Archive for July, 2017

Can I used expired asthma inhaler?

Jul 31 2017 Published by under Common Health Questions

How does asthma affect the lungs and breathing?

Asthma is a common long term inflammatory diseases of the airways of the lungs. It is condition in which airways of lungs gets narrower and swell and produce extra mucus. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. General symptoms of asthma are wheezing, coughing, chest tightness and shortness of breath.

The episodes of asthma attack are found to be few times a day or few times a week. This asthma episodes may increase or get worse depending on the person at night or during and after exercise.

Asthma is though to be caused by the combination of genetic and environmental factors.

Their is no cure for asthma but it can be symptoms can be prevented by avoiding triggers such as allergens and irritant. This symptoms can be prevented by inhaling corticosteriods , long acting beta agonist (LABA) or antileukotriene  may be used to control asthma.

Signs and symptoms of Asthma

Signs and symptoms may vary form person to person and also influenced by environmental conditions.This include;

  • shortness of breath
  • tightness of chest and pain
  • trouble sleeping due to shortness of breath and chest pain
  • coughing
  • sneezing
  • whistling sound during inhaling and exhaling

What is an Asthma attack?

An asthma attack is when you symptoms starts getting worse compared to usual, enough to cause the person distress. Asthma attack can come quickly or gradually. The number of  attack can range form few per day to few per week. The symptoms that are seen during the asthma attack are :

  • increase in wheezing, coughing,
  • chest tightening
  • shortening of breathe
  • chest pain
  • long breath
  • changes in heart beats and rhythm

Asthma and its triggers

Allergic reactions may be delayed in some children, making it difficult to identify the trigger involved. The most common asthma triggers include:

  • Pollens from grasses, trees and flowers
  • Air pollution
  • Smoke from tobacco and burning wood
  • Mold spores
  • Dust mites
  • Cockroaches and their droppings
  • Furry pets and pet dander

Less common asthma triggers include:

  • Physical exercise
  • Some medications, both over-the-counter (OTC) and prescription
  • Upper respiratory infections such as colds and the flu
  • Acid reflux (stomach acids rising up into the esophagus, causing heartburn and indigestion)
  • Weather extremes such as thunderstorms, high humidity, or cold, dry air
  • Some foods, food additives and fragrances

Can Alcohol aggravate Asthma?

Yes, alcohol can cause asthma to worsen. One possible reason is that alcohol can cause various degrees of acid reflux.  In this common condition, acidic stomach fluids bubble up into the food tube (esophagus) and sometimes make their way into the breathing tubes via the back of the throat.

This may also happen shortly after eating, or during the night as you sleep. Any acid in the breathing tubes is very aggravating, causing swelling and the production of mucus.
Advair Diskus 250/50. Can Drinking Alcohol Trigger an Asthma Attack?

What is Asthma inhaler

An asthma inhaler is an handheld device that delivers medication straight into your lungs. You get the drugs faster and with fewer side effects then any other kind of dosage form like pills or I.V injections and I.V bolus.

What are the types of Asthma inhaler?

Asthma inhalers are available in different types they are Metered Dose Inhalers (MDIs) , Dry Powder Inhalers (DPIs) and Nebulizers. They contain different kind of medication, to provide fast relief or long acting symptoms of asthma. This different medication have different mechanism of action. This systems sometimes have to pumped and others are breath activated.

Metered Dose Inhalers (MDIs): This system provide the drug through a small, handheld aerosol canister. They basically work like an spray can. You have to push the inhaler system and it sprays out the medicine, and you Deep breathe it in. A tube like gadget is their called spacer which helps kids and old people who have trouble breathing it in.

Dry Powder Inhalers (DPIs) – Breathe activated inhalers:

This kind of system have dry powders in them. You need not to press or pump for the medication to be released. The system require you to breathe quickly and deeply which will make you inhale the single dose in it for treatment. This are basically hard to use under the asthma attack because one can not take a deep breathe which is required by the system.

Nebulizers: Nebulizers are mechanical system through which it deliver medication via mouthpiece or mask. They are easy to use because you can breathe normally. This system have an advantage for both categories like old people and under asthma attack. Therefore it makes them good for children and people with severe asthma who may not be able to use MDIs or DPIs.c

Common Asthma inhaler

The common types of asthma inhaler are divided into short acting bronchodilators and long acting bronchodilators.

