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General health

## Quick facts
- Underlying anxiety and a history of trauma may be one of the reasons for panic attacks
- Cognitive Behavioural Therapy (CBT) can be used to treat panic disorder – it can also provide tools that help you manage a panic attack
- Low blood sugar can trigger a panic attack — eating regular meals emphasising wholegrains and proteins may help

If you’ve ever experienced a panic attack, you already know how distressing they can be. ‘A panic attack is a sudden episode of intense fear that triggers a range of unpleasant sensations,’ says Dag Härdfeldt, Licensed Psychologist at Livi. ‘Typical symptoms may include a dry mouth, shortness of breath, a racing heartbeat, feeling faint, dizzy, chest pains, trembling, shaky limbs, nausea, sweating and tingling in your fingers. There may also be feelings of impending doom, terror and being out of control. You may even fear that you are having a heart attack. A panic attack can occur at any time and typically lasts for 5-20 minutes.’ 

## What’s going on in your body during a panic attack?

‘The physiological reactions that occur during a panic attack come from the body’s “fight or flight” response,’ says Härdfeldt. This is an automatic ‘somatic’ response — meaning it occurs in the body — but is activated by the sympathetic nervous system, whenever you feel you’re in danger. 

This stress response begins in the brain where the amygdala, the area to do with emotional processing, sends a signal to the hypothalamus, the area that communicates with the rest of the body. The hypothalamus activates the sympathetic nervous system, which signals to the adrenal glands to produce more adrenaline. As a result, your heart beats faster, breathing is quicker and more blood and oxygen go to your muscles, preparing your body to fight or run away. This can make you feel shaky, sweaty, dizzy or sick. 

‘The fight or flight response is an important survival mechanism that we all have,’ Härdfeldt points out. ‘It becomes a problem if this response is repeatedly triggered when there is no actual danger, as it does during a panic attack, because your brain can’t distinguish between a real or perceived threat.’

Panic disorder is when you regularly have feelings of anxiety and fear that lead to panic attacks, often for no apparent reason. ‘Sometimes, people who have had a panic attack become so worried about it happening again that they misinterpret certain bodily signs,’ says Härdfeldt. 

‘For example, if they get up quickly and feel dizzy, they worry that they’re about to have a panic attack. This fear triggers a fight or flight response that causes a panic attack. This makes them even more scared. It’s a vicious circle.’ 

## Reasons for panic attacks

‘The causes of panic disorder are not yet fully understood — but research has shown a link between the disorder and factors such as genetic composition, major life transitions, overwhelming stress, and a history of trauma.’

### 1. Psychological triggers
‘One of the most common reasons for panic attacks is if you’ve experienced an event that triggered an intense fight or flight reaction,’ says Härdfeldt. ‘For example, if you had an accident as a child, that experience is stored in your emotional memory. Then, when you undergo extreme stress in later life, you might be susceptible to a panic attack.’

People who have been through trauma have an increased risk of panic attacks. ‘The brain has a tendency to favour emotionally-charged memories. If you experience something during strong emotional distress, that memory can come to play a big role in the anticipation of future events. So, if you’ve experienced immense emotional danger and fear before, your brain will be more inclined to interpret stressful events as dangerous in the future. Another way of putting it is that your fight or flight system has become hypersensitive.’

### 2. Caffeine
Caffeine in coffee, energy drinks and certain medications may be a reason for panic attacks in people susceptible to anxiety. ‘Caffeine increases heart rate and can make you nervous and jittery,’ says Härdfeldt. ‘In people who are sensitive to caffeine’s effects, these physiological reactions can exacerbate anxiety and trigger a panic attack.’ Conversely, caffeine may be used in controlled doses as a treatment — see below.

### 3. Medications
‘Antihistamines and benzodiazepines almost always have great anxiety-reducing effects in the moment, but can make the anxiety worse in the long run, because you’re conditioning your brain to believe that panic attacks are something so dangerous, they need to be medicated away,’ says Härdfeldt.

‘In contrast, caffeine almost makes the anxiety worse immediately, but in some treatments you actually increase the caffeine amount in order to “expose” the patient to its effect,’ he explains.

A recent study showed that some antidepressants can increase anxiety in the first few weeks of use. If you’re concerned about any medications you’re taking, always talk to your doctor.

### 4. Carbohydrates and sugar
Eating too many refined carbohydrates and sugary foods and drinks can worsen symptoms of panic attacks. A recent study reported that dietary carbohydrates may be significantly related to emotional and cognitive symptoms such as anxiety and difficulty in concentrating.

### 5. Low blood sugar
Low blood sugar (hypoglycaemia) is when your blood sugar drops too low, causing symptoms such as dizziness and, in some cases, shaking and sweating — similar to the symptoms of a panic attack. Eating a healthy diet of whole, unprocessed food with the emphasis on wholegrains and good quality proteins can help keep your blood sugar stable between meals. Eating regular meals can also help to keep blood sugar levels balanced. Sugary foods and drinks can also increase anxiety levels, so try to avoid them. 

### 6. Alcohol
Alcohol lowers chemicals in the brain such as serotonin, which help to regulate and balance mood. Drinking too much alcohol can contribute to feelings of depression and anxiety, and can be a cause of panic attacks.

## Can anything help to prevent panic attacks?

The best approach to panic attacks is to try to prevent them from happening. The time to act is when you start to feel anxious. By dealing with the anxiety and fear that triggers the fight or flight response, you’ll lessen the likelihood of a panic attack occurring. 

### Relaxation practices
‘Relaxation techniques can help to reduce stress and anxiety and manage the symptoms of panic attacks,’ says Härdfeldt. ‘Deep breathing exercises, visualisation, progressive muscle relaxation, meditation and yoga help to lower the heart rate, slow breathing, reduce muscle tension and calm the mind.’ 

To be of benefit, you need to practice these skills regularly, even when you’re not feeling anxious. Aim to practise a relaxation technique for at least 5 to 10 minutes every day. This will make it easier to put the method into practice whenever you feel panicked and anxious.

### Regular physical exercise 
This will help reduce stress and tension. Walking, running, yoga, tennis, cycling and dancing can all help you to relax and help the body to process excess stress hormones, such as adrenalin and cortisol, in a healthy way. Additionally, ‘What happens in our bodies during intense physical training isn’t that different from what happens during a panic anxiety attack. Regular physical exercise can therefore help your brain to get used to the somatic symptoms,’ says Härdfeldt.

### Breathing techniques 
Learn a couple of breathing techniques to help ease symptoms when they occur (see below). ‘One of the most effective ways to manage anxiety and panic attacks is through breathing,’ says Härdfeldt. ‘Slowing down your breathing can help reduce symptoms.’

## Coping with panic attacks when they happen — a toolkit

These techniques will help you cope when a panic attack strikes. Choose the ones that resonate with you.

