Introduction

Cold sores are small blisters that develop on

the lips or around the mouth. They're caused by
the herpes simplex virus and usually clear up
without treatment within 7 to 10 days.
You may not have any symptoms when you first
become infected with the herpes simplex virus. An
outbreak of cold sores may happen some time
later.
Cold sores often start with a tingling, itching or
burning sensation around your mouth. Small fluidfilled sores then appear, usually on the edges of
your lower lip.
Read more about the symptoms of cold sores.

When to visit your GP

If you've had outbreaks of cold sores before, it's

likely that you'll know what they are if they return.

You only need to visit your GP if you're unsure

whether it's a cold sore or if it's severe and
spreading further than just the lip. See your GP if a
cold sore hasn't healed after 7 to 10 days.

What causes cold sores?

The strain of herpes simplex virus usually
responsible for cold sores is known as HSV-1.
In rare cases, cold sores can also be caused by the
herpes simplex virus type 2 (HSV-2). This can be
the result of having oral sex with someone who
has genital herpes.
Read more about the causes of cold sores.

Herpes simplex virus

The herpes simplex virus or "cold sore virus" is
highly contagious and can be easily passed from
person to person by close direct contact. After
someone has contracted the virus, it remains
inactive (dormant) most of the time.
However, every so often the virus can be activated
by certain triggers, resulting in an outbreak of cold
sores. These triggers vary from person to person,
but can include sunlight, fatigue, an injury to the
affected area, and, in women, their period.
Some people have frequently recurring cold sores
around two or three times a year, while others have

one cold sore and never have another. Some

people never get cold sores at all because the virus
never becomes active.

Treating cold sores

Cold sores usually clear up by themselves without
treatment within 7 to 10 days.
However, antiviral creams are available over the
counter from pharmacies without a prescription. If
used correctly, these can help ease your symptoms
and speed up the healing time.
To be effective, these treatments should be applied
as soon as the first signs of a cold sore appear
when you feel a tingling, itching or burning
sensation around your mouth. Using an antiviral
cream after this initial period is unlikely to have
much of an effect.
Cold sore patches are also available that contain
hydrocolloid gel, which is an effective treatment for
skin wounds. The patch is placed over the cold
sore while it heals.
Antiviral tablets may be prescribed for severe
cases.
Read more about treating cold sores.

Complications of cold sores

Cold sores are usually mild, but may cause

complications in rare cases. People with weak
immune systems caused by illness or treatments
such as chemotherapy are particularly at risk of
complications.
Dehydration sometimes occurs if drinking fluids
becomes painful. Young children are particularly at
risk of becoming dehydrated.
The herpes simplex virus can also spread to other
parts of your body. Examples of when this can
occur include:
skin infections these often occur if the virus comes into contact with
broken skin, such as a cut or graze, or a skin condition such as eczema
herpetic whitlow (whitlow finger) this causes painful sores and blisters to
appear on and around your fingers
herpetic keratoconjunctivitis this causes swelling and irritation
(inflammation) of your eye area and sores to develop on your eyelids

Left untreated, herpetic keratoconjunctivitis can

cause the cornea, the transparent layer at the front
of your eye, to become infected, which can
eventually lead to blindness.
It's therefore important not to touch your eyes if you
have an unhealed cold sore. If you must touch your
eyes for example, to remove contact lenses
wash your hands thoroughly first.
In very rare cases, encephalitis, a condition where
the brain becomes inflamed and swollen, can be
caused by the cold sore virus spreading to the

brain. It can be treated with intravenous injections

of antiviral medications, such as aciclovir.

Preventing infection
It's not possible to prevent infection with the herpes
simplex virus or prevent outbreaks of cold sores,
but you can take steps to minimise the spread of
infection.
Cold sores are at their most contagious when they
burst (rupture), but remain contagious until they're
completely healed. Avoid close contact with others
until your cold sore has completely healed and
disappeared.
However, there's no need to stay away from work
or miss school if you or your child have a cold sore.
You can help minimise the risk of the cold sore
virus spreading and cold sores recurring by
following the advice below:
avoid touching cold sores unless you're applying cold sore cream creams
should be dabbed on gently rather than rubbed in, as this can damage
your skin further
always wash your hands before and after applying cold sore cream and
after touching the affected area
don't share cold sore creams or medication with other people as this can
cause the infection to spread
don't share items that come into contact with the affected area, such as
lipsticks or cutlery
avoid kissing and oral sex until your cold sores have completely healed

 be particularly careful around newborn babies, pregnant women and

people with a low immune system, such as those with HIV or those
having chemotherapy
if you know what usually triggers your cold sores, try to avoid the triggers
for example, a sun block lip balm (SPF 15 or higher) may help prevent cold
sores triggered by bright sunlight

About Ringworm

Ringworm (Tinea corporis) is a type of fungal infection that can be

contracted almost anywhere on the body. When contracted on the feet, this
infection is known as athletes foot. On the groin area, its called jock
itch. The name is misleading, because there is no actual worm involved.
One of the most common types of skin infections, ringworm appears on the
skin as a raised circle or ring. It is typically red or brown around the edges
with scaly, peeling skin throughout.
Ringworm thrives in warm, moist areas and can be contracted from many
sources, including but not limited to: Unclean locker rooms, clothing,
showers, mats, and of course, skin-to-skin contact with infected individuals.
Ringworm can also be found on some animals.
Symptoms:
Ringworm has a very distinctive appearance, and typically appears in the
form of a ring-shaped, itchy rash that is slightly raised above the skin that
surrounds it. Every case is different, and sometimes it will not appear in this
shape and may not be irritating. Sometimes, reddish or brownish bumps
appear in addition to scaly, peeling skin. It is also common to contract
ringworm in difficult places to view, such as the scalp or underneath the
fingernails.