The short acting bronchodilators are:

  • Albuterol ( ventolin HFA, Proair HFA, Proventil HFA, this are also available in generic drug solution for nebulizers).
  • Metaproterenol
  • Levalbuterol
  • Pirbuterol

Long acting bronchodilators:

  • Advair
  • Dulera
  • Symbicort
  • serevent
  • foradil (formoterol)

when does symbicort inhaler expire

Does asthma inhaler expire?

Yes, asthma inhaler has an expiry date, by this date the manufacturer guarantees 100% safety and efficacy of the medication in the inhaler. After this date of expiration the manufacturer no longer guarantees 100% safety and efficacy of the drug. If one uses expired asthma inhaler and side effects are observed the manufacturer and regulatory authorities are not responsible for this kind of side of effects.

This medication begins to breakdown by time and loses its potency over time. For this reason, US Food and Drug Ddministration (FDA) mandates all medication should have an expiry date on it. This date is estimated date at which time the medicine will lose its 10% of its potency.

How long is an asthma inhaler good for?

Any drug is under manufactured guaranteed efficacy and safety  on and before expiration date. Likewise, asthma inhaler have an expiration date until which the manufacturer provides the guaranteed efficacy and safety of drug. After the expiration date passes it starts losing its efficacy and after which manufacturer is no longer responsible for safety and efficacy of it.

Side effects of expired Asthma inhaler

Side effects can be minor to major depending upon person to person as well as on environmental factors. The common side effects are :

  • headache, dizziness
  • sleep problems
  • cough, sore throat , stuffy or running nose
  • mild nausea, vomiting
  • dry mouth and throat
  • muscle pain
  • diarrhea

Serious side effects of expired asthma inhaler are:

  • tremor, nervousness
  • bronchospasm
  • chest pain and fast, pounding or uneven heart beats
  • high blood pressure
  • changes in vitamins levels

Can honey go bad over time? Can I eat expired honey?
What is Diaphoresis? Diaphoresis – Types, Causes and Treatments

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Pediophobia: definition, pronunciation, causes, symptoms, test, treatments

Jul 28 2017 Published by under Phobias

What is Pediophobia?

Pediophobia or “the fear of dolls” is a specific type of phobia and subtype of anxiety disorder characterized by persistent, unwarranted, irrational and intense fear or worry of dolls. Pediophobia is closely related to Automatonophobia which is general name for various types of fears such as those of ventriloquist’s dummies, marionettes, wax figures, animatronic creatures, and other humanoid figures.

Some individuals are afraid of all dolls or stuffed toys, while others are only afraid of specific ones. It appears that most intensive fear is manifested after seeing dolls that move or talk or of old-fashioned china dolls.

In normal occasions, dolls are just a child’s toys. It is known that little girls especially love their dolls and pretend to speak and play with them which according to some studies are a good thing for brain development as it can help in growing imagination and creativity.

But in some cases, different children may differently react, so some of them may be feared of them. Fortunately such cases are not so common. While most childhood cases of Pediophobia disappear once the child has grown, in some cases though, this fear can persist even in adulthood.

What is the fear of dolls? Pediophobia

If this really frighten you, then you may have pediophobia

Pediophobia pronunciation and word origin

Pediophobia is pronounced as (pē′dē-ō-fō′bē-ă).

The word pediophobia comes from Greek word “paidon” meaning “little child” and φόβος, phóbos, meaning “fear”.

How common is pediophobia?

The first written medical description of pediophobia was noted in psychiatric literature of Rangell (1952). Although other forms of specific phobias are known to be common in the general population, pediophobia has not been reported so often.

The rarity of this phobia despite high presence of dolls in almost every culture can be explained by different frequencies of contact with stimuli (in this case doll) and a preparedness and prepotency of certain signs to provoke fear more than others do, as a result of its evolutionary history.

During last 20-30 years the incidence of pediophobia gets higher since dolls has been greatly exploited in different pop culture settings, ranging from various horror movies to Halloween events.

It can be said that an apparently harmless doll has become a conscious being bent on destruction. No matter this doll get the power from magical spells or some other occasion, the conclusion is the same: a kindly child’s plaything has become destructive and deadly thing.

