice treated at the same time. Indigestion and Heartburn >> There is no need to treat clothing infestation should only be made if a • Recommended treatments are: Infrequent Constipation or bedding that has been in contact live head louse is found. Detection Infrequent Migraine >>Wet comb using a special fine-toothed with lice Insect Bites and Stings combing is the best way to confirm comb with conditioner to remove lice, the presence of lice. This is the Mild Acne combing from roots to ends. Repeat • The following products are not systematic combing of wet or dry hair Mild Dry Skin every few days for 2 weeks recommended for the treatment of Sunburn using a fine-toothed (0.2–0.3 mm head lice infestation due to a lack apart) head lice detection comb. >>A physical insecticide, such as of consistent evidence for their safety Sun Protection dimeticone 4% lotion (Hedrin®) Hay Fever/Seasonal Rhinitis and efficacy Minor Burns and Scalds >> A traditional insecticide, such as >> Essential oil-based treatments (such Mild General Aches Supporting malathion 0.5% aqueous liquid as tea tree oil, eucalyptus oil, and ® and Pains resources (Derbac-M ) lavender oil) and herbal remedies Mouth Ulcers • Try not to scratch affected area. Repeat >> Electric combs - in addition, expert Nappy Rash NHS Choices treatment, if necessary consensus is that they should not Oral Thrush be used because they are expensive Prevention of Dental Caries NICE CKS • Detection combing should be done after all treatments to confirm the and can pose a safety risk if used Ringworm/Athletes Foot/ Self-care forum incorrectly Fungal Nail Infection success of the treatment. Children of ® Teething/Mild Toothache GP handout primary school age should be examined >> Nitlotion (contains coconut oil) Threadworms regularly at home >> Hair conditioner. Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 70 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Head Lice

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 71 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Head Lice

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 72 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Indigestion and Heartburn

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of minor, short-term Dry Eyes/Sore (Tired) Eyes indigestion and heartburn • The following lifestyle changes may >> Alginates (such as sodium alginate) Earwax will not be routinely offered help symptoms: and compound alginate preparations Excessive Sweating are available over-the-counter in local to patients as these are >> Lose weight if overweight or obese (Hyperhidrosis) pharmacies, in petrol stations and in Head Lice appropriate for self-care. >> Avoid any trigger foods, such as supermarkets Indigestion and Heartburn Patients should seek medical coffee, chocolate, tomatoes, fatty or Infrequent Constipation spicy foods >> H2-receptor antagonists, such advice if their symptoms do as ranitidine, and proton pump Infrequent Migraine not respond to treatment, or >> Eat smaller meals and eat evening Insect Bites and Stings inhibitors (PPIs), such as omeprazole if their symptoms worsen. meal at least 3 hours before going to and pantoprazole, are widely Mild Acne bed, if possible Mild Dry Skin available (PPIs only from pharmacies) >> Stop smoking, if appropriate Sunburn • These medicines should not be Sun Protection Supporting >> Reduce alcohol consumption to taken for prolonged periods without recommended limits, if appropriate Hay Fever/Seasonal Rhinitis resources consulting a health professional Minor Burns and Scalds • Raise the head of the bed if nightime • Avoid aspirin-like drugs (NSAIDs) Mild General Aches NHS Choices symptoms are a problem and Pains (e.g. ibuprofen) Mouth Ulcers NICE CKS • Widely available treatments include: • Seek the advice of a pharmacist or Nappy Rash Self-care forum >> Antacids (such as aluminum other healthcare professional if you Oral Thrush hydroxide and magnesium think medication you take is causing Prevention of Dental Caries GP handout carbonate, hydroxide and trisilicate) the problem. e.g. aspirin, ibuprofen. Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 73 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Indigestion and Heartburn

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Long-term indigestion • Severe persistent (longer than three weeks), worsening and Earwax • History of gastric cancer unexplained upper abdominal pain, particularly if occurring Excessive Sweating together with other symptoms, such as central chest pain, (Hyperhidrosis) • ‘Red flag’ symptoms shortness of breath, or sweating Head Lice • See earlier for general exceptions. Indigestion and Heartburn • Persistent vomiting, haematemesis, and tar-like stools Infrequent Constipation GMMMG formulary available here. (melaena), together with feeling faint or even collapsing, Infrequent Migraine suggesting a gastrointestinal bleed – a medical emergency Insect Bites and Stings (but remember that taking iron tables can also cause Mild Acne blackened stools) Mild Dry Skin • Difficulty swallowing Sunburn • Unexplained fever, weight loss or night sweats Sun Protection Hay Fever/Seasonal Rhinitis • An upper abdominal swelling or mass Minor Burns and Scalds • Chronic GI bleeding Mild General Aches and Pains • Over 55 years with unexplained and persistent dyspepsia Mouth Ulcers • Iron deciciency anaemia. Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 74 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Indigestion and Heartburn

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Products listed in table are licensed to treat this condition. Please note there may be limited clinical evidence available to support use of some products. Diarrhoea (Adults) We recommend patients speak to a pharmacist for individual advice. Exceptions included are not an exhaustive list, please check product licences. Prices Dry Eyes/Sore (Tired) Eyes correct at time of writing and are subject to change. Earwax Excessive Sweating Example OTC medications (generic) Brand Price OTC restrictions (Hyperhidrosis) Head Lice Sodium alginate, Calcium carbonate, • Gaviscon® tablets • Children under 12 years Indigestion and Heartburn Sodium bicarbonate tablets • Gaviscon Double • Renal failure Infrequent Constipation ® action • Hypercalcaemia Infrequent Migraine • Nephrocalcinosis Insect Bites and Stings Calcium Carbonate, Magnesium • Rennie® chewable Mild Acne Carbonate tablets tablets • Kidney stones Mild Dry Skin Sunburn Ranitidine tablets ( ) • Zantac® • Children under 16 years Sun Protection • Peptic ulceration Hay Fever/Seasonal Rhinitis • Elderly taking NSAIDs Minor Burns and Scalds • Pregnancy, breastfeeding Mild General Aches and Pains ® Mouth Ulcers Esomeprazole 20mg tablets • Nexium Control • Children under 18 years Nappy Rash • Adults over 55 years ® Oral Thrush Pantoprazole 20mg tablets • Pantoloc Control • Pregnancy, breastfeeding Prevention of Dental Caries • Jaundice or liver disease Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Pharmacy only medication Less than £1 £1 - £5 More than £5 Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 75 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Infrequent Constipation (Adults)

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of infrequent constipation Dry Eyes/Sore (Tired) Eyes in adults will not be routinely • Eat a healthy balanced diet and have regular meals. Include whole grains, fruits (and Earwax their juices), and vegetables Excessive Sweating offered to patients as the (Hyperhidrosis) condition is appropriate for • Fibre intake should be increased gradually (to minimize flatulence and bloating) — Head Lice self-care. adults should aim to consume 30g of fibre per day Indigestion and Heartburn • Avoid dehydration and drink plenty of water Infrequent Constipation • Being physically active helps your bowels move more regularly. Adults should aim for a Infrequent Migraine minimum of 150 minutes per week of activity leaving them out of breath but still able Insect Bites and Stings Supporting to hold a conversation (or 75 minutes of higher intensity exercise). Increase in activity Mild Acne resources levels should be gradual Mild Dry Skin Sunburn NHS Choices • Respond to your bowel’s natural pattern and do not delay going to the toilet when Sun Protection NICE CKS you feel the urge to go Hay Fever/Seasonal Rhinitis • Simple pain killers such as paracetamol can help to relieve pain Minor Burns and Scalds Self-care forum • Medicines to ease constipation are available over-the-counter to help you open your Mild General Aches GP handout and Pains bowels. These include bulk-forming preparations, stool softeners, bowel stimulants Mouth Ulcers and suppositories Nappy Rash • Seek advice from a healthcare professional before stopping any prescribed medication. Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 76 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Infrequent Constipation (Adults)