### Get into the moment — and wait 20 minutes
Don’t fight a panic attack. Breathe slowly and deeply, reminding yourself that the attack will pass. 

‘The fight or flight response cannot last forever,’ Härdfeldt points out. ‘It will eventually run out of gas. It usually peaks within 10 minutes then starts to wind down. 

‘So, the best thing you can do is to remind yourself that, no matter how difficult it becomes, it will be over in about 20-30 minutes. And, the peak usually only lasts a couple of seconds. Focus on keeping your body relaxed and your breathing steady. It’s important not to act like you’re in danger. Sit still, don’t run around. Don’t walk between rooms. Try to ride the panic like a wave. This is where mindfulness techniques can be helpful.’

### Deep-breathing exercises
Research shows that deep breathing (diaphragmatic breathing) can help to reduce anxiety and promote relaxation. The following can be done anywhere for a quick way to feel calmer:
- Stand up, or sit on a chair or the floor, or lie down on a bed or a mat
- If sitting or standing, place feet flat on the ground, hip-width apart
- Inhale through your nose, deep into your tummy 
- Gently exhale through your mouth
- Count 1 to 5 as you breathe in, and 1 to 5 as you breathe out
- Continue for 3 to 5 minutes

### How can your GP help?
‘If you experience panic attacks, consult a healthcare professional as soon as possible,’ says Härdfeldt. ‘Your doctor can refer you to a specialist. It’s usually possible to treat panic attacks in about 2 to 3 months.’ A GP may also carry out tests to rule out any underlying medical conditions that could be causing panic attacks. 

Talking and psychological therapies, such as CBT, are the main treatment for panic disorder. These can help you change your behaviour so that you find it easier to remain calm during an attack. In some cases, it might be helpful to prescribe medication.

__This article has been reviewed by Dag Härdfeldt, Licensed Psychologist at Livi__


Livi.co.uk > Your health > 6 causes of panic attacks — and expert tools for how to cope

6 causes of panic attacks — and expert tools for how to cope

If you suffer from panic attacks, read our expert advice to help you figure out why, and see what you can do to get them under control

Kry.co.uk > Your health > 6 causes of panic attacks — and expert tools for how to cope

Reasons for Panic Attacks - 6 Causes, Expert Tools & How to Cope

General health and seasonal

As the chill of winter creeps in, the temptation to stay inside is real. But if you’re happy to brave the outdoors, studies show that continuing to keep fit outside could be beneficial for both body and mind.

### 1. General health

There are several studies linking exercising in green spaces to lower risks of heart disease, obesity, asthma and diabetes. Exercising outdoors has also been shown to boost your mental health and overall happiness.

A study in June 2019 found that those who spent [at least 2 hours a week in nature](https://www.livi.co.uk/your-health/5-health-benefits-of-being-in-nature/) were 20% more likely to report overall satisfaction with their lives than those who spent no time outdoors at all.

The benefits to physical health were even greater, with 60% of those who spent more than 2 weekly hours outdoors reporting being in good health compared with those staying indoors. What’s more, it didn’t matter whether this outdoor experience was taken in one long session or broken up into smaller sessions.

### 2. Pain

Inflammation can be reduced with local exposure to cold – just think of the effect of putting ice packs onto sprains.

But there is some evidence to show that cold temperatures might suppress pain too. Finnish researchers discovered that women who plunged into cold water (just above freezing) for 20 seconds a day for 3 months had higher levels of norepinephrine levels in their blood. This is a chemical in the nervous system that – among other things – may help suppress pain.

### 3. Immunity

Exercise helps support immunity. As we head into winter during the Covid-19 pandemic – with many unable to visit gyms or sports clubs – experts are encouraging people to keep fit.

The World Health Organization (WHO) suggests adults do at least 150 minutes of moderate-intensity physical activity throughout the week or at least 75 minutes of vigorous physical activity.

### 4. Mood

Winter workouts also increase exposure to natural light, which itself may help to ward off seasonal affective disorder (SAD) – a type of depression that some people experience during the winter months.

Sunlight exposure stimulates the hypothalamus, a part of the brain that helps control your circadian rhythm which is the body’s 24-hour internal ‘clock’. Lack of light can disrupt this clock, causing your brain to produce too much of the sleep hormone melatonin and to release less of the ‘feel-good’ hormones such as serotonin. The result is that you feel low and may also experience sleeping difficulties.

A lunchtime walk in winter on sunny days could help begin to counteract this effect. But there is no evidence about the optimum amount of sunlight you need to be exposed to for your mood to be enhanced. Length of time will vary due to factors such as variation in skin colour and how close you are to the equator.

### 5. Metabolism

Cold temperatures may make your body burn more calories through a process called thermogenesis, in which your body generates its own heat to keep you warm. One study found that people who hiked in cold temperatures of -9ºC to -5ºC burned 34% more calories than people who hiked in temperatures of 12ºC. Of course, many factors influence how many calories you burn and being active is important all year around.

## 3 precautions to keep you well while exercising outdoors

### 1. Layer up

Cold air temperatures can cause vasoconstriction – narrowing of the blood vessels – which can lead to circulation problems and an increase in blood pressure. It’s a good idea to wear layers of clothing, starting with a thin layer of synthetic material such as polypropylene, which draws sweat away from the body. Avoid cotton, which absorbs sweat and can make you colder. Then add a layer of fleece or wool for insulation and top with a waterproof, breathable layer.

### 2. Use sunscreen

Apply sunscreen of at least SPF 30 and be careful not to underestimate the amount of UV radiation passing through clouds. Many surfaces reflect UV radiation and add to the overall UV levels you experience. Fresh snow, for example, is a particularly good reflector and almost doubles a person’s UV exposure. Even on cloudy days UV radiation can reach the Earth and cause sun damage, so it’s still important to apply SPF on an overcast day.

### 3. Stay hydrated

Several studies show that you are more likely to get dehydrated in winter. One piece of research found that exposure to cold reduced the signals between the brain and the kidneys to conserve fluid. The thirst sensation was also reduced. Make sure you drink water regularly when you’re exercising outside, even when you’re not feeling thirsty.

__Reviewed by Dr Rhianna McClymont, Lead GP at Livi__


Livi.co.uk > Your health > 5 reasons to keep exercising outside

KRY10003 KRY ColdWeather Header MC0924-02

Exercising outside was the norm for many of us during the summer. But as it gets cooler, there are benefits to continuing with outdoor workouts.

Kry.co.uk > Your health >5 reasons to keep exercising outside

5 reasons to keep exercising outside

A certain amount of stress can be energising. An urgent deadline can sharpen your concentration and push you to keep on going. But too much stress over long periods has the opposite effect, leading to a condition known as burnout.