So, these movies have become a primal fear and possibly one of the most important causes of pediophobia. In a world filled with threats, bioterrorism, etc., this silent/innocent-looking killer make us worry that things we cannot recognize as dangerous before could lead to our destruction.

Pediophobia in children

Many may become distressed if their little child gets frightened, screams or cries when a doll is presented. However, it is important to know that small children are just learning to separate fantasy from reality, and doll they got as a present may be a strange living thing for them.

So, a doll which looks like a human can be very terrifying to a child who does not yet understand this concept. Thus, like in cases of other phobias, pediophobia won’t be diagnosed in children unless it persists for more than 6 months. Of course, if your child’s fear is severe, it is important to ask for the advice of the child’s doctor.

What are patients with pediophobia afraid of?

Patients (both adults and children) with pediophobia are most commonly afraid of:

  • Human-like dolls
  • Puppets
  • Marionettes
  • Stuffed dolls
  • Waxed figures
  • Aimatronic creatures
  • Movies with evil dolls

Annabelle from movie Annabelle, Chucky from Child’s Play, the episode of The Twilight Zone are often a root causes of pediophobia. There is also even a creepy tourist attraction in Mexico known as Isla de las Muñecas, or the Island of the Dolls, where tourists go to see tumble-down old dolls strung up on trees in order to appease the spirit of a local girl who drowned.

The story gets even creepier if you find out that the man who originally organized this strange decorating project, incidentally, come to believe that the dolls are possessed. Good story for tourist attraction, isn’t it better than Dracula?

Fear of Dolls Phobia

Isla de las Muñecas dolls

Pediophobia case reports

Here is one report of a mother whose girl has pediophobia:

Person #1

Mrs. X daughter was very much scared of a doll with scintillating eyes. Though the doll was kept in a show-case in their household, if she saw the doll, she would scream, run away and cry out of fear for 30 minutes or so.

It was difficult for the family to soothe her. She avoided using the door near which the show case was kept. She insisted on getting rid of that doll. The child was however able to play with other toys normally. Her interactions with her family, friends and schoolmates were normal and no significant abnormality in any other areas of life was noted. No other fears were reported by the mother

What causes pediophobia?

The same as other phobias, pediophobia can be also triggered after some trauma or intensely negative incident in childhood connected to the dolls. The trauma will be repressed and young mind will forever link dolls with the trauma and remembering of negative feelings experienced then. Genetic factors including: brain chemistry, heredity and tendency to think negatively may also influence to the development of pediophobia

Also, some dolls are purposely made to be creepy, because of popular scary movies or Halloween. Also, some dolls are used for witch craft such as voodoo dolls. Burning voodoo dolls in order to bring misfortune to someone was a common practice in the past. So, for an individual who is already suffering from some anxiety or nervous system disorders, all dolls represent evil.

Dolls have are made to have fixed staring eyes and some of them also have button eyes that looks like “soulless pools devoid of any emotion akin to those of a corpse”.

Additionally, popular novels (Althea, Stone Dead etc) and horror movies (Annabel and Chucky in Child’s Play) have represented dolls as evil or criminal characters that come to life to cause harm to children and humans and this is never good, as it can induce fear in young or agitated minds.

Nevertheless, many adults like to scare little children and may accidentally introduce a fear of dolls in the minds of younger children most commonly by telling stories of dolls coming to life at night.

Pediophobia: definition, pronunciation, causes, symptoms, test, treatments

Chucky and Annabelle

Uncanny Valley Hypothesis of pediophobia development

The Japanese roboticist named Masahiro Mori postulated the theory behind the development of pediophobia through his so called uncanny valley hypothesis. This scientist studied different emotional responses of persons after their notification of non-living objects with human-like features.

He hypothesized that when non-living objects such as dolls, mannequins but also his robots imitate human characteristics, we will react positively as they look similar to us.

However, when we start detecting their imperfections including the absence of breathing, dolls sitting frivolously and staring blankly at the viewer, lack of human touch, negative reactions may be triggered and we will respond with revulsion.

Such minor ‘flaws’ from these objects give us creepy feeling. According to Mori: “ The abrupt dip in emotional response that turns into revulsion is referred to as ‘uncanny valley”. The uncanny valley actually represents a tough negative response to the non-living objects that are more like humans.