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Frequent constipation • Suspected serious underlying cause such as colorectal cancer Earwax • Opioid induced constipation • Suspected secondary cause of constipation, which cannot be Excessive Sweating (Hyperhidrosis) • When self-care measures have been ineffective, or symptoms managed in primary care Head Lice have not adequately responded, treatment with prescription • Symptoms that persist or recur despite optimal self-care Indigestion and Heartburn laxatives could be offered management in primary care Infrequent Constipation • ‘Red flag’ symptoms • Symptoms are not improving with treatment Infrequent Migraine Insect Bites and Stings • See earlier for general exceptions. • Constipation is regular and lasts a long time Mild Acne • Bloating that lasts a long time Mild Dry Skin • Blood in faeces Sunburn Sun Protection • Unexpected weight loss (or a child has not grown Hay Fever/Seasonal Rhinitis or gained weight) Minor Burns and Scalds • Continual extreme tiredness Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 77 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Infrequent Constipation (Adults)

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Products listed in table are licensed to treat this condition. Please note there may be limited clinical evidence available to support use of some products. Diarrhoea (Adults) We recommend patients speak to a pharmacist for individual advice. Exceptions included are not an exhaustive list, please check product licences. Prices Dry Eyes/Sore (Tired) Eyes correct at time of writing and are subject to change. Earwax Excessive Sweating Example OTC medications (generic) Brand Price OTC restrictions (Hyperhidrosis) Head Lice Ispaghula Husk Granules • Fybogel® • Children under 6 years Indigestion and Heartburn • Manevac® • Diabetes Infrequent Constipation Infrequent Migraine Lactulose • Duphalac® • Galactosaemia Insect Bites and Stings • Gastro-intestinal obstruction, digestive perforation or risk Mild Acne of digestive perforation Mild Dry Skin Sunburn Bisacodyl 5mg tablets • Dulcolax® • Acute inflammatory bowel • Pregnancy and Sun Protection diseases breastfeeding Hay Fever/Seasonal Rhinitis • Severe dehydration • Children under 4 years Minor Burns and Scalds • Senokot® tablets • Severe dehydration Mild General Aches Senna tablets ( ) and Pains and liquid • Children under 18 years Mouth Ulcers • Pregnancy, breastfeeding Nappy Rash Oral Thrush Glycerol suppositories (generic) • Not licensed for children under 12 years Prevention of Dental Caries Docusate 100mg capsules • Dioctyl capsules • Not licensed for children under 12 years Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Pharmacy only medication Less than £1 £1 - £5 More than £5 Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 78 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Infrequent Migraine

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment of Self-care measures Diarrhoea (Adults) infrequent migraine will not be Dry Eyes/Sore (Tired) Eyes routinely offered to patients as • Treat with OTC products such as a triptan, paracetamol or ibuprofen tablets Earwax (see OTC restrictions) Excessive Sweating the condition is appropriate for (Hyperhidrosis) self-care. While the underlying • Opioids are present in some OTC combination treatments for migraine but are not Head Lice disorder cannot be cured, it recommended for use because they may increase nausea and can increase the risk of Indigestion and Heartburn can be effectively treated with medication overuse headache Infrequent Constipation self-care measures, and usually • Maintain a generally healthy lifestyle and keep a headache diary to Identify and reduce Infrequent Migraine improves over time. triggers such as: Insect Bites and Stings >> Menstrual cycle in women Mild Acne Mild Dry Skin >> Altered sleep patterns Sunburn Supporting >> Stress relaxation after stress, so-called 'weekend migraine' Sun Protection resources >> Specific foods - these should only be suspected as a trigger when migraine occurs Hay Fever/Seasonal Rhinitis within 6 hours of intake, and this effect is reasonably reproducible. Once a food Minor Burns and Scalds NHS Choices has been identified as a trigger, a trial of avoidance can be undertaken to see if the Mild General Aches NICE CKS migraine improves. Chocolate, cheese, caffeine, and alcohol have been reported as and Pains precipitants Mouth Ulcers Self-care forum >> Strong smells, bright light Nappy Rash Oral Thrush GP handout >> Dehydration and missed meals Prevention of Dental Caries >> Jet lag Ringworm/Athletes Foot/ >> Strenuous exercise is thought to trigger migraine in those unaccustomed to it, Fungal Nail Infection however regular exercise may help to prevent migraine. Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 79 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Infrequent Migraine

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Diagnosis of migraine is uncertain • A more serious cause of headache is suspected Earwax • Self-care treatment does not adequately control the • Person is in severe, uncontrolled status migrainosus Excessive Sweating (Hyperhidrosis) symptoms (suspect medication-overuse headache) (migraine lasting for more than 72 hours) Head Lice • Preventive treatment does not adequately reduce the • Frequent migraines. Indigestion and Heartburn frequency of headaches Infrequent Constipation • See earlier for general exceptions. Infrequent Migraine Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 80 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Infrequent Migraine

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Products listed in table are licensed to treat this condition. Please note there may be limited clinical evidence available to support use of some products. Diarrhoea (Adults) We recommend patients speak to a pharmacist for individual advice. Exceptions included are not an exhaustive list, please check product licences. Prices Dry Eyes/Sore (Tired) Eyes correct at time of writing and are subject to change. Earwax Excessive Sweating Example OTC medications (generic) Brand Price OTC restrictions (Hyperhidrosis) Sumatriptan 50mg tablets (generic) • Imigran recovery® • Under 18 years of age and over 65 years of age Head Lice Indigestion and Heartburn Paracetamol 500mg tablets and • Anadin paracetamol® • Long-term conditions requiring regular pain relief Infrequent Constipation capsules ( / 16 tablets) • Mandanol® • Children under 12 years Paracetamol 500mg soluble tablets Infrequent Migraine • Panadol® • Severe renal or severe hepatic impairment Insect Bites and Stings Ibuprofen 200mg, 400mg capsules • Anadin® Ibuprofen • Long-term conditions requiring regular pain relief Mild Acne and tablets ( / 16 tablets) ® Mild Dry Skin • Nurofen • Asthma ® Sunburn • Calprofen • Unstable high blood pressure ® Sun Protection • Cuprofen • Taking anticoagulants Hay Fever/Seasonal Rhinitis • Pregnancy, breastfeeding Minor Burns and Scalds Prochlorperazine maleate sublingual • Buccastem® M • Impaired liver function • Protastic hypertrophy Mild General Aches 3mg tablet tablet 3mg and Pains • Existing blood dyscrasias • Narrow angle glaucoma Mouth Ulcers • Epliepsy • Pregnancy, breastfeeding Nappy Rash • Parkinson’s Disease • Children under 18 years Oral Thrush Co-codamol 8/500mg tablets, • Migraleve® Yellow • Children under 12 years Prevention of Dental Caries capsules, effervescent tablets ( ) tablets • Severe liver disease Ringworm/Athletes Foot/ ® Fungal Nail Infection • Paracodol • Pregnancy, breastfeeding Teething/Mild Toothache Threadworms Pharmacy only medication Less than £1 £1 - £5 More than £5 Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 81 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Insect Bites and Stings