‘Stress causes the body to release stress hormones, including cortisol and adrenaline,’ says licensed psychologist Linda Karlsson. ‘In the short term, this can temporarily boost performance and make you more alert. But if you’re under continuous and prolonged stress, without sufficient rest and recovery, this can increase your risk of developing burnout, which is when you feel mentally, physically and emotionally depleted.’

It’s important to spot the mental and physical symptoms of burnout as early as possible, to avoid them having greater implications for your health.

## What is burnout?

The term burnout was first defined in the 1970s by US Psychologist Herbert Freudenberger who described the key symptoms as loss of motivation, emotional depletion and cynicism caused by work-related stress.

According to the World Health Organization (WHO), 1 in 4 adults will be affected by burnout at some point. The WHO recently included burnout in its International Classification of Diseases (ICD-11), describing it as ‘chronic workplace stress that has not been successfully managed’. Its 3 main areas of symptoms include lack of energy and exhaustion, feeling detached, negative or cynical about one’s job, and reduced work performance.

A recent UK survey showed that two-thirds of employees experienced burnout: 23% reported they felt it often or always and 44% sometimes. The top reasons were unfair treatment at work, an unmanageable workload, lack of clarity, lack of communication, lack of support in the workplace and unreasonable time pressure.

## What are the early signs of burnout?

‘It can take weeks, months and, in some cases, even years to recover from burnout,’ says Karlsson. ‘So, ideally, you want to spot potential symptoms early before they become chronic.  That way, you can take steps to pull yourself back from the brink before the situation becomes too problematic.’

Here are the common early signs & symptoms of burnout to look out for.

### 1. Exhaustion
This is the kind of [persistent tiredness](https://www.livi.co.uk/your-health/whats-causing-your-tiredness/) that is not relieved by rest, so you feel mentally and emotionally drained and physically run-down most of the time. You’re low in energy and frequently feel overwhelmed. Research shows that when there is work overload, there is little opportunity to rest, recover and restore balance.

### 2. Loss of enthusiasm for work
The stress and frustration make you increasingly negative, cynical and resentful about work. You no longer feel enthusiastic about anything and start to distance yourself emotionally. You wake up every day with a feeling of dread about work. Studies have shown that lack of control, insufficient recognition and reward (financial, institutional or social) makes people more vulnerable to burnout symptoms because they feel devalued.

### 3. Reduced work performance
You have difficulty concentrating and you’re less efficient. You’re finding it hard to do work assignments, or are late with them when you never used to be. You’re forgetful. These are some of the common signs of burnout. The more stressed you are, the harder it is to deal with new stressors. Stress also affects the medial prefrontal cortex, the part of the brain associated with executive function – one of the physical symptoms of burnout it’s important to avoid.

### 4. Worry and anxiety
You feel anxious and worried, especially if it’s linked to your performance at work. You might feel better when you get home and do things you enjoy but the [anxiety](https://www.livi.co.uk/medical-advice/mental-health/anxiety/) returns as soon as you’re back at work. Research shows that burnout is related to the development of mood disturbance,
[depressive symptoms](https://www.livi.co.uk/medical-advice/mental-health/depression/) and anxiety.

### 5. Sleep problems
[Stress is affecting your sleep](https://www.livi.co.uk/your-health/3-ways-stress-can-disturb-your-sleep/). You may have developed insomnia and are finding it hard to fall asleep, keep waking in the night, or wake too early and then can’t get back to sleep.

### 6. Physical burnout symptoms
Chronic stress can lead to physical symptoms such as [headaches (caused by tension) and migraines](https://www.livi.co.uk/your-health/9-types-of-headache-and-what-you-can-do/), back pain, [skin problems](https://www.livi.co.uk/your-health/ultimate-guide-to-the-6-most-common-skin-conditions/) and general aches and pains. A review of the scientific literature on burnout has shown that it is a contributory factor for physical symptoms including headache, back ache, respiratory and gastro-intestinal issues.

### 7. Irritability and mood swings
You may feel moodier than usual. This is because the amygdala — the part of the brain associated with fear and aggression — is larger in people suffering from burnout. There are also strong connections between the amygdala and areas of the brain linked to emotional distress.

## 6 ways to help control early stage burnout

Here are Karlsson’s pointers for things that could help slow or stop your early signs of burnout.

### 1. Set boundaries
- Start and finish work at a reasonable time. Stick to regular hours, when you can
- Take regular breaks throughout the day
- Set aside a time each day when you completely disconnect from your mobile, computer, email and social media groups
- Always take your holidays and make sure you switch off from work in the evenings and during the weekend
- Don’t overextend yourself – you’re more likely to suffer from burnout symptoms if you find it hard to say no. Delegate if you can.

### 2. Maintain a healthy work/life balance
‘When you’re stressed it’s easy to forget that spending time with friends and family and doing things you enjoy is just as important as work,’ says Karlsson. ‘You can’t just work all the time and give up other activities. We’re not created to handle stress over a prolonged period of time.
Maintaining a balance between your work and personal life allows you to switch off and recharge, so that when you do get back to work you feel more energised. Even if you’re worried about losing your job, you need to remember that if you don’t have your health, you can’t work.’

### 3. Prioritise exercise
’Exercise is one of the best things you can do to protect yourself from burnout symptoms,’ says Karlsson. ‘Doing at least 30 minutes of cardiovascular exercise every day such as walking, cycling, swimming or dancing helps your body to discharge excess stress chemicals. You’ll also produce more endorphins (feel-good chemicals in the brain) to make you feel better.’

### 4. Stop trying to be perfect
‘If you’re a perfectionist you’re more likely to suffer from burnout,’ says Karlsson. ‘It’s likely that you put high demands on yourself. But, you need to ask yourself — does everything always have to be perfect? What’s the worst thing that can happen if you don’t make that call, send that email right now? It might not be as catastrophic as you think. Talking to a psychologist can be useful.’

### 5. Eat well
‘What you eat can have a huge impact on your mood and energy levels,’ says Karlsson. ‘Eating the right foods will help your body to cope better when you’re under pressure.’
- Avoid all processed foods, white carbohydrates and caffeine
- Eat fresh, healthy foods, including vegetables, fruit, wholegrains, lean proteins such as meat, chicken and oily fish, or eggs and dairy for vegetarians, tofu, beans and pulses for vegans, as well as healthy fats, nuts and seeds
- Eat foods that are high in Vitamin C. These include leafy greens, citrus fruit, kiwis and berries. Vitamin C helps to reduce cortisol levels
- Get enough magnesium. Magnesium is essential for energy production and can have a calming effect. It is found in dark green leafy vegetables, nuts, seeds, legumes and wholegrains. If suitable, you might also want to take a supplement. One study showed that daily supplementation with magnesium can lead to a significant decrease in symptoms of depression and anxiety
- Drink more water and herbal teas

### 6. Don’t be ashamed of getting help
‘If you’re worried that you may be at risk of burnout, always talk to a GP’ says Karlsson. ‘They will check that there aren’t any underlying physical causes for your burnout symptoms. If there’s nothing medically wrong, ask for a referral to a psychologist.