Pediophobia signs and symptoms

The signs and symptoms of pediophobia are not typical and usually vary from person to person. Most commonly when pediophoobiac is confronted with their fear of dolls, he or she may begin to sweat, become uncomfortable or get nausea. Rarely difficult to speak or to think with clarity may be also experienced. Other patients may experience very intense anxiety, panic attacks or even paralyses.

Other signs and symptoms of pediophobia may include:

  • Dry mouth
  • Dizziness
  • Muscle tension
  • Abdominal pain
  • Heightened senses
  • Breathlessness
  • Hyperventilation
  • Trembling
  • Tachycardia
  • Feeling out of control
  • Nervousness
  • Insomnia
  • Feeling trapped & unable to escape
  • Intense feeling of impending disaster
  • Hallucinations

Pediophobia diagnosis and tests

Except history and clinical representation or eventually direct fear after exposure to doll, there are no other diagnostic methods for identifying whether the person is suffering from pediophobia or not.

Pediophobia treatment

Pediophobia is a type of specific phobia, so the best treatment option is to face your fear of dolls and learn how to overcome it. The same treatment options used for overcoming other kinds of specific phobias can be also used for treating pediophobia

Following treatment options can be considered in patients with pediophobia:

  • Cognitive behavior therapy
  • Exposure therapy
  • Relaxation
  • Behavior therapy
  • Hypnosis
  • Psychotherapy
  • Relaxation techniques-controlled breathing, visualization
  • Energy Psychology
  • Neuro-Linguistic Programming (NLP)
  • Pharmacological therapy

Cognitive behavioral therapy (CBT) for pediophobia

CBT focuses on altering a person’s thinking which include conversion of negative, harmful or unproductive thoughts patterns into positive and controlled ones. It eventually helps the person with pediophobia to find the difference between reality and imagination and overcome fear of dolls.

Exposure therapy for pediophobia

Exposure therapy is a form of behavior therapy in which the feared object (e.g. doll) is purposely brought in front of the patient. Initially, the patient will most commonly feel anxious. However, after repeated sessions and exposure to the object, the person might have better control over his/her negative feelings, which may help in reducing the fear of dolls

Relaxation therapy for pediophobia

Relaxation techniques including: deep breathing, meditation, yoga and advanced muscle relaxation may be very helpful in relieving anxiety related with pediophobia. Other techniques such as visualization in which the person with pediophobia visualizes a comforting scene or place, may also be helpful.

Hypnosis for pediophobia

Probable cause of pediophobia is emotional trauma in childhood. Hypnosis has been shown as effective treatment for many persons with phobias. It works by retrieving the underlying cause of the phobia and eliminating affected person’s response to the stimulus. The initial goal of the hypnotherapist is to discover the event from which the phobia is developed.

In most cases the cause is traumatic event which in the past. Regularly the phobic individual does not remember this past event as it can be repressed for many years. Repression is known as a protective mechanism of our mind that utilizes by keeping memory of the trauma out of our conscious until we are ready and able to deal with it.

In order to access this memory state of heightened relaxation and focus or hypnotic trance need to be achieved so unconscious can be accessed. Thus unconscious memories can be revealed and brought to conscious awareness. When this is achieved, the phobia will generally disappear.

Psychotherapy for pediophobia

Taking the help and advice of a psychologist or psychiatrist and talking about issues relating to the phobia can help identify the underlying cause. Regular counseling might be very helpful for a control of your feelings, moods, and behavior. This in turn may contribute in coping with pediophobia.

Medications for pediophobia

Pharmacological therapy with short-term anxiolytic drugs should be considered only in severe cases of pediophobia accompanied with serious distress and panic attacks. So, doctor may prescribe antianxiety medications to relieve that eerie feeling associated with dolls. However, there are no studies there suggesting that antianxiety medicines are effective in the treatment of pediophobia.

Neuro-Linguistic programming therapy for pediophobia

Neuro-Linguistic programming is principally the study and practice on how we create our reality. The basic concept of neuro-Linguistic programming is that the words we use reproduce an internal, subconscious perception of our problems. If these perceptions and words are incorrect, they will possibly generate an underlying issue as long as we remain to use them and to think them.

In neuro-linguistic programming sessions, therapist analyzes every word or phrase you use in telling your signs, symptoms or concerns about health. Facial expressions and body movements are also examined. After determining issues in your perception, the therapist will help you understand the predisposing source.