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of insect bites and stings Dry Eyes/Sore (Tired) Eyes will not be routinely offered • Usually no treatment other than simple first aid is required Earwax • If a sting or tick is visible in the skin, remove it using tweezers Excessive Sweating to patients as these are (Hyperhidrosis) appropriate for self-care. • Wash the affected area with soap and water Head Lice • Apply a cold compress (such as a flannel or cloth cooled with cold water) or an ice Indigestion and Heartburn pack to any swelling for at least 10 minutes Infrequent Constipation Supporting Infrequent Migraine • Raise or elevate the affected area if possible, as this can help reduce swelling Insect Bites and Stings resources • Keep the area clean and avoid scratching the area, to reduce the risk of infection Mild Acne • Oral analgesics such as paracetamol and ibuprofen can help ease pain (see OTC Mild Dry Skin NHS Choices restrictions). Oral antihistamines or topical corticosteroids may help reduce Sunburn NICE CKS itching. Topical antipruritics, topical antihistamines and topical anesthetics sold Sun Protection Self-care forum over-the-counter are of uncertain value in the treatment of insect bites. Hay Fever/Seasonal Rhinitis Minor Burns and Scalds GP handout Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 82 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Insect Bites and Stings

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Patient should seek further medical advice if a secondary • Systemic hypersensitivity or toxic reaction Earwax infection is suspected or worsening erythema, pain, or fever, • Angio-oedema or anaphylaxis Excessive Sweating a large local reaction or a systemic reaction develops (Hyperhidrosis) • Sting on the face or tongue and risk of airway obstruction Head Lice • ‘Red flag’ symptoms • Patient has cellulitis associated with systemic effects Indigestion and Heartburn • See earlier for general exceptions. Infrequent Constipation • Symptoms are worsening despite treatment in primary care. Infrequent Migraine Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 83 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Insect Bites and Stings

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Products listed in table are licensed to treat this condition. Please note there may be limited clinical evidence available to support use of some products. Diarrhoea (Adults) We recommend patients speak to a pharmacist for individual advice. Exceptions included are not an exhaustive list, please check product licences. Prices Dry Eyes/Sore (Tired) Eyes correct at time of writing and are subject to change. Earwax Excessive Sweating Example OTC medications (generic) Brand Price OTC restrictions (Hyperhidrosis) Head Lice Chlorphenamine tablets/syrup • Piriton® • Tablets not licensed for under 6 years Indigestion and Heartburn (30 tablets), • Syrup not licensed for under 1 years Infrequent Constipation (150ml) Infrequent Migraine Cetirizine tablets 10mg ( ) / liquid • Zirtek® • Children under 6 years - tablets Insect Bites and Stings • Piriteze® • Children under 2 years – syrup Mild Acne ® Mild Dry Skin • Benadryl • Pregnancy, breastfeeding ® Sunburn • Benadryl liquid • Liver impairment • Rare hereditary problems of galactose intolerance, Sun Protection Loratadine 10mg tablets ( ) or • Clarityn® Hay Fever/Seasonal Rhinitis the Lapp lactase deficiency or glucose- galactose Loratadine 5mg/5ml syrup • Clarityn® liquid Minor Burns and Scalds malabsorption Mild General Aches Mepyramine maleate 2% • Anthisan® Bite & Sting • Broken or infected skin and Pains Cream 2% (20g) • Children under 2 years Mouth Ulcers Nappy Rash Lidocaine hydrochloride/zinc sulphate/ • Savlon® Bites & Stings • Children under 12 years Oral Thrush cetrimide Pain Relief Gel • Animal bites Prevention of Dental Caries • Broken or infected skin Ringworm/Athletes Foot/ Fungal Nail Infection Calamine/zinc oxide • Calamine lotion • Broken or infected skin Teething/Mild Toothache Threadworms Pharmacy only medication Less than £1 £1 - £5 More than £5 Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 84 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild Acne

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of mild acne will not Dry Eyes/Sore (Tired) Eyes be routinely offered to • Avoid over cleaning the skin. Acne is not caused by poor hygiene and twice daily Earwax washing with a gentle soap and fragrance-free cleanser is adequate Excessive Sweating patients as the condition is (Hyperhidrosis) appropriate for self-care. • Minimise the use of make-up and cosmetics and completely remove make-up Head Lice before going to bed Indigestion and Heartburn • If acne presents with dry skin, use water-base emollient Infrequent Constipation Supporting • After exercise take regular showers to wash away sweat and excess sebum Infrequent Migraine from skin and hair Insect Bites and Stings resources Mild Acne • Don’t try to “clean out” blackheads or squeeze spots. This can make them Mild Dry Skin NHS Choices worse and cause permanent scarring Sunburn NICE CKS • Treatments are effective but take time to work (usually up to 8 weeks) and Sun Protection Self-care forum may irritate the skin, especially at the start of treatment Hay Fever/Seasonal Rhinitis • Ensure you maintain a healthy diet. Minor Burns and Scalds GP handout Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 85 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild Acne

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Severe acne associated with visible scarring, risk of scarring or Earwax significant hyperpigmentation Excessive Sweating (Hyperhidrosis) • Significant psychological distress is associated with acne Head Lice regardless of severity Indigestion and Heartburn • Diagnostic uncertainty Infrequent Constipation • Multiple treatments in primary care have failed Infrequent Migraine Insect Bites and Stings • See earlier for general exceptions. Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 86 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild Acne

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 87 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild Dry Skin

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of mild dry skin will not Dry Eyes/Sore (Tired) Eyes be routinely offered to • Moisturise your skin with an emollient 2 to 3 times a day, or as often Earwax as needed Excessive Sweating patients as the condition is (Hyperhidrosis) appropriate for self-care. • Emollients are best applied after washing hands, taking a bath or Head Lice showering because this is when the skin most needs moisture. Apply Indigestion and Heartburn emollients liberally Infrequent Constipation Supporting • Avoid skin care products and soaps that contain alcohol, fragrances, Infrequent Migraine dyes, or other chemicals Insect Bites and Stings resources • Take short, warm baths or showers. Mild Acne Mild Dry Skin NHS Choices Sunburn Self-care forum Sun Protection GP handout Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 88 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild Dry Skin

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • More serious skin conditions, such as allergic reactions, Earwax eczema and psoraisis Excessive Sweating (Hyperhidrosis) • See earlier for general exceptions. Head Lice Indigestion and Heartburn Infrequent Constipation Infrequent Migraine Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 89 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild Dry Skin

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 90 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Sunburn

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of sunburn will not be Dry Eyes/Sore (Tired) Eyes routinely offered to • Get out of the sun as soon as possible and cover sunburnt skin from Earwax direct sunlight until skin has fully healed Excessive Sweating patients as the condition is (Hyperhidrosis) appropriate for self-care. • Cool the skin with a cool, not cold, bath or shower Head Lice • Drink plenty of fluids to prevent dehydration Indigestion and Heartburn • Take painkillers to ease pain and apply a cold compress Infrequent Constipation Supporting Infrequent Migraine • Use emollients or gels such as emulsifying ointment to moisturise and Insect Bites and Stings resources soothe the skin. Mild Acne Mild Dry Skin NHS Choices Sunburn NICE CKS Sun Protection Self-care forum Hay Fever/Seasonal Rhinitis Minor Burns and Scalds GP handout Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 91 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Sunburn