‘While there’s a lot you can do yourself, it’s not always easy to break certain deep-rooted patterns of behaviour and thinking. This is where a psychologist can help you to get to know yourself better.

‘This can mean that in the future you’ll know what signs to look out for and have the tools to stop yourself going in the wrong direction.’

__This article has been reviewed by Linda Karlsson, licensed psychologist__


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Livi.co.uk > Your health > 7 early signs of burnout

Burnout

Most of us have days when we feel depleted, stressed and lacking in energy, but if you feel like that most of the time, you may be at risk of burnout.

Kry.co.uk > Your health > 7 early signs of burnout

Signs of burnout – 7 burnout symptoms to look out for

7 early signs of burnout and how to avoid it

Skin complaints are among the most common reasons people see their doctor. And whether it’s itching, flaking or [spots](/your-health/acne-types-and-their-treatments-help-to-clear-your-skin/), the good news is there are many treatments available, from things you can do yourself, to over-the-counter measures, and medical help. These are the 6 most common skin conditions our doctors see in patients...

### 1. Eczema

There are different types of this non-contagious, inflammatory, dry skin condition, but the most common is atopic eczema (atopic dermatitis).

__What it looks like:__ The skin will be itchy, dry, cracked and sore.
Inflamed skin can become red on lighter skin, and darker brown, purple or grey on darker skin. Atopic eczema can affect any part of the body, but it most commonly affects hands, insides of the elbows, backs of the knees, face and scalp.

__Causes:__ It’s not known exactly what causes eczema. It often occurs in people who are susceptible to allergies. People with eczema tend to have an over-reactive immune system that responds to certain triggers by producing inflammation that causes red, itchy, painful skin. There may also be a genetic component and it often develops alongside other conditions such as asthma and hay fever.

__Self-help:__ Keep a diary to help you become aware of potential triggers such as metals, soaps, fragrances, antibacterial lotions, shampoo or body wash. Include what you eat and how you feel, as food allergies and intolerances, as well as stress, can also trigger outbreaks. Moisturise skin regularly (five to six times a day can be required) with an emollient cream.

If your eczema is particularly inflamed, or not improving with regular emollient use, then you can also try a small amount of an over-the- counter cortisone cream such as hydrocortisone. Only use this for a maximum of two weeks and if there is no improvement see your GP. These creams should not be used in children under 2 years. Adding oatmeal or baking soda to the bath can help to soothe itchy skin.

__When to see a doctor:__ If the eczema is spreading, has become infected and/or isn’t responding to over-the-counter treatment, speak to a doctor. Treatment includes prescription creams as well as medical light treatments, in some cases.

### 2. Rosacea

A common skin condition that mainly affects the face, rosacea is more common in women and people with fair skin, though symptoms can be worse in men.

__What it looks like:__ Rosacea causes redness (like a blush) across the nose, cheeks, forehead and chin. There may also be tiny, broken blood vessels and small pinkish-red bumps filled with pus. Other symptoms may include swelling around the eyes, sore eyelids and thickened skin on the nose. Many cases are mild and not everyone develops all the symptoms.

__Causes:__ Genetics, the immune system and environmental factors may all play a part, but the exact cause isn’t known. Certain triggers can worsen symptoms, especially alcohol and spicy foods but also cheese, caffeine, hot drinks, vigorous exercise, stress and sunlight.

__Self-help:__ Avoid the triggers that make your symptoms worse and always wear a high SPF sunscreen (30+).

__When to see a doctor:__ There’s no cure for rosacea but your doctor can advise you on the best treatments. These include prescription gels and creams, antibiotics, or light treatments. Sometimes rosacea can affect the eyes (ocular rosacea) so always see your doctor if you develop a red, painful, gritty eye or blurred vision. These may be symptoms of keratitis (inflammation of the cornea) which needs to be treated urgently.

### 3. Fungal infection

There are many types of fungal infections affecting skin, hair and nails and nearly a billion people are affected worldwide.

__What it looks like:__ An itchy, scaly rash, sometimes with skin discolouration. Common forms include:

- __Athlete’s Foot (tinea pedis):__ Symptoms include itchy, white patches between the toes. There may also be red, sore, flaky patches on the feet. Skin may crack and bleed. Athlete’s Foot can spread, causing fungal nail infection.
- __Ringworm__ can appear anywhere on the body, including the scalp and groin. The main symptom is a red or silver rash that is dry, scaly, swollen and itchy. The rash is usually circular.
- __Intertrigo__ is a fungal infection that appears under the breasts, in the groin or skin folds. Typical symptoms are inflammation, soreness, discomfort, itching, discolouration and a strong, musty smell.

__Causes:__ Common fungal infections are caused by yeasts such as candida or the fungus dermatophytes. Certain conditions cause them to proliferate. Obese people and diabetics are more susceptible.

__Self-help:__ If you suffer from Athlete’s Foot, a cream, spray or powder from the pharmacy can help. Always wash and dry your feet, wear clean tights or socks every day and alternate shoes regularly. For intertrigo, keep the area as dry and clean as possible. Most fungal infections can be helped with an antifungal ointment, gel or cream from the pharmacy. If you’re concerned about ringworm, make sure you get any pets examined by a vet, as they might carry the fungus.

__When to see a doctor:__ If the rash covers large parts of the body or you’ve been using over-the-counter medication for two weeks and it hasn’t helped, see a doctor as you may need prescription cream.

### 4. Psoriasis

Common and non-infectious, psoriasis is an autoimmune disease that affects at least 100,000 million people worldwide.

__What it looks like:__ The most common type is plaque psoriasis which causes red, flaky, crusty patches of skin covered in silvery scales, most
commonly affecting the elbows, knees, scalp and lower back. Psoriasis causes shedding skin which can be distressing and may also affect the nails. In some sufferers, it can also lead to psoriatic arthritis, an inflammatory disease in which joints may swell and become red and hot.

__Causes:__ Psoriasis is an autoimmune disease, which causes the body to attack its own tissue, leading to an increased production of skin cells. This creates a build-up of patches of dry, scaly skin. It’s not known exactly what causes the immune system to behave in this way, although certain genes and environmental triggers, such as stress, may play a role.

__Self-help:__ If you think you have psoriasis, make sure you keep the area well-lubricated with an over-the-counter emollient. It’s important to see a doctor as quickly as possible (see below).