This treatment may you to remodel your thoughts and mental relations in order to repair preconceived notions. These preconceived notions may be responsible for keeping you from attaining the success you deserve.

Why do people have a fear of holes? How many people in the world have Trypophobia?

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Trypophobia: definition, pronunciation, causes, symptoms, test, treatments, prevention, pictures

Jul 27 2017 Published by under Phobias

Contains disturbing graphics

What is Trypophobia?

Trypophobia or “the fear of holes” is a specific type of phobia under anxiety disorder characterized by persistent, irrational and intense fear of holes, usually not the huge ones but the small holes seen within asymmetrical clusters. According to Cole and Wilkins article published in Psychological Science 2013, trypophobia is the disgust response or unpleasant feeling often accompanies with somatic responses (e.g., goose bumps) made by observing a cluster of innocuous objects such as for example lotus seed pods.

Although to average person this phobia may look funny, one study also published in Psychological Science has estimated that trypophobia is present in even 16% of people. The study described that the condition may provoke very intense reaction, even though “the stimuli are usually groups of holes of any type that are almost always harmless and seemingly pose no threat.” The intensity of the fear varies from person to person.

While some persons may find that hole clusters causes them to feel very uncomfortable, others claimed that just a look at images can be so frightened to them that make them to shake all over in fear.

Trypophobia or “the fear of holes”

Lotus flower seed head. Most persons with trypophobia have a fear of this image

Trypophobia pronunciation and word origin

Trypophobia is pronounced as (Try-Poh-Foe-Be-Uh) .

The word trypophobia comes from Greek word τρύπα, trýpa, meaning “hole” and φόβος, phóbos, meaning “fear”.

Is trypophobia a skin disease?

No, trypophobia is not a skin disease. It is specific phobia, a subtype of anxiety disorder. Pictures you saw on the internet like these below are photoshoped!

Is trypophobia a skin disease? fake trypophobia images

However, holes, especially those in organic objects that can be caused by various skin diseases such as blisters or rash related with measles or chicken pox may subconsciously remind us of the symptoms of contagious skin diseases.

Also one more skin condition can be caused by black flies, which carry a parasitic worm that causes thickening of the skin. In overacting individuals, these images of such skin conditions may cause trypophobia to occur, and to further connect in future every similar cluster “hole” formation with such skin diseases.

How common is trypophobia?

One study, published Psychological Science has estimated that trypophobia with different range of severity is present in about 16 % of people. So, according to this it is very common type of phobia

In order to find out initial estimation of how common trypophobia is, one case report study asked 286 adults (91 male and 195 female) who were 18–55 years old to view an image of the lotus seed head. The participants need to answer whether the image was “uncomfortable or even repulsive to look at.”  Results were following:

  • 10 males (11%) reported aversions
  • 36 females (18%) reported aversions

Since there has been a very little investigation on this phenomenon, some scientists that trypophobia may be the most common phobia you have never heard of.
Trypophobia definiton, causes, hand, images, test, cure, is "fear of holes " real?

What are patients with Trypophobia afraid of?

Sufferers of trypophobia usually report aversions to visual stimuli embracing particular configurations of holes. There are a number of Internet-based support groups, including a Facebook group (, where trypophobia sufferers provide testimonials. These testimonials show that trypophobia significantly affects their everyday lives and routines so it can be very debilitating.

The image that will most trypophobiacs report provoking the phobia is the lotus flower seed head. Other also well-known examples may include soap bubbles and the aerated chocolate holes. Sufferers from this phobia usually report that the visual perception is particularly very aversive.

Additionally, the severity of trypophobia seems to be more severe if the holes occur on human skin for example: the skin prints of stones after sitting on sand. It is only in this respect that the phobia involves any reference to the semantics of the image. The visual nature of trypophobia provides a clue as to its cause.