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • No routine exceptions have been identified • Infected sunburn, severe sunburn, signs or symptoms Earwax • ‘Red flag’ symptoms of heat stroke or exhaustion Excessive Sweating (Hyperhidrosis) • See earlier for general exceptions. • Fatigue, dizziness, nausea or vomiting Head Lice • Headache, muscle cramps, irritability Indigestion and Heartburn • Confusion, disorientation, hallucinations Infrequent Constipation Infrequent Migraine • Fever and/or tachycardia Insect Bites and Stings • Blisters. Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 92 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Sunburn

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 93 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Sun Protection

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for sun Self-care measures Diarrhoea (Adults) protection should not be Dry Eyes/Sore (Tired) Eyes routinely offered to • Use sunscreen preparations with minimum sun protection factor (SPF) 15 to protect Earwax against UVB and 4 or 5 star rating to protect against UVA Excessive Sweating patients as the condition is (Hyperhidrosis) appropriate for self-care. • Spend time in the shade when the sun is strongest. In the UK, this is between 11am Head Lice and 3pm from March to October Indigestion and Heartburn • Cover up with suitable clothing, hat and sunglasses Infrequent Constipation Supporting • Take extra care with children Infrequent Migraine Insect Bites and Stings resources • Make sure the sunscreen is not past its expiry date Mild Acne • Ensure sunscreen is applied liberally and regularly throughout the day. Mild Dry Skin NHS Choices Sunburn Self-care forum Sun Protection GP handout Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 94 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Sun Protection

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Sunscreen should only be prescribed for skin protection Earwax against ultraviolet radiation and/or visible light in abnormal Excessive Sweating cutaneous photosensitivity causing severe cutaneous (Hyperhidrosis) reactions in genetic disorders (including xeroderma Head Lice pigmentosum and porphyrias), severe photodermatoses Indigestion and Heartburn (both idiopathic and acquired) and in those with increased Infrequent Constipation risk of ultraviolet radiation causing severe adverse effects due Infrequent Migraine to chronic disease (such as haematological malignancies), Insect Bites and Stings medical therapies and/or procedures. Mild Acne Mild Dry Skin • See earlier for general exceptions. Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 95 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Sun Protection

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 96 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Hay Fever/Seasonal Rhinitis

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of mild to moderate hay Dry Eyes/Sore (Tired) Eyes fever/seasonal rhinitis will • Use allergen avoidance techniques e.g. nasal irrigation, wear wraparound Earwax not be routinely offered to sunglasses to stop pollen getting into the eyes and use petroleum jelly around Excessive Sweating the nostrils to trap pollen (Hyperhidrosis) patients as the condition is Head Lice appropriate for self-care. • Avoid walking in areas with known allergens especially in the early morning or Indigestion and Heartburn late evening when pollen counts are highest Infrequent Constipation • Keep windows closed at night Infrequent Migraine • Shower and change your clothes after you’ve been outside Insect Bites and Stings Supporting Mild Acne resources • Vacuum regularly and dust as much as possible. Pollen filters for air vents in the Mild Dry Skin car and special filters for the vacuum cleaner can help NHS Choices Sunburn • A combination of oral antihistamines, intranasal products and eye drops may Sun Protection NICE CKS be required to control moderate to severe symptoms. Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Self-care forum Mild General Aches GP handout and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 97 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Hay Fever/Seasonal Rhinitis

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Severe symptoms not controlled with OTC products • Unilateral symptoms, blood-stained nasal discharge, Earwax • Rhinitis that is not seasonal recurrent epistaxis, or nasal pain Excessive Sweating (Hyperhidrosis) • Symptoms that are significantly affecting the patient's • There is predominant nasal obstruction and/or a Head Lice quality of life structural abnormality Indigestion and Heartburn • ‘Red flag’ symptoms • There are persistent symptoms despite optimal management Infrequent Constipation in primary care. Infrequent Migraine • See earlier for general exceptions. Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 98 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Hay Fever/Seasonal Rhinitis

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Products listed in table are licensed to treat this condition. Please note there may be limited clinical evidence available to support use of some products. Diarrhoea (Adults) We recommend patients speak to a pharmacist for individual advice. Exceptions included are not an exhaustive list, please check product licences. Prices Dry Eyes/Sore (Tired) Eyes correct at time of writing and are subject to change. Earwax Excessive Sweating Example OTC medications (generic) Brand Price OTC restrictions (Hyperhidrosis) Head Lice Chlorphenamine 4mg tablets or • Piriton® • Tablets not licensed for children under 6 years Indigestion and Heartburn chlorphenamine 2mg/5ml syrup • Syrup not licensed for children under 1 year Infrequent Constipation Infrequent Migraine Loratadine 10mg tablets ( ) or • Clarityn® • Children under 6 years - tablets Insect Bites and Stings Loratadine 5mg/5ml syrup • Clarityn® liquid • Children under 2 years – syrup Mild Acne Mild Dry Skin • Pregnancy, breastfeeding Cetirizine tablets 10mg ( ) / liquid • Zirtek® Sunburn • Liver impairment ® Sun Protection • Piriteze • Rare hereditary problems of galactose intolerance, ® Hay Fever/Seasonal Rhinitis • Benadryl the Lapp lactase deficiency or glucose- galactose Minor Burns and Scalds • Benadryl® liquid malabsorption Mild General Aches and Pains Sodium cromoglicate 2% eye drops • Opticrom® allergy eye • Children under 6 years Mouth Ulcers drops Nappy Rash Oral Thrush Beclometasone nasal spray • Beconase® nasal spray • Under 18 years Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Pharmacy only medication Less than £1 £1 - £5 More than £5 Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 99 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Minor Burns and Scalds

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of minor burns and scalds Dry Eyes/Sore (Tired) Eyes will not be routinely offered • Cool the burn with cool or lukewarm running water for 20 minutes as soon as Earwax to patients as these are possible after the injury. Never use ice, iced water, or any creams or greasy substances Excessive Sweating like butter (Hyperhidrosis) appropriate for self-care. Head Lice • The following measures may provide symptom relief: Indigestion and Heartburn >> Taking a cool bath or shower Infrequent Constipation Supporting >> Applying topical emollients, such as emulsifying ointment after the burn Infrequent Migraine has cooled completely Insect Bites and Stings resources >> Applying cold compresses Mild Acne NHS Choices Mild Dry Skin • Treat the pain from a burn with paracetamol or ibuprofen (see OTC restrictions). Sunburn NICE CKS Children under 16 years of age should not be given aspirin Sun Protection Self-care forum • Drink plenty of fluids to help wound healing and reduce risk of complications Hay Fever/Seasonal Rhinitis Minor Burns and Scalds GP handout • Massage the area daily with an emollient, such as emulsifying ointment, until the burn Mild General Aches is no longer dry or itchy. and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 100 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Minor Burns and Scalds

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • More serious burns always require professional medical • Consider arranging urgent hospital referral if there are signs Earwax attention or symptoms of heat exhaustion or heat stroke, such as: Excessive Sweating (Hyperhidrosis) • Burns requiring hospital A&E treatment include but are not >> Fatigue, dizziness, nausea or vomiting Head Lice limited to: >> Headache, muscle cramps, irritability Indigestion and Heartburn >> All chemical and electrical burns >> Confusion, disorientation, hallucinations Infrequent Constipation >> Large or deep burns >> Fever and/or tachycardia Infrequent Migraine >> Burns that cause white or charred skin Insect Bites and Stings • Arrange for urgent medical review if blisters develop. Mild Acne >> Burns on the face, hands, arms, feet, legs or genitals that Mild Dry Skin cause blisters Sunburn • ‘Red flag’ symptoms Sun Protection Hay Fever/Seasonal Rhinitis • See earlier for general exceptions. Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 101 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Minor Burns and Scalds