__When to see a doctor:__ There are many treatments a GP or dermatologist can prescribe, including topical creams and ointments as well as oral and injected medications and phototherapy, where skin is exposed to ultraviolet light. Normally psoriasis can be diagnosed on a clinical examination, but if there’s doubt, sometimes a skin sample (biopsy) is needed to confirm the diagnosis.

### 5. Shingles

Shingles is an infection that causes a painful rash. Get medical advice
as soon as you can if you suspect you have it.

__What it looks like:__ The first sign of shingles is a painful, tingling sensation. You may also have a headache and feel unwell. This is followed a few days later by a red, itchy, blotchy rash on only one side of the body, usually on the chest and stomach, but it can also affect the face, eyes and genitals. The rash then turns to itchy blisters that ooze fluid.

__Causes:__ Most people have chickenpox in childhood but after the illness has gone, the varicella-zoster virus remains inactive in the nervous system. Later in life, this virus can be reactivated and cause shingles.

__Self-help:__ Take paracetamol and keep the rash clean. Do not apply sticky dressings, plaster, or antibiotic creams. Wear loose clothing and keep the area clean. Use a cool compress a few times a day. It can take up to 4 weeks for shingles to heal.

__When to see a doctor:__ Get medical advice as soon as you think you have shingles. Ideally, speak to a doctor within 3 days of your symptoms starting as you may need medicine to speed up your recovery.

### 6. Acne

Acne is a common skin condition that affects the tiny pores of the skin, particularly on the face, back and chest.

__What it looks like:__ Acne can vary from mild to severe. There are six different types of acne. Non inflammatory acne includes blackheads (small, dark dots) and whiteheads (small, white bumps). Inflammatory acne includes papules (small red bumps that may be tender), pustules (similar to papules, but with a small white tip filled with pus), nodules (large, hard bumps below the surface of the skin) and cysts (large pus-filled lumps).

__Causes:__ Acne is caused when the tiny pores in the skin, known as hair follicles, become blocked with excess sebum (a mixture of oils and waxes) produced by the sebaceous (oil) glands. This creates the ideal environment for the propionibacterium (a bacteria present on human skin) to thrive. Sebaceous glands most commonly produce too much sebum during times of hormonal changes such as puberty. Some women may develop ‘adult acne’ during perimenopause and menopause, when a drop in oestrogen and progesterone hormones creates a temporary imbalance in circulating androgens (male hormones, including testosterone). Androgens are a potent stimulator of the sebaceous glands in the skin, and this can lead to an excess of sebum that causes acne.

__Self-help:__ If you’ve got mild acne, over the counter topical treatments that contain benzoyl peroxide (an antiseptic that helps to reduce bacteria) may help. Do not wash affected areas of skin more than twice a day, as this can irritate the skin and make acne worse. Lifestyle changes may also help, for example, avoiding sugar and processed foods, as these may increase inflammation and exacerbate acne.

__When to see a doctor:__ If your acne is not clearing up, talk to your  doctor. Prescription medicines that can be used to treat acne include topical retinoids, topical and oral antibiotics, azelaic acid and the combined oral contraceptive pill (in women). For severe acne, your doctor can refer you to a dermatologist for further treatment.

Find out more about the [treatments and causes of acne.](/your-health/acne-types-and-their-treatments-help-to-clear-your-skin/)

__Reviewed by: Rhianna McClymont, Lead GP, Kry__


Kry.co.uk > Your health > Ultimate guide to the 6 most common skin conditions

Ultimate guide to the 6 most common skin conditions

There’s no need to suffer in silence with a skin condition. Our doctor’s guide explains what to look for and the help available.

Livi.co.uk > Your health > Ultimate guide to the 6 most common skin conditions

## Quick facts

- Smokers are 14 times more likely to develop severe disease
- On average, it takes around 30 quit attempts before smokers succeed in giving up
- Psychological, over-the-counter and medical help is available 


It’s never a good time to be a smoker and right now is no different.

As well as the clear links to increased risk of heart disease, stroke, lung disease and many other cancers, studies have shown that smokers with Covid-19 are far more likely to go on to develop serious and sometimes fatal complications.
 
Cigarette toxins cause lung damage, reducing lung capacity and the ability to use oxygen. That means that once someone who smokes gets Covid-19, they can potentially become very ill quickly – sometimes worse than non-smokers – and may develop severe pneumonia. Part of this is because tiny hairs (cilia) that help clear infection from the lungs don’t work so well in smokers. In China, smokers were found to be 14 times more likely to develop severe disease. 

The World Health Organisation have also said that the physical act of smoking and possibly sharing smoking paraphernalia means smokers also have a greater chance of getting infected.


__Don’t give up on giving up__

It is estimated that half a million British people have tried to quit since the onset of the coronavirus pandemic.  
If the current situation has made you consider giving up smoking, you may have tried already without success. But that’s no reason to despair – research has found it takes an average of 30 attempts to give up before people finally succeed in kicking the habit.

When you stop smoking you will notice the following effects. 
After:

- 20 minutes - blood pressure and heart rate drop
- 12 hours - carbon monoxide (toxin) drops in your blood to normal
- 2 weeks - circulation and lung function improve
- 4 weeks - coughing and shortness of breath improve
- 1 year - your risk of coronary heart disease is half that of a smoker
- 5 years - your stroke rate is the same as a non-smoker
- 10 years - your risk of all cancers is much lower
- 15 years - your risk of coronary heart disease is the same as someone who never smoked


__First, some steps to getting yourself ready:__


__1.__ __Set the scene__

Once you have made the decision to quit, tell everyone – make a quit plan and then set a quit date.
 
Now, remove smoking items from your home, your car and – if you’re travelling to work – your workplace.
 
At least for a while, minimise smoking ‘cues’ such as alcohol – these are things you associate habitually with smoking.
 
Ask others to respect your decision by not smoking around you.


__2.__ __Know the side effects to expect__

Know what side effects can occur as your body withdraws from its addiction to nicotine. Then be prepared to deal with them. Most commonly, this will include headaches so make sure you sleep, hydrate, exercise and eat well.
 
You may also experience more coughing. This is because those cilia in your lungs come to life again making you temporarily cough more. Drink plenty of water. You might also find having hot drinks, such as tea with honey, can help.


__3.__ __Be ready__

‘Acknowledge that quitting smoking is a process. Motivation changes over time and setbacks are not uncommon,’ says Jesper Enander, chief psychologist, Kry.
 
‘For success, make a list of pros and cons and work out why you want to quit. Give yourself slack if things go wrong and get back to the plan as soon as you can,’ he advises.
 
‘Identify situations where you might be tempted, such as parties or stress. Then, plan in advance how you will deal with the urge to smoke. For example, buy chewing gum so when cravings hit, you can chew instead of smoking’.