But, the fear of holes is not only associated with images, some persons may also fear holes in pores on the skin, meat, on vegetables or fruits. There are also cases where people fear of sponges, wood, honeycombs etc.  For some individuals, even the verbal mention of phrase “fear of small holes” is enough to trigger fear. There are also persons that think that something might be living inside those holes

Following objects or images of it have triggered tryptophobia in some individuals:

  • Lotus flower seed head
  • Soap bubbles
  • Aerated chocolate holes
  • Skin prints of stones
  • Sponges
  • Corals
  • Woodpecker holes
  • Honeycombs
  • Condensation drops on a bottle
  • Sandstone structures
  • Holes made on delicious pancakes
  • Cantaloupe holes
  • Holes in pomegranates
  • Stretch marks on the skin after pregnancy


trypophobia imagestrypophobia images real

Trypophobia case reports

Here are some reports of persons with trypophobia:

Person #1

“I can’t really face small, irregularly or asymmetrically placed holes, they make me like, throw up in my mouth, cry a little bit, and shake all over, deeply.”

Person #2

“Guardians of the galaxy has quite a few trypophobia triggers in it. More so near the end. Left me very itchy and had to look away at least 3 times. Otherwise it was an amazing move!”

Person #3

“I have Trypophobia and find some images easier to look at than others. They can even have more holes and I won’t bother me… BUT this only happens if the holes are aligned such as Honey combs. If they’re scattered and just everywhere, that’s what gets me! … the ones that were in straight lines I could handle very well but the ones that were randomly placed were the ones I would start to feel my anxiety rising…”

According to some data, even reality star Kendall Jenner has admitted that she struggles to look at clusters of holes, writing on her website: “Things that could set me off are pancakes, honeycomb, or lotus heads (the worst!).”

What causes trypophobia?

According to findings of Geoff Cole and Arnold Wilkins from the University of Essex, the brains of individuals with trypophobia connect the holes with some kind of danger.

However, what kind of danger trypophobiac senses or imagines is yet unknown. Other thinks that trypophobia is actually a type of basophobia or fear of falling, which is according to some scientist one of fears that we are born with (including fears of strangers, pain/death and failure).

Some psychiatrists may include following causes that can lead to trypophobia

  • Deep rooted traumatic emotional problem associated with childhood may somehow trigger traumatic memories associated with holes. Possible bee allergy to stings and traumatic event from it in the past that led to a swelling wherein the swollen skin displayed every pore may be a good example why someone gets trypophobia.
  • Evolution may be one of the major causes behind trypophobia. Scientists explain this cause by giving the example of “pockmarked objects” which do not seem “quite right or completely normal”.  Some primitive parts of the brain don’t perceive it properly or associate these ‘pockmarks’ with something dangerous.
  • Holes also tend to be related with troublesome conditions such as rashes or skin blisters that typically follow an episode of measles or chicken pox. Wilkins and Cole described this in their study a study from 2013. They claimed that it is instinctual to associate different shapes with danger, as the brain naturally relates them with disease or wound
  • Some experts think that it is human DNA to feel repelled by the repeated patterns.

Evolutionary survival response theory of trypophobia development

New research conducted by psychological scientists G. Cole and A. Wilkins of the University of Essex proposes that trypophobia may happen as a result of a particular visual feature also found among numerous poisonous animals.

According to giving survival information (in this case wrong) that we are looking at a poisonous animal, plant, or place where some animal is hiding (snakes, scorpions, spiders, bees and various insects, they are all living in holes or clusters of holes). They concluded that clusters of holes are aversive because they might share a visual feature with animals that during evolution, humans have learned to avoid as a in order to survive

One of the best proofs that support this theory is a story of one trypophobia sufferer in which he tells that he has seen an animal that caused him to experience a trypophobic reaction, and this was actually the blue-ringed octopus.

Blue-ringed octopus

New mathematical theory of trypophobia development

In most cases of trypophobia, holes are no obvious threat and danger. Person can’t fall in these holes and can’t get possibly injured.  Also different photos that may induce the phobia do not have something in common with one another, other than their configuration.

So, it appears that actually the configuration may hold the key to the emotion that these photos can induce. It has been also shown that people without trypophobia may find trypophobic photos aversive, even they do not experience fear or any other emotion. It has been suggested that maybe configuration gives the image some mathematical properties that are shared by most images able to cause eyestrain, visual discomfort or headache.

Images with such mathematical patterns in some individuals can’t be processed efficiently by the brain and thus brain needs more oxygenation. One finding suggest that discomforts may occur specifically because people avoid looking at the images since they need excessive oxygenation of the brain. As, the brain uses about 20% of the body’s energy, there is physiology mechanism that its energy usage needs to be kept to a minimum.