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 102 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild General Aches and Pains

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Step 3 - paracetamol (1 gram four Diarrhoea (Adults) of general aches and pains times a day) should be added to low- Dry Eyes/Sore (Tired) Eyes will not be routinely offered • Non-drug options should be dose ibuprofen Earwax considered depending on type of pain Excessive Sweating to patients as these are Step 4 - If nonsteroidal anti- (Hyperhidrosis) appropriate for self-care. • Breathing correctly and concentrating inflammatory drugs (NSAID) (such Head Lice on your breathing can help to ease as ibuprofen) are unsuitable, a full Indigestion and Heartburn The underlying cause of the pain pain and encourage relaxation therapeutic dose of a weak opioid should be treated whenever Infrequent Constipation • For adults, a stepwise strategy for should be used (such as codeine 60 possible and patients signposted Infrequent Migraine managing mild-to-moderate pain is mg every 4–6 hours; maximum 240 to appropriate services. Insect Bites and Stings recommended: mg daily) Mild Acne Step 1 - Paracetamol. An initial • If pain still uncontrolled, refer for Mild Dry Skin low dose should be tried, which if alternative non-OTC treatment Sunburn necessary, can be increased to the • People at increased risk of Sun Protection maximum dose of 1 gram four times a gastrointestinal adverse effects should Hay Fever/Seasonal Rhinitis Supporting day if ineffective, before switching to consider alternatives to an oral NSAID Minor Burns and Scalds (or combining with) another analgesic such as paracetamol Mild General Aches resources and Pains Step 2 - paracetamol should be • Caution is needed with long-term Mouth Ulcers NHS Choices substituted with low-dose ibuprofen use of weak opioids as tolerance and Nappy Rash NICE CKS (400 mg three times a day). If dependence can occur Oral Thrush necessary, the dose of ibuprofen Self-care forum • Effervescent preparations should Prevention of Dental Caries chould be increased to a maximum of be avoided due to high salt content Ringworm/Athletes Foot/ GP handout 2.4 grams daily, except where this is Fungal Nail Infection contraindicated • For children (under 16 years of age), Teething/Mild Toothache either paracetamol or ibuprofen alone Threadworms are suitable first-line choices. Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 103 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild General Aches and Pains

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • People with: • Cauda equina syndrome >>Severe unremitting pain that remains Earwax >> Long-term pain • Bilateral sciatica when the person is supine, aching night Excessive Sweating pain that prevents or disturbs sleep, pain (Hyperhidrosis) >> Severe pain • Severe or progressive bilateral neurological aggravated by straining and thoracic pain Head Lice >> Palliative pain deficit of the legs Indigestion and Heartburn >>Localised spinal tenderness • Urinary retention with overflow urinary Infrequent Constipation • ‘Red flag’ symptoms. >>No symptomatic improvement after four incontinence Infrequent Migraine to six weeks of conservative low back Insect Bites and Stings • Loss of sensation of rectal fullness pain therapy Mild Acne • Faecal incontinence >>Unexplained weight loss Mild Dry Skin • Perianal, perineal or genital sensory loss >>Past history of cancer — breast, lung, Sunburn gastrointestinal, prostate, renal, and • Spinal fracture red flags include: Sun Protection thyroid cancers Hay Fever/Seasonal Rhinitis >> Sudden onset of severe central spinal • Infection red flags include: Minor Burns and Scalds pain which is relieved by lying down. Mild General Aches >>Fever and Pains >> History of major trauma >>Tuberculosis, or recent urinary Mouth Ulcers >> Minor trauma in people with osteoporosis tract infection Nappy Rash or those who use corticosteroids Oral Thrush >> Structural deformity of the spine >>Diabetes Prevention of Dental Caries >>History of intravenous drug use • Cancer red flags include: Ringworm/Athletes Foot/ >>HIV infection, use of Fungal Nail Infection >>The person being 50 years of age or more immunosuppressants, or the person Teething/Mild Toothache >>Gradual onset of symptoms being otherwise immunocompromised. Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 104 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mild General Aches and Pains

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Products listed in table are licensed to treat this condition. Please note there may be limited clinical evidence available to support use of some products. Diarrhoea (Adults) We recommend patients speak to a pharmacist for individual advice. Exceptions included are not an exhaustive list, please check product licences. Prices Dry Eyes/Sore (Tired) Eyes correct at time of writing and are subject to change. Earwax Excessive Sweating Example OTC medications (generic) Brand Price OTC restrictions (Hyperhidrosis) Head Lice Paracetamol 500mg tablets and • Anadin paracetamol® • Long-term conditions requiring regular pain relief Indigestion and Heartburn capsules ( / 16 tablets) • Mandanol® • Children under 12 years Infrequent Constipation Paracetamol 500mg soluble tablets • Panadol® • Severe renal or severe hepatic impairment Infrequent Migraine Insect Bites and Stings Ibuprofen 200mg, 400mg capsules • Anadin® Ibuprofen • Long-term conditions • Stomach ulcer, perforation Mild Acne and tablets ( / 16 tablets) • Nurofen® requiring regular pain relief or bleeding (active or Mild Dry Skin ® • Asthma history of) Sunburn • Calprofen • Renal impairment Sun Protection • Cuprofen® • Unstable high blood pressure • Hepatic impairment Hay Fever/Seasonal Rhinitis • Taking anticoagulants Minor Burns and Scalds Ibuprofen 100mg/5ml liquid/ • Nurofen® for Children • Pregnancy, breastfeeding • Cardiac impairment Mild General Aches suspension sugar free 3 months to 12 years and Pains Mouth Ulcers Paracetamol liquid 120mg/5ml • Calpol® /100ml • Children under 2 months Nappy Rash (infant suspension +2months) Oral Thrush Paracetamol liquid 250mg/5ml /80ml Prevention of Dental Caries (six plus suspension) Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Pharmacy only medication Less than £1 £1 - £5 More than £5 Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 105 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mouth Ulcers

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of mouth ulcers will not be Dry Eyes/Sore (Tired) Eyes routinely offered to patients • Use a soft-bristled toothbrush Earwax • Drink cool drinks through a straw and avoid very hot drinks or acidic Excessive Sweating as the condition is appropriate (Hyperhidrosis) for self-care. If ulcers are drinks like fruit juice Head Lice infrequent, mild, and not • Eat softer foods and avoid: chewing gum, rough crunchy food such as crisps Indigestion and Heartburn interfering with daily activities and toast and very spicy or acidic food Infrequent Constipation (for example eating), treatment • Get regular dental checks. If patient experiences repeated symptoms, they Infrequent Migraine may not be needed. should see their dentist for further advice Insect Bites and Stings Mild Acne • Avoid 'trigger factors' (such as coffee, chocolate, peanuts, and Mild Dry Skin gluten-containing products) Sunburn Supporting • People with local trauma (e.g. from sharp and/or broken teeth, dentures and Sun Protection resources orthodontic appliances, and biting during chewing) should seek appropriate Hay Fever/Seasonal Rhinitis dental treatment Minor Burns and Scalds NHS Choices • Patients should seek dental or medical attention if: Mild General Aches and Pains NICE CKS >>Symptoms last for more than 3 weeks Mouth Ulcers Self-care forum >>Mouth ulcers keep coming back Nappy Rash >>Area becomes more painful and red as this may be a sign of infection. Oral Thrush GP handout Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 106 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mouth Ulcers