Treatment:
Most cases of ringworm are extremely minor and can be treated with overthe-counter, topical medications that are commonly used for fungal
infections. Make sure to follow the directions of any medication exactly. It
may take several days to several weeks for the infection to be healed,
depending on severity. Lamisil is a good cream that works wonders.
Often times, your doctor will be able to identify ringworm with a quick
examination of your skin. If your infection is strong, oral antifungal
medications may be prescribed in addition to prescription topical
medications. After a few days of treatment, ringworm becomes noncontagious, although it is still apparent on the skin. It may take up to several
weeks for ringworm to completely disappear.

About Impetigo:

Impetigo is a bacterial infection that can be

found nearly anywhere on the body, and is caused by one of two types of bacteria:
Streptococcus (strep) or staphylococcus (staph). Impetigo is usually caused by one
of these types of bacteria entering the body through a cut or animal/insect bite, or
any other type of open sore. However, a break in the skin is not always needed to
contract an infection.
Impetigo typically begins as small clusters of red bumps that break open into a
yellowish scab. This infection may be spread by skin-to-skin contact, or by using
facilities and equipment (BJJ mats especially) where the bacterium is present.
Impetigo is highly contagious and, if left untreated, could cause other very serious
health problems.
Symptoms
When Impetigo appears on the skin, it typically starts as localized clusters of

delicate, yellowish bumps that may increase in size and number. These clusters
often cause no pain, but can be very itchy and irritating. When the blisters are
popped, reddish sores are left on the skin, which will eventually crust over due to
the fluid. Impetigo may cause flu-like symptoms such as headache, fever, fatigue,
and also swollen glands.
Treatment
A physician can typically identify impetigo with a simple examination of the skin.
Sometimes, extremely small samples of the skin are needed for a sure diagnosis.
Most cases of impetigo can be treated with some topical, non-prescription
antibacterial medications. For more serious cases, doctors will usually prescribe a
combination of topical and oral antibiotics. Typically after one or two days of
treatment, the infection becomes non-contagious, with the sores disappearing in
about a week of starting treatment. Washing with soap and water before medicating
may help increase the effectiveness of the medication.

This image displays intact blisters and crusted erosions showing the spectrum of skin
lesions typical of impetigo.

Overview
Impetigo is a common and contagious bacterial skin infection that is usually a minor problem, but
sometimes complications may occur that require treatment. Complications of impetigo can include
deeper skin infection (called cellulitis), inflammation around the brain or spinal cord (meningitis), or a
kidney inflammation (post streptococcal glomerulonephritis). Impetigo often starts with a cut or break in
the skin, which allows bacteria to enter. Impetigo is usually caused by "staph" (Staphylococcus) or "strep"
(Streptococcus) bacteria.

Who's At Risk

Impetigo is very common in children, affecting up to 10% of children who come to a pediatric
clinic. Children up to 6 years old are most likely to be infected. Those who live in a warm, humid climate
are more often affected. Insect bites, crowded living conditions, and poor skin cleansing increase
the risk of infection. (It may spread easily through schools and day-care centers.) Sports requiring skin-toskin contact, having a weak immune system, or having a chronic skin problem such as eczema can also
increase your child's risk of getting impetigo. Lesions on the neck and scalp may occur with head lice
(pediculosis capitis).

Signs and Symptoms

There are 2 common forms of impetigo: impetigo with blisters or impetigo without blisters (fluid-filled
bubbles on the skin surface).
Non-blistering impetigo:

Blistering:

The infection may be:

Tiny pimples or red areas quickly turn into oozing, honey-colored, crusted
patches (usually less than an inch) that spread.
The face or injured (traumatized) areas of the skin are affected.

There may be some itching or swollen lymph nodes, but the child feels
generally well.
Sometimes deeper, pus-filled sores and scabs that leave scars occur.

Painless blisters (about an inch or less) occur that may break easily.

These often spread to the face, trunk, arms, or legs.

The person feels generally well.

Mild Only a few of either type of lesion over a small area of skin, and the
child feels well otherwise.
Moderate Over 10 lesions, and several small skin areas are affected.

Severe Many lesions; large areas of skin are affected; and/or the child
feels ill, with fever, diarrhea, or weakness.

Self-Care Guidelines
Prevention:

For mild infection:

Keep the skin clean with soap and water.

Treat cuts, scrapes, and insect bites by cleaning with soap and water and
covering the area if possible.