So trypophobic images are among those that for some individuals are extremely uncomfortable to look at. Currently it is investigating why trypophobiacs and not others experience an emotional response.

It has been also noted that images of example skin diseases can provoke disgust in most people, which is probably an evolutionary mechanism promoting avoidance for survival value.

Results showed that images of skin lesions or mould have mathematical patterns similar to images that are trypophobics afraid of. Probably, discomfort caused in trypophobiacs is a useful mechanism for avoiding both excessive oxygenation and objects that provide a danger in terms of contamination. It may be that in trypophobiacs, this mechanism is expressed too much.

Trypophobia signs and symptoms

Patient with trypophobia may experience following signs and symptoms:

  • Sensation of skin ‘crawling’
  • Shuddering
  • Feeling itchy
  • Feeling sickened or disgusted
  • Nausea and vomiting
  • Bizarre thoughts of falling into the deep holes
  • Sweating
  • Aggression and agitation
  • Compulsive thinking about holes
  • Shortness of breath
  • Rapid heart beats
  • Panic attacks

Typical clinical representation of trypophobia is following. When the attack of trypophobia takes place, the first noticeable symptom is the paleness in skin. After this trypophobic person usually begins to sweat. In some cases allergic reactions including skin redness or bright spots on skin can be manifested as a result of the emotional reaction that occurs. Soon trypophobiac may feel weakness in limb.

Tachycardia and difficulty in breathing are also often. If the attack is not so severe the worst symptoms affected person may experience are: nausea, vomiting, headache, dizziness and agitation. If the fear continues to grow, usually heartbeat increases.

In rare cases, this quick change can result in a heart attack. Panic attacks are also common. A person who has trypophobia may also feel shortness of breathing, which can sometimes be life-threatened.

According to all stated, the signs and symptoms of trypophobia are most commonly not so severe, they are distinct and easy to identify.

Trypophobia diagnosis and tests

Except clinical representation or eventually direct fear manifested when cluster hole images are shown to  trypophobiac, there are no other diagnostic methods  for identifying whether the person is suffering from trypophobia or not.

In some cases, neurological testing can be helpful in order to check brain readings and identify if the person has fear of holes. The trypophobia can also be diagnosed if doctor notice a certain change in a reaction such as gag reflex in trypophobiac at the sudden imagery of clustered holes.

Trypophobia treatment

Since trypophobia is a type of specific phobia, the best treatment option is to face your fear of holes and learn how to overcome it. True cause of trypophobia is not yet undertood, however, the same treatment options used for overcoming other kinds of specific phobias can be also used for treating trypophobia.

Following treatment options can be considered in patients with trypophobia:

  • Cognitive behavior therapy
  • Exposure therapy
  • Morita therapy
  • Behavior therapy
  • Counseling
  • Hypnosis
  • Neuro Linguistic programming therapy
  • Pharmacological therapy

Cognitive behavioral therapy (CBT) for trypophobia

Different from psychoanalysis, where the therapist search for unconscious causes behind behaviors and then confirms a diagnosis, CBT is typically “problem-focused” and “action-oriented”. This means that CBT is used to treat specific mental problems related to an already diagnosed disorder whereas the therapist’s role is to assist in finding and training effective strategies in order to decrease symptoms of the disorder and achieve final goal.

CBT is typically based on the belief that distortions of thoughts and maladaptive behaviors play the most important role in the development of psychological disorders. So, by teaching new ways of information-processing skills and by coping mechanisms symptoms of mental disordrs can be reduced.

CBT focuses on altering a person’s thinking which include conversion of negative, harmful or unproductive thoughts patterns into positive and controlled ones. It eventually helps the trypophobic individual to find the difference between reality and imagination and overcome fear of holes.

Typical example how CBT may work for particular case of trypophobia is following:

Trypophobiac may think to her/himself: “I can’t go outside because I might see a flower that has holes in it.” CBT therapist will challenge you to realize that this thought is irrational and unrealistic; possibly by pointing out that there is no way that this flower can hurt you.

Then, you will be challenge to revise the thought so that it is positive and more realistic, such as: “I might see a flower with holes in it if I go outside, but it can’t hurt me. I can always look away if it somehow bothers me.”

Hypnosis for trypophobia

Hypnosis has been shown as effective treatment for many persons with phobias. It works by retrieving the underlying cause of the phobia and eliminating affected person’s response to the stimulus. The initial goal of the hypnotherapist is to discover the event from which the phobia is developed.