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • No routine exceptions have been identified • Oral malignancy Earwax • ‘Red flag’ symptoms • Other underlying or chronic symptoms. Excessive Sweating (Hyperhidrosis) • See earlier for general exceptions. Head Lice Indigestion and Heartburn Infrequent Constipation Infrequent Migraine Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 107 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Mouth Ulcers

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 108 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Nappy Rash

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of nappy rash will not Dry Eyes/Sore (Tired) Eyes be routinely offered to • Ensure the nappy fits properly Earwax • Consider using a nappy with high absorbency Excessive Sweating patients as the condition is (Hyperhidrosis) appropriate for self-care. • Change the nappy every 3–4 hours, or as soon as possible after wetting or soiling. Head Lice Clean the whole nappy area gently but thoroughly, wiping from front to back Indigestion and Heartburn • Use water, or fragrance-free and alcohol-free baby wipes. Dry baby gently after Infrequent Constipation Supporting washing – avoid vigorous rubbing Infrequent Migraine Insect Bites and Stings resources • Leave nappies off for as long as possible to help skin dry Mild Acne • Bath the child daily, but avoid excessive bathing as this may dry out the skin Mild Dry Skin NHS Choices • Use a barrier preparation to protect the skin Sunburn NICE CKS Sun Protection • Do not use soap, bubble bath, lotions or talcum powder as these contain ingredients Self-care forum Hay Fever/Seasonal Rhinitis that could irritate baby’s skin. Minor Burns and Scalds GP handout Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 109 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Nappy Rash

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • No routine exceptions have been identified • Rash appears inflamed and is causing discomfort Earwax • ‘Red flag’ symptoms • Rash persists and candidal infection or bacterial infection Excessive Sweating (Hyperhidrosis) • See earlier for general exceptions. is suspected. Head Lice Indigestion and Heartburn Infrequent Constipation Infrequent Migraine Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 110 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Nappy Rash

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 111 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Oral Thrush

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of oral thrush will not Dry Eyes/Sore (Tired) Eyes be routinely offered to • Smokers should attempt to quit Earwax • Reduce alcohol consumption Excessive Sweating patients as the condition is (Hyperhidrosis) appropriate for self-care. • Visit the dentist regularly Head Lice • Cut down on sugary and starchy food and drinks, particularly between meals or Indigestion and Heartburn within an hour of going to bed Infrequent Constipation Supporting Infrequent Migraine • Brush the teeth properly with a fluoride toothpaste twice a day, using floss and an Insect Bites and Stings resources interdental brush at least once a day Mild Acne • See the dentist if you have a persistently dry mouth, dental caries or toothache. Mild Dry Skin NHS Choices Sunburn NICE CKS Sun Protection Self-care forum Hay Fever/Seasonal Rhinitis Minor Burns and Scalds GP handout Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 112 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Oral Thrush

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Candidal infection fails to respond to 1–2 weeks of • Patient systemically unwell or has a widespread infection Earwax antifungal treatment • Patient is immuno-supressed. Excessive Sweating (Hyperhidrosis) • The person has recurrent episodes of oral candidiasis Head Lice • ‘Red flag’ symptoms Indigestion and Heartburn • See earlier for general exceptions. Infrequent Constipation Infrequent Migraine Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 113 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Oral Thrush

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 114 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Prevention of Dental Caries

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for high fluoride Self-care measures Diarrhoea (Adults) over-the-counter toothpaste Dry Eyes/Sore (Tired) Eyes should not be routinely offered • Smokers should attempt to quit Earwax • Reduce alcohol consumption Excessive Sweating to patients as the condition is (Hyperhidrosis) appropriate for self-care. • Visit the dentist regularly Head Lice • Cut down on sugary and starchy food and drinks, particularly between meals or Indigestion and Heartburn within an hour of going to bed Infrequent Constipation Supporting Infrequent Migraine • Brush the teeth properly with a fluoride toothpaste twice a day, using floss and an Insect Bites and Stings resources interdental brush at least once a day Mild Acne • See the dentist if you have a persistently dry mouth, dental caries or toothache. Mild Dry Skin NHS Choices Sunburn NICE CKS Sun Protection Self-care forum Hay Fever/Seasonal Rhinitis Minor Burns and Scalds GP handout Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 115 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Prevention of Dental Caries

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 116 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Prevention of Dental Caries

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 117 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Ringworm/Athlete’s Foot/Fungal Nail Infection

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures For fungal foot and nail infections: Diarrhoea (Adults) of ringworm or athlete’s foot Dry Eyes/Sore (Tired) Eyes • Wear well-fitting, non-occlusive will not be routinely offered For ringworm: Earwax footwear that keeps the feet cool and • Wear loose-fitting clothes made of Excessive Sweating to patients as the condition is dry. Consider replacing old footwear (Hyperhidrosis) appropriate for self-care. cotton or a material designed to keep which could be contaminated with Head Lice moisture away from the skin fungal spores Treatment with a topical antifungal Indigestion and Heartburn • Avoid scratching affected skin, as this • Maintain good foot hygiene by wearing cream is recommneded if there is Infrequent Constipation may spread infection to other sites a different pair of shoes every 2–3 days Infrequent Migraine mild, non-extensive disease in children • Clean clothes and bed sheets regularly • Wear clean cotton, absorbent socks Insect Bites and Stings and adults. Mild Acne • Do not share clothes/towels or items • Avoid scratching affected skin, as this Mild Dry Skin with others and in the case of athlete’s may spread infection to other sites Sunburn Supporting foot use a separate towel for the feet • After washing the feet, dry thoroughly, Sun Protection • Maintain good hygiene by washing especially between the toes Hay Fever/Seasonal Rhinitis resources affected skin areas daily • Do not share towels, and wash them Minor Burns and Scalds NHS Choices - Ringworm • Do not share towels, and wash frequently, to reduce the risk of Mild General Aches and Pains NHS Choices - Athlete’s Foot them frequently, to reduce the risk transmission Mouth Ulcers of transmission NICE CKS Ringworm • Do not walk around barefoot, wear Nappy Rash • Wash clothes and bed linen frequently slippers in changing rooms and showers Oral Thrush NICE CKS Athlete’s foot to eradicate fungal spores to reduce the risk of transmission Prevention of Dental Caries Self-care forum • If a child is affected, it is not necessary • Avoid prolonged or frequent exposure Ringworm/Athletes Foot/ to exclude them from school or nursery. to warm, damp conditions if possible Fungal Nail Infection GP handout Teething/Mild Toothache • If a child is affected, it is not necessary Threadworms to exclude them from school or nursery. Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 118 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Ringworm/Athlete’s Foot/Fungal Nail Infection

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions ‘Red flag’ symptoms Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Antifungal treatment is not needed for nail infections if the • Lymphoedema or history of lower limb cellulitis Earwax person is not troubled by the appearance of the nail(s), and/or • Severe or extensive disease, bacterial infection, Excessive Sweating infection is asymptomatic (Hyperhidrosis) diabetes - athlete’s foot. Head Lice • See earlier for general exceptions. Indigestion and Heartburn GMMMG specific guidance for Fungal Nail Infection can be Infrequent Constipation found here. Infrequent Migraine Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 119 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Ringworm/Athlete’s Foot/Fungal Nail Infection

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 120 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Teething/Mild Toothache