Gently wash the area with a mild soap and water twice or more daily and
cover with gauze or a non-stick dressing if possible.
Apply an over-the-counter antibiotic ointment after washing the skin 34
times daily. Wash hands after application or wear gloves to apply.
To remove crusts, soak with a vinegar solution (1 tablespoon of white
vinegar to a pint of water) for 1520 minutes.
Wash clothing, towels, and bedding daily, and don't share these with others.

Wash hands frequently, try not to touch the affected areas, and keep
fingernails cut.
Keep your child home until scabs or open areas have healed.

When to Seek Medical Care

See your child's doctor for any infection that does not improve. See the doctor immediately for moderateto-severe infection or if your child has a fever or severe pain.
If your child is currently being treated for a skin infection that has not improved after 23 days of

antibiotics, return to the child's doctor.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a strain of "staph"
bacteria resistant to antibiotics in the penicillin family, which have been the cornerstone of antibiotic
therapy for staph and skin infections for decades. CA-MRSA previously infected only small segments of
the population, such as health care workers and persons using injection drugs. However, CA-MRSA is
now a common cause of skin infections in the general population. While CA-MRSA bacteria are resistant
to penicillin and penicillin-related antibiotics, most staph infections with CA-MRSA can be easily treated by
health care practitioners using local skin care and commonly available non-penicillin-family antibiotics.
Rarely, CA-MRSA can cause serious skin and soft tissue (deeper) infections. Staph infections typically
start as small red bumps or pus-filled bumps, which can rapidly turn into deep, painful sores. If you see a
red bump or pus-filled bump on your child's skin that is worsening or showing anysigns of infection (ie, the
area becomes increasingly painful, red, or swollen), see the child's doctor right away. Many people
believe incorrectly that these bumps are the result of a spider bite when they arrive at the doctor's office.
Your doctor may need to test (culture) infected skin for MRSA before starting antibiotics. If your child has
a skin problem that resembles a CA-MRSA infection or a culture that is positive for MRSA, the doctor may
need to provide local skin care andprescribe oral antibiotics. To prevent spread of infection to others,
infected wounds, hands, and other exposed body areas should be kept clean and wounds should be
covered during therapy.

Treatments Your Physician May Prescribe

In addition to measures for mild impetigo already mentioned, the doctor mayprescribe:
Topical antibiotics (usually mupirocin)

Oral antibiotics (cephalosporins, amoxicillin, cloxacillin, dicloxacillin,

erythromycin, or clindamycin)
If your child's doctor prescribes antibiotics, be sure the child takes the full course.

What is ringworm?
Ringworm is a very infectious and common skin infection causing a ring shaped red rash.
Ringworm is most common among children, but can affect people of any age.

Picture of ringworm: Image copyright Pulse Picture Library/CMP Images / Phototake -- All rights reserved.

Ringworm isn't caused by worms. The skin infection, also known as tinea, is caused by fungi called
dermatophytes. Fungi are microscopic organisms that can live off the dead tissues of your skin, hair,
and nails, much like a mushroom can grow on the bark of a tree.

What causes ringworm?

Ringworm is caused by a fungus that grows on the skin. Once the fungus is established, it spreads out in
rings. The centre of the ring may clear up, while a new ring of infection develops at the edge of the old
ring.
Children are most likely to get ringworm. Ringworm of the scalp can spread from child to child when
children share hats, combs, or brushes. Ringworm of the body can be spread on towels, clothing, or
sports equipment. Personal hygiene is important in preventing the spread of ringworm. Dogs and cats can
also be infected with ringworm, and they can pass it to people through direct contact.

What are the symptoms of ringworm?

Ringworm of the scalp:

Dry, brittle hair or hair loss in patches

Severe itching

Red-ringed patch of small blisters or scaly skin

Ringworm of the body:

Red-ringed patch of small blisters or scaly skin

Severe itching is sometimes present

Consult your practice nurse or doctor if you have a red-ringed skin infection, severe itching of the skin or
scalp, a scaly rash or hair loss.

How do I know if I have ringworm?

Your doctor will probably recognise the characteristic rash of ringworm. However, he or she may also:

Look at the infection with a special ultraviolet light that can detect traces of fluorescent materials
that occur in a ringworm infection.
Scrape an area of affected skin and look at the sample under the microscope.
Take a sample of skin scrapings for culture, to find out which fungus is causing the infection in
order to select the most effective antifungal medicine.

What are the treatments for ringworm?

Your doctor may prescribe an antifungal medication. These drugs work to kill fungi and prevent the
condition from coming back. You may use the antifungal agent on your skin as a medicated shampoo,
powder, cream or lotion; or you may be given a tablet so the medicine can spread throughout your body.
You may be recommended a combination of these treatments.

How can I prevent ringworm?

Good personal hygiene helps prevent the spread of ringworm. Teach your child to practise good hygiene
and generally not to share combs, brushes, or hats. Children also shouldn't share towels, clothes, or
sports equipment that haven't been properly cleaned.
Ringworm can also be transmitted from an infected dog or cat, so avoid animals who look mangy or
have bald spots in their coats. If you have an animal that you think may have ringworm, take it to the vet
for treatment.