In most cases the cause is traumatic event which in the past. Regularly the phobic individual does not remember this past event as it can be repressed for many years. Repression is known as a protective mechanism of our mind that utilizes by keeping memory of the trauma out of our conscious until we are ready and able to deal with it.

In order to access this memory state of heightened relaxation and focus or hypnotic trance need to be achieved so unconscious can be accessed. Thus unconscious memories can be revealed and brought to conscious awareness. When this is achieved, the phobia will generally disappear.

Exposure therapy for trypophobia

Different psychological methods can be assumed in order to overcome the specific phobia in the person by calming the person with some images which gives positive emotions to trypophobiac, and which don’t make her or him to fear and then show another image of clustered patterns. This way the brain can be trained to reduce the obsession in affected person. These principles are known as the exposure therapy.

Morita therapy for trypophobia

Morita therapy can be also used which teaches how to go with the flow can also be adopted. The final goal is character building, which enables the patient to live responsibly and constructively. Morita therapy was influenced by the psychological principles of Zen Buddhism.

Medications for trypophobia

Pharmacological therapy with short-term anxiolytic drugs should be considered only in severe cases of trypophobia accompanied with serious distress and panic attacks. Sedatives and antihistamines can be prescribed to control the skin rashes that may appear in some individuals due to fear. Medicines like phenytoin tablets are also used to calm the trypophobia or fear of holes patient down

Neuro-Linguistic programming therapy

This therapy can be also used in treating patients with trypophobia. This includes exposing the subject to fears in this case holes and altering or reprogramming them in order to reduce the phobia.

Yoga, meditation, or some other relaxation technique for trypophobia

If your phobia is just too severe enough to oppose the object at first, try using different relaxation techniques such as meditation or yoga in order to reduce your anxiety.

Yoga and meditation are great techniques for relaxation, and they will also work better if you try progressive muscle relaxation, proper breathing exercises, or simply take a long soothing shower. You can also try to find something that works best for you and use it to help you deal with anxiety from your triggers.

Lifestyle changes for trypophobia

Exercises, healthy diet, good rest, adequate social life, are all significant components of proper mental health. Since trypophobia may be taking a strong impact on your routine activities, it is required from you to put extra effort into maintaining your health.

Regular exercises of about 30 minutes per day, a healthy diet of healthy whole foods like fruit, vegetables, whole grains, and lean proteins, and adequate sleep of 7-9 hours can also regulate your anxiety under control. It is important to make mentioned things to be your everyday routine.

Share your fear with family and best friends

It’s always a good option to talk to with your family and closest friends about your fears or anxiety. Try to open yourself up to somebody who you trust and who can understand your fear and might help you to start dealing with it.

You can also consider joining to some online forum if you don’t feel comfortable and easy for sharing your fear with any of your family or friends just yet. This is important, as you may find that there are also people with similar concerns and experiences that may help you to feel less alone. Such people may also suggest different methods that they’ve used for dealing with trypophobia.

How long trypophobia usually lasts?

The general prognosis for trypophobia is good. Usually 3 to 8 months may be necessary in order to clinically to treat the patient with psychological care.

The time required to recover you from this specific phobia commonly depends on the treatment. You can also consult your healthcare provider regarding the time length of treatment and also about the fact that trypophobia may reoccur to you or not. Recovery period/ healing time will be faster if you get help at the early stage of the trypophobia.

Trypophobia prevention

Once you overcome the fear, daily exercises with objects that might raise the fear in you are recommendable.

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Pericoronitis – Definition, Reasons, Sign and Symptoms, Contagious, Pain management and Prevention

Jul 26 2017 Published by under Diseases

What is pericoronitis?

An inflammation in the gum tissue surrounding the crown portion of a tooth is called as pericoronitis. In this, the lower third molar (wisdom) tooth gets covered and chewing surface overlapped by gum tissue. Pericoronitis can be chronic or acute.

Chronic Pericoronitis: In this, the inflammation is mild but persistent.

Acute Pericoronitis: In this, infection starts spreading and cause fever, swelling and intense pain.

Pericoronitis is usually confused with peridontitis, and is differentiated by peridontitis in a way that peridontitis occurs specifically around