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for teething in Self-care measures Diarrhoea (Adults) babies or toothache in children Dry Eyes/Sore (Tired) Eyes and adults will not be routinely For teething infants: • Consider paracetamol or ibuprofen Earwax offered to patients as these • Gentle rubbing of the gum with suspension for relieving the discomfort Excessive Sweating of teething symptoms in infants 3 conditions are appropriate for a clean finger (Hyperhidrosis) months of age or older. Paracetamol is Head Lice self-care. Patients of teething • Teething rings give babies something preferred for infants with asthma Indigestion and Heartburn infants should be reassured to chew safely. This may ease Infrequent Constipation that teething is normal, not an their discomfort and distract them • For adults with toothache, oral analgesics such as paracetamol and Infrequent Migraine illness and will pass. from any pain Insect Bites and Stings ibuprofen can help ease toothach • Some teething rings can be cooled first Mild Acne pain (see OTC restrictions). Patients in the fridge, which may help to soothe Mild Dry Skin with toothache should seek advice the baby’s gums. The instructions that Sunburn Supporting from their dentist come with the ring should indicate how Sun Protection resources long to chill it for. Never put a teething • Use a soft tooth brush, avoid flossing Hay Fever/Seasonal Rhinitis ring in the freezer, as it could damage • Avoid food or drinks that are too hot Minor Burns and Scalds NHS Choices the baby’s gums if it gets frozen or cold Mild General Aches and Pains NICE CKS • Teething gels often contain a mild local Mouth Ulcers Self-care forum anaesthetic, which helps to numb any Nappy Rash pain or discomfort caused by teething. MHRA Oral Thrush The gels may also contain antiseptic Prevention of Dental Caries GP handout ingredients, which help to prevent Ringworm/Athletes Foot/ infection in any sore or broken skin in Fungal Nail Infection the baby’s mouth Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 121 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Teething/Mild Toothache

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Babies who are systemically unwell Earwax • See earlier for general exceptions. Excessive Sweating (Hyperhidrosis) Head Lice Indigestion and Heartburn Infrequent Constipation Infrequent Migraine Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 122 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Teething/Mild Toothache

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 123 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Threadworms

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of threadworm should not Dry Eyes/Sore (Tired) Eyes be routinely offered to For adults and children over 2 years, • Bathe or shower each morning, Earwax patients as the condition is treat with a single dose of an anti- washing the perianal area, to remove Excessive Sweating helminthic such as mebendazole eggs from the skin. Do not share towels appropriate for self-care. (Hyperhidrosis) (unless contraindicated) — the dose and flannels Head Lice may need to be repeated in 2 weeks Indigestion and Heartburn • Pregnant women and children under 6 if infection persists: months should use hygiene measures Infrequent Constipation Supporting Infrequent Migraine • Children under the age of 6 months alone for 6 weeks Insect Bites and Stings resources and pregnant or breastfeeding women • Ensure children wear nightwear and Mild Acne should be treated with hygiene change bed clothes and nightwear daily NHS Choices Mild Dry Skin measures alone for 6 weeks for several days after treatment Sunburn NICE CKS • Mebendazole is not licensed for the • Do not shake out items as this may Sun Protection treatment of threadworm in children Self-care forum distribute eggs around the room Hay Fever/Seasonal Rhinitis under the age of 2 years Minor Burns and Scalds GP handout • Washing/drying in a warm cycle will kill • Wash hands thoroughly with soap Mild General Aches threadworm eggs and warm water after using the toilet, and Pains • Thoroughly dust and vacuum (including Mouth Ulcers changing nappies and before handling food. Scrub underneath fingernails vacuuming mattresses) and clean the Nappy Rash bathroom by ‘damp-dusting’ surfaces, Oral Thrush • Cut finger nails regularly, avoid biting washing the cloth frequently in hot Prevention of Dental Caries nails and scratching around anus water. Disinfect bathroom and kitchen Ringworm/Athletes Foot/ surfaces Fungal Nail Infection Teething/Mild Toothache • Infected people do not have to stay off Threadworms school, nursery or work. Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 124 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Threadworms

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • Children under 2 years Earwax • See earlier for general exceptions. Excessive Sweating (Hyperhidrosis) Head Lice Indigestion and Heartburn Infrequent Constipation Infrequent Migraine Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 125 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Threadworms

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 126 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Travel Sickness

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of travel sickness should Dry Eyes/Sore (Tired) Eyes not be routinely offered to • You can buy medication from • Breathe fresh air if possible – for Earwax patients as the condition is pharmacies to prevent or alleviate example, by opening a car window Excessive Sweating motion sickness, including: (Hyperhidrosis) appropriate for self-care. • Close your eyes and breathe slowly Head Lice >>Tablets – dissolvable tablets are while focusing on your breathing Indigestion and Heartburn available for children • Do not read, watch films or use Infrequent Constipation Supporting >>Patches – can be used by adults and electronic devices Infrequent Migraine children over 10 • Do not look at moving objects, such as Insect Bites and Stings resources >>Acupressure bands – these don't work passing cars or rolling waves Mild Acne for everyone Mild Dry Skin NHS Choices • Break up long journeys to get some Sunburn Self-care forum • Your pharmacist will be able to fresh air, drink water or take a walk recommend the best treatment for Sun Protection • You can try ginger, which you can take GP handout you or your child Hay Fever/Seasonal Rhinitis as a tablet, biscuit or tea. Minor Burns and Scalds • Avoid eating heavy meals before Mild General Aches travelling and Pains • Avoid strong smells, particularly petrol Mouth Ulcers and diesel fumes Nappy Rash Oral Thrush • Minimise motion – sit in the front of a Prevention of Dental Caries car or in the middle of a boat Ringworm/Athletes Foot/ • Look straight ahead at a fixed point, Fungal Nail Infection such as the horizon Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 127 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Travel Sickness

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 128 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Travel Sickness

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Products listed in table are licensed to treat this condition. Please note there may be limited clinical evidence available to support use of some products. Diarrhoea (Adults) We recommend patients speak to a pharmacist for individual advice. Exceptions included are not an exhaustive list, please check product licences. Prices Dry Eyes/Sore (Tired) Eyes correct at time of writing and are subject to change. Earwax Excessive Sweating Example OTC medications (generic) Brand Price OTC restrictions (Hyperhidrosis) Head Lice Cinnarizine 15mg tablets • Stugeron® Tablets • Parkinson’s Indigestion and Heartburn 15mg • Porphyria Infrequent Constipation • Children under 5 years Infrequent Migraine Insect Bites and Stings • People with fructose or galactose intolerance, Lapp lactase deficiency, glucose- galactose malabsorption or Mild Acne sucrase- isomaltase insufficiency, should not take this Mild Dry Skin medicine because it contains lactose and sucrose Sunburn • Pregnancy, breastfeeding Sun Protection Hay Fever/Seasonal Rhinitis Hyoscine hydrobromide 150mcg • Joy-Rides® Tablets • Children under 3 years (Joyrides®) under 4 years (Kwells®) Minor Burns and Scalds tablets Chewable 150mcg Mild General Aches • Epilepsy and Pains • Kwells 300mcg • Glaucoma tablets Mouth Ulcers • Pregnancy, breastfeeding • Kwells Junior® Tablets Nappy Rash • Paralytic ileus, pyloric stenosis, prostatic enlargement 150mcg Oral Thrush • Myasthenia gravis Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Pharmacy only medication Less than £1 £1 - £5 More than £5 Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 129 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Warts and Verrucae