__4.__ __Know your options__

Thankfully, there are now more options than ever to help you give up smoking. If something doesn’t work for you, try something else. Here’s a summary:


__5.__ __Talking and communication__

You can find local stop smoking support services and groups through the [NHS Smokefree site](https://www.nhs.uk/smokefree/help-and-advice/local-support-services-helplines#bt4Q3X2d7CKUh5Ml.97). 

Allen Carr’s famous book, The Easy Way to Stop Smoking claims to change the thought processes around the need to smoke. Although there have not been enough formal studies done on this method, there are abundant anecdotal success stories from patients.


__6.__ __Nicotine Replacement Therapy (NRT)__

Nicotine replacement therapy (NRT) bought over-the-counter from the chemist, or prescribed by your regular NHS GP or smoking-cessation service can take the form of gum, tablets, oral strips, lozenges, spray or inhalators. These can be good for immediate cravings as they are short-acting.  
 
Long-acting NRT options such as patches can be helpful for cravings by delivering nicotine to your system over the course of a day. Various strengths are available so you can be gradually weaned down. Patches are removed at night so you can sleep (as nicotine is a stimulant).
 
Treatment with NRT lasts 8 to 12 weeks after which you gradually wean yourself off.
 
Side effects include insomnia, upset tummy, dizziness, headaches, sore skin from patches, sprays irritating nose and throat. Talk to your doctor if these don’t resolve.
 
If you have kidney, liver, cardiovascular problems or are pregnant/breastfeeding discuss NRT with your GP first.


__7.__ __E-cigarettes__

Many have successfully quit real cigarettes using e-cigarettes. However, we don’t have long-term data on their safety.
 
In one study, rates for stopping smoking with e-cigarettes were 83% higher than using traditional NRT.
 
However, they can cause mouth or throat irritation and some investigators suggest long term e-cigarettes may cause other damage and also be addictive. 
 
Be mindful of your use of e-cigarettes and make sure you discuss this with your doctor first.


__Getting medical help__

Do consider speaking to a pharmacist first for advice on over-the-counter medications.

If you’ve tried other methods to give up smoking without success, it may be useful to speak to your GP about the other treatments that are available and whether these are suitable for you. 


__Reviewed By: Dr Rhianna McClymont, Lead GP, Kry__
 





kry.co.uk > Your health >Giving up smoking – what help is available?

Giving up smoking – what help is available?

If you have tried giving up smoking before without success, don’t despair. There are now more options than ever to help


With so much conflicting advice about weight loss, it’s easy to go down a path that doesn’t work for you. But don’t blame yourself. It is likely that some of the information about weight management you’ve been receiving is inaccurate. 

## Here we take a look at some common weight loss myths:

## 1. ‘All calories are equal’

Calories are definitely not created equal. Say you eat a biscuit that’s 100 calories. This won’t have the same nutritional benefits as a small fillet of rainbow trout with the same calorific value. The biscuit contains ‘empty’ calories that have little nutritional value. The fish will provide you with protein, essential omega-3 fatty acids and other key nutrients, as well as keeping you fuller for longer.  

Nutrient-dense foods, such as fresh fruits, vegetables and lean proteins, are usually high in nutrients and lower in calories. They provide us with the vitamins, minerals and other nutrients that we need for our bodies to function healthily.

It’s much easier to lose weight and control your appetite when you’re eating more nourishing foods. Research shows that nutrient-dense foods such as vegetables, nuts, whole grains and fruit are more beneficial for weight loss than foods high in processed ingredients (such as white flour and sugar), which are associated with weight gain.

 __What you can do__

- Choose foods that are high in nutrients, such as fresh vegetables, fruit, nuts, seeds, beans, lentils, leafy greens, lean meat, fish, poultry and eggs.
- Avoid processed foods and drinks where you can.

## 2. ‘Eating fat makes you fat’

Including healthy fats in your diet stimulates your metabolism and helps fill you up, so you’re more likely to feel satisfied after eating and less likely to be hungry between meals.

Moderately increasing the amount of good fats in your diet and reducing simple carbohydrates (including white pasta and bread) may help with weight loss.

__What you can do__

- Eat more healthy fats, such as oily fish (including sardines, salmon, herring and mackerel), avocados, olive oil, nuts and seeds.
- Avoid sugar and processed carbohydrates.

## 3. ‘It’s all about what you eat’

Sometimes changing your diet isn’t enough. If you’re finding it hard to lose weight, there may be other factors contributing.

Stress, for example, can make it harder to lose weight. If you’re producing too much of the stress hormone cortisol, this triggers an increase in blood sugar and insulin levels and causes more weight to be stored, particularly around the abdomen.

There is also emerging evidence that an imbalance of gut bacteria (dysbiosis) may make it harder to lose weight, as beneficial gut bacteria are involved in healthy metabolism, digestion and appetite control. 

__What you can do__

- Find ways to reduce stress such as meditation or mind-body exercises including Tai chi or yoga.
- If stress is chronic and ongoing seek help from a GP. 
- Include healthy fermented foods such as live yogurt, kefir, sauerkraut and kimchi in your diet. This will help balance your gut bacteria.

 ## 4. ‘Being overweight is your own fault’ 

There’s much more to obesity and being overweight than is commonly thought. So don’t beat yourself up if you have trouble with weight management.

A report by The British Psychological Society states that most people become overweight or obese as a result of a complex combination of biological, psychological and social factors.

The report highlights that people most likely to be an unhealthy weight may have a high genetic risk of developing obesity. High levels of stress, including major life challenges and trauma, can also make some people more susceptible to weight gain. Financial difficulties can also make it hard to access affordable, healthy food.

There may also be medical reasons. For example, hypothyroidism, a condition where not enough thyroid hormone is produced, affecting metabolism and causing the body to slow down. 

Lack of sleep can also play a part. It affects the hunger hormone, ghrelin, that increases appetite, and the satiety hormone, leptin, which makes you feel full. Sleep deprivation can cause ghrelin to rise and leptin to fall, which often leads to over-eating. A UK review of several studies has shown that sleep-deprived people consume on average, an extra 385 calories a day.

__What you can do__

- Talk to your Kry GP, if you’ve been suffering from insomnia or stress for more than two weeks. 

## 5. ‘There’s one single best diet for everyone’

When it comes to weight loss, there’s simply no such thing as one size fits all according to a recent study.

Researchers looked at the responses to meals of 1,100 adults (60 percent of them twins) over two weeks, measuring blood sugar, insulin, fat levels and other markers.

The results revealed a wide variation in blood responses to the same foods, and personal differences in metabolism, gut microbiome, meal timing and exercise.

This is only partly explained by genetic factors. The results suggest a personalised approach to nutrition is likely to provide the best results for weight loss.