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff A prescription for treatment Self-care measures Diarrhoea (Adults) of warts and verrucae will not Dry Eyes/Sore (Tired) Eyes be routinely offered to • Most warts will usually resolve • Treatments may be prolonged and Earwax patients as these are spontaneously within months or, at the may cause adverse effects e.g. local Excessive Sweating most, within 2 years skin irritation Apply petroleum jelly to appropriate for self-care. (Hyperhidrosis) surrounding skin to decrease irritation Head Lice • However, treatment could be Indigestion and Heartburn For most people there is a strong considered if: • Use waterproof plasters/duct tape (can case for not treating warts or Infrequent Constipation >>The wart is painful be purchased from hardware stores) if verrucae. Warts do not usually cause swimming, wear flip-flops in communal Infrequent Migraine >>The wart is cosmetically unsightly Insect Bites and Stings symptoms. wet areas and do not share footwear >>The wart is persisting for a long time Mild Acne and towels Mild Dry Skin • Wash hands after touching the wart/ • Dispose of skin filings hygienically and Sunburn Supporting verruca do not use the emery board elsewhere Sun Protection resources • Avoid biting nails or sucking fingers to avoid spreading the warts. Hay Fever/Seasonal Rhinitis with warts on them Minor Burns and Scalds NHS Choices Mild General Aches • Take care not to cut a wart when and Pains NICE CKS shaving and avoid scratching or picking Mouth Ulcers a wart Self-care forum Nappy Rash Oral Thrush GP handout Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 130 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Warts and Verrucae

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Exceptions Diarrhoea (Adults) Dry Eyes/Sore (Tired) Eyes • The person has a facial wart Earwax • The diagnosis is uncertain Excessive Sweating (Hyperhidrosis) • The person is immunocompromised Head Lice • The person has areas of skin that are extensively affected Indigestion and Heartburn Infrequent Constipation • Genital warts Infrequent Migraine • See earlier for general exceptions. Insect Bites and Stings Mild Acne Mild Dry Skin Sunburn Sun Protection Hay Fever/Seasonal Rhinitis Minor Burns and Scalds Mild General Aches and Pains Mouth Ulcers Nappy Rash Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 131 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

Overview Warts and Verrucae

Self-care conditions Self-care Guidance Exceptions & Red Flags Available Treatments

Mild Irritant Dermatitis Dandruff Products listed in table are licensed to treat this condition. Please note there may be limited clinical evidence available to support use of some products. Diarrhoea (Adults) We recommend patients speak to a pharmacist for individual advice. Exceptions included are not an exhaustive list, please check product licences. Prices Dry Eyes/Sore (Tired) Eyes correct at time of writing and are subject to change. Earwax Excessive Sweating Example OTC medications (generic) Brand Price OTC restrictions (Hyperhidrosis) Head Lice Verucca gel (containing salicyclic acid • Bazuka® Extra strength • Diabetes patients Indigestion and Heartburn and lactic acid) gel • Face, neck, ano-genital area Infrequent Constipation ® • Bazuka Gel • Moles, birthmarks, hairy warts or skin lesions Infrequent Migraine • Broken skin Insect Bites and Stings Wart paint (containing salicyclic acid • Salactol® Mild Acne • Impaired peripheral blood circulation and lactic acid) • Salatac® Mild Dry Skin • Verrugon® ointment Sunburn Sun Protection Wart freeze treatments containing • Scholl® Freeze • Children under 4 years Hay Fever/Seasonal Rhinitis liquid freezing agents (dimethyl ether, • Bazuka® Sub Zero • Diabetes patients Minor Burns and Scalds propane and isobutane) Mild General Aches • Face, armpits, breasts, ano-genital area and Pains • Moles, birthmarks, hairy warts or skin lesions Mouth Ulcers • Broken skin Nappy Rash • Impaired peripheral blood circulation Oral Thrush Prevention of Dental Caries Ringworm/Athletes Foot/ Fungal Nail Infection Teething/Mild Toothache Threadworms Pharmacy only medication Less than £1 £1 - £5 More than £5 Travel Sickness Warts and Verrucae

ENHANCING SELF-CARE MEDICINES USE SELF-CARE CONDITIONS 132 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

National Materials and Shared Learning

Acknowledgements Further Support Materials

ENHANCING SELF-CARE MEDICINES USE FURTHER SUPPORT MATERIALS 133 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

National Materials and Shared Learning

Acknowledgements

National Materials and Shared Learning

Monitoring of self-care prescribing is being done on a national basis and details of self-care prescribing can be monitored local EPACT reporting or via national tools such as NHSBSA national self-care prescribing monitoring dashboard (access to EPACT 2 required) If you are a subscriber to PrescQIPP there is a scorecard available.

ENHANCING SELF-CARE MEDICINES USE FURTHER SUPPORT MATERIALS 134 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

National Materials and Shared Learning National Materials and Shared Learning

Acknowledgements National support materials Self Care Forum supporting documents

Patient leaflets How to Implement a Self Care Aware Approach to Demand Management Information Booklet NHSE Over the counter leaflet 1a Changes leaflet NHSE Over the counter leaflet 1b easy read Posters Condition advice NHSE Over the counter 1c Is your medicine cabinet fit for the winter? Be prepared... To make over your medicine cabinet Pharmaceutical Services Negotiating Committee information Ask your pharmacist how you can be self care aware I don’t feel very well... how long should I wait PSNC Support for Self Care before I need treatment? PresQIPP resources Treat yourself better with pharmacist advice Resources for professionals Home care is best - Most common illnesses don’t need antibiotics NICE support Factsheets Summary of antimicrobial prescribing guidance – managing common infections Shared Learning examples Community pharmacies: promoting health and wellbeing Brighton & Hove CCG Healthy London Partnership - Steps towards implementing self-care: A resource for local commissioners Derby & Burton Facebook Advert

ENHANCING SELF-CARE MEDICINES USE FURTHER SUPPORT MATERIALS 135 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS

National materials and Shared Learning Acknowledgements

Acknowledgements This interactive PDF has been produced for Greater Manchester Medicines Management Group (GMMMG). It has been developed by Midlands and A range of publicly Lancashire Commissioning Support Unit in collaboration with NHSE, Clarity available/NHS Consulting Associates Ltd, Deloittes LPP, MIAA Solutions. information has The collaborative project group included: been utilised from the following Midlands and Lancashire Commissioning Support Unit organisations: Project lead: Paula Wilson Project support: Daya Singh, Diane Hornsby • NHS England Project supervisor: Jonathan Horgan • National Self Care Forum NHSE and Clarity Consulting Associates Ltd • NHS South West London Shoshana Bloom - National QIPP Head of PMO (North) • NHS Birmingham and Solihull CCG Deloitte LLP • NHS Bexley CCG Ashley Parkes, Christine Armistead • NHS Warrington CCG MIAA • NHS Eastern Cheshire Keith Bowman, Dave Kitchen CCG, NHS South Cheshire CCG and This work was supported by Karen O’Brien, Liz Baily, Anna Swift, NHS Vale Royal CCG Keith Pearson and all medicines management leads from Greater Manchester • PrescQIPP (GMMMG) including: • NHS Bolton CCG • NHS Salford CCG • NHS Bury CCG • NHS Stockport CCG • NHS Heywood, Middleton • NHS Tameside & Glossop CCG and Rochdale CCG • NHS Trafford CCG • NHS Oldham CCG • NHS Wigan Borough CCG • NHS Manchester CCG

ENHANCING SELF-CARE MEDICINES USE FURTHER SUPPORT MATERIALS 136 General Enquiries For general enquiries regarding the tool, please contact MLCSU via: [email protected]

This tool is intended for NHS use

Design by the Creative, Campaigns and Digital Team at Midlands and Lancashire Commissioning Support Unit

August 2019