__What you can do__

- Forget fad diets and find a weight loss regime that works for you. 
- Get advice on nutrition and weight loss from the NHS ‘[how to diet](https://www.nhs.uk/live-well/healthy-weight/how-to-diet/)’ site. 

__Reviewed by Dr Rhianna McClymont, Lead GP, Kry__

kry.co.uk > Your health > 5 weight loss myths exploded

5 weight loss myths exploded

Some commonly-held beliefs about weight loss are simply not accurate. Know the full picture – and talk to your GP – before deciding on a healthy lifestyle to suit you


## Quick facts

- Obesity has nearly tripled worldwide in the past 2 decades
- Fat around the middle may carry an increased risk of illness
- There are psychological, behavioural and medical treatments available from your doctor

Being far over your ideal weight can bring feelings of helplessness. Your decision to take action is a deeply personal one. When you are ready, help is at hand.

In the UK, more than 60% of adults are deemed overweight or obese. Over the past two decades, obesity has nearly tripled worldwide.

## What do the words ‘overweight’ and ‘obesity’ mean?

The World Health Organization describes being overweight or obese as ‘abnormal or excessive fat accumulation that may impair health’. The term ‘obese’ generally means a much higher amount of body fat than ‘overweight’. We use body mass index (BMI) to distinguish between the two.

The World Health Organization (WHO) classifies the result for adults as:

- __Underweight__ <18.5
- __Healthy weight__ 18.5-24.9
- __Overweight__ 25-29.9
- __Obese__ >30

Be aware, though, that a BMI score might not always mean the equivalent degree of fatness. For example, heavier muscular athletes with minimal body fat might have a high BMI but not carry the same health risks as less muscular people with the equivalent BMI.

## What’s the difference between being overweight and obesity?

Being overweight is a signal that you need to take action. A doctor will assess the risk presented by being overweight as more important if other risk factors are present. These include a larger waist size (see below), high blood pressure and family history of disease as well as lifestyle factors such as poor diet and smoking.

Obesity is associated with an increased risk of disease, which seems most evident when the BMI score is above 35. This is related not only to the amplified physical effects on our breathing and movement of carrying excess fats, but also to the metabolic effects on our body’s function and internal organs. All of these can potentially lead to illness. Some of these effects might also be present if you are overweight, but to a lesser degree - and your doctor will assess this.

## What are some of the benefits of losing weight?

- __Reduced risk of disease__
Whether you’re classified as overweight or obese, losing just 5-10% of your weight could reduce your risk of developing the following: 
- Cardiovascular disease and heart attack
- Type 2 diabetes
- Joint and muscle problems
- Some cancers
- Gallbladder disease
- Sleep disorders, such as sleep apnoea.

- __Improved fertility__
Losing excess body weight increases your chances of being successful if you are trying for a baby. It also reduces your risks of miscarriage . It is important to note that being underweight also negatively affects fertility. The key is to be in a healthy weight range (see above).

- __Reduced risk of disease__
Not everyone’s confidence is impacted by being overweight - but if your weight affects you emotionally, your self-esteem might be low. Losing weight may increase your physical confidence and encourage more activity and socialising.

- __Reduced risk of Covid-19 complications__ 
Mounting evidence suggests that obesity can increase the risk of suffering potentially fatal complications if you contract Covid-19. Losing weight could lower this risk.

## Does it matter where most of my body fat is located?

Excessive tummy fat is an indicator of fat around your internal organs. This is called ‘visceral fat’, and it secretes a protein that increases resistance to insulin – the hormone that your pancreas makes to process glucose – putting you more at risk of long-term health problems such as type 2 diabetes.

Fats around the middle of your tummy also produce inflammatory proteins that can trigger heart disease and cause blood pressure to rise. Fat on our arms and legs do not have this effect.

Sometimes doctors look at waist size in conjunction with BMI when they are assessing a patient’s risk of disease from being overweight or obese.

Waist circumferences larger than 88cm for women and 102cm for men are linked with a higher risk of serious medical conditions. In fact, a large amount of fat around the middle may put you at more risk of heart disease, breast cancer, colorectal cancer and Alzheimer’s disease.

## What causes overweight and obesity?

It’s easy to assume that too many calories in and not enough burned off is the prime reason you’re overweight or obese. But many other – sometimes insidious – factors can contribute which make it more difficult to maintain a healthy weight. These are just some:

- __Easy access to high-calorie foods__
Energy-dense foods and drinks high in fats and sugars are everywhere we turn. Marketing for such foods is aggressive and targets consumers from an early age. Moreover, average portion sizes have increased over the past decade, so you might not even be aware of how much more you’re eating.

- __Low protein content in unhealthy foods__
Healthy protein leads to more satiety after eating, so we feel the need to eat less. Processed and junk foods often contain little of these healthy proteins, so your system doesn’t always register feeling full.

- __Moving less__
This has been exacerbated by coronavirus-related social restrictions worldwide, with more hours spent on laptops, phones and watching TV. 

- __Genetic factors__
People’s metabolisms respond in different ways to diets and lifestyles because genes play a role in our shapes, sizes and weight fluctuations.

- __Binge eating disorder__
Binge eating disorder is the most common eating disorder, and is characterised both by eating an unusually large amount of food over a short duration of time, and feeling a sense of loss of control over one’s eating during this time. Studies have shown that people suffering from Binge Eating disorder are 3-6 times more likely to be obese than the general population. This disorder is often accompanied by feelings of sadness, anxiety or guilt. It can be effectively treated with a course of cognitive behavioural therapy (CBT) to help break this pattern. Talk to your Kry doctor for further advice regarding this...

- __Medicines__
Steroid medications, anticonvulsants, some diabetes medicines, antidepressants and antihistamines are all linked with weight gain. But before you make any changes to your medication, please talk to your doctor.

- __Illnesses__
Certain illnesses can play a part in weight gain, such as polycystic ovary syndrome (PCOS), Cushing’s disease and an underactive thyroid. 

## What works for weight loss?

Slow weight loss is more likely to stay off, research has found. So, aim to lose no more than 1-2lb (0.5-1kg) a week.

Crash diets do not generally work. Initial weight loss is usually fluid and the weight is often regained when you start eating normally again.

These are some simple things you can do today to start your journey:

- __Eat well__ Eat a balanced calorie-controlled diet that is high in nutrients. For more information and ideas on a balanced diet visit [NHS Eat Well](https://www.nhs.uk/live-well/eat-well/). Your GP may also be able to advise. 
- __Move more__ Make time for 2.5-5 hours’ weekly activity such as jogging, aerobics or dancing or low-impact exercise such as walking, swimming, yoga, cycling or Pilates.
- __Get connected__ Slimming groups can be useful to help you get motivated and stay connected to others on the same journey.

## What else can my doctor offer?

If your BMI measurement suggests you’re either overweight or obese, a good starting point is your Kry doctor. He/she is well equipped with psychological, behavioural and even medical solutions to help improve your quality of life, health and wellbeing.

It’s useful to keep a food and exercise diary in the 2 weeks leading up to your appointment, if you can.

Your Kry GP can:
- Listen to your weight concerns.
- Examine your food and exercise diary.
- Explain the benefits of losing weight and the risks of not doing anything.
- Do blood tests to check for medical causes, and check your blood sugar and cholesterol levels.
- Help you set achievable goals, plan for a start date and set review dates to track your progress.
- Discuss the options of speaking to a psychologist if it appears that a condition such as low mood, anxiety or binge eating is affecting your eating patterns (a course of talking therapy such as CBT can help change the way you think about food and eating).
- In some areas of the UK, and depending on your weight and other factors such as whether you have high blood pressure or diabetes, your doctor can also refer you to a weight loss and exercise programme. Check with your doctor if this is something that is available in your area.
- If needed — usually as a last resort ­— they may discuss medication and surgical options with you.

Whatever you do, don’t despair. There is help available to enhance your decision to embark on a healthier lifestyle and we are here to support you along the way.

__Reviewed by 
Dr Rhianna McClymont, Lead GP, Kry__

kry.co.uk > Your health > What is being overweight or obese, and where can you find help? 

What is being overweight or obese, and where can you find help? 

What is being overweight or obese? We can help you understand the terms overweight and obesity, their causes and where to find help.


## Quick facts 

- Prevention is the best policy — but be prepared and carry first aid essentials
- Cooling sprays and gels provide rapid relief from muscle sprains
- Rehydration salts speed recovery

Life doesn’t always go to plan — particularly when young children are part of your life. So, it’s wise to be prepared with a first aid kit of the essentials needed to treat a range of summer injuries and health issues.

You can buy ready-made kits which include the basics, such as plasters, alcohol wipes and an antiseptic cream. But it’s easy to create your own, and tailor it to cover the family’s activities, [allergies](https://www.livi.co.uk/medical-advice/allergies/) and individual needs.

Start with a waterproof, drawstring bag which you can sling over a shoulder or buggy. Then use our list to ensure that you’re the mum, or dad, who is well-prepared this summer.

## 1. Water

You won’t find it in ready-made kits but a bottle of water is often the first thing you’ll need to rinse an injury, wash off an irritant, or provide a distraction from discomfort. It also ensures healthy hydration or rehydration in the event of tummy troubles, sunburn or heat stroke — especially when used with rehydrating salts (see below).

## 2. Sunscreen

Prevention is always the best policy, so use a sunscreen that protects against both UVA (a 3 star-rating or more) and UVB (an SPF of 30 or higher). As a guide, adults need 2 teaspoons to cover the neck, arms and face, or 2 tablespoons when wearing a swimsuit. But as children come in all sizes, the best advice is to apply it liberally and regularly.

Read more about [sun safety for the family.](https://www.livi.co.uk/your-health/how-to-enjoy-the-sun-safely-and-what-to-do-about-sunburn/) 

## 3. Disposable gloves

More of us are carrying them already because of Covid-19 but using thin gloves will also prevent any cross-contamination while treating cuts, abrasions and other injuries. Look for non-latex, powder-free gloves if allergies are an issue.

## 4. Hand sanitiser

Regular use of a hand-sanitising gel or wipes is essential when it isn’t possible to wash your hands. Use hand sanitiser before eating or after touching high-traffic surfaces such as handrails. Be sure to choose products which work against both bacteria and viruses.

## 5. Bandages and plasters

Start with a selection of sterile gauze, stretch bandages and waterproof plasters. You might also want to add transparent film dressings. These act as a second skin and are great for grazes and awkward but accident-prone areas such as knees and elbows. Butterfly bandages, also known as wound-closure strips, are useful for deeper cuts.

## 6. Insect repellent

Repellents which contain 50% DEET are the best for most pests. Make sure you reapply often. 

## 7. Antiseptic liquid and cream
To clean and dress wounds and insect bites.

## 8. Tweezers
Essential for removing splinters that aren’t embedded, and ticks (with these, make sure you latch onto the head and don’t just pull off the body). Read more about prevention and treatment of [tick bites.](https://www.livi.co.uk/your-health/tick-bites-what-you-need-to-know/) 

## 9. Small scissors
You’ll need them to cut bandages. They’re also useful for trimming nails if you stub a toe or tear a fingernail.

## 10. Cooling spray or gel

To reduce pain and inflammation, muscle strains and sprains should be cooled as quickly as possible. You probably won’t have ice or a cold pack to hand, but you can carry a cooling spray or gel. Check the instructions as some are not suitable for young children — in this case, a damp cloth or towel will help. Strap the injury with elasticated bandaging, then elevate and rest it as much as possible for 48 hours.

## 11. Painkillers

Ibuprofen is a versatile painkiller which provides relief from sunburn, bites, injuries and any aches but do not give it to children who suffer from asthma. As it’s also anti-inflammatory, it’s particularly useful for muscle sprains. Paracetamol is not anti-inflammatory but it does reduce fever. Young children are more likely to accept liquids or lozenges. Make sure you don’t exceed the recommended dose. Ibuprofen can be used in babies from 3 months but is not recommended for anyone with asthma. Paracetamol syrups can be used for infants from the age of 2 months and tablets for children aged from 6 years.

## 12. Antihistamines

Oral antihistamines are useful for helping to calm allergies and insect bites, though some of these can cause drowsiness. Topical antihistamines, which are applied to the skin, are not recommended.

## 13. Hydrocortisone cream

Also known as corticosteroid cream, this over-the-counter cream provides rapid relief from insect bites and stings as well as prickly [heat rash](https://www.livi.co.uk/your-health/how-to-prevent-and-and-treat-summer-rashes/). But it is not suitable for children aged under 10, unless on a doctor’s advice.

## 14. Rehydration salts

Usually a combination of sugar and salts, rehydration salts are available in convenient sachets. They help ensure rehydration after vomiting, diarrhoea or heat exhaustion. Do note that with heat stroke or exhaustion it’s also important to cool the patient as quickly as possible.

## 15. Aloe vera

Gels made from aloe vera retain skin moisture, so they are useful to ease the pain and tightness of sunburn. Aloe vera gels can also help relieve dry, itchy skin and promote wound healing. Look for one which is at least 95% aloe vera. Moisturisers with aloe won’t have the same effect.

livi.co.uk > Your health > 15 summer first aid kit essentials

15 summer first aid kit essentials

Whether you’re holidaying somewhere local or have managed to get a flight abroad, stock up on these holiday first aid essentials


kry.co.uk > Your health > 15 summer first aid kit essentials

kry.co.uk > General health and seasonal > Articles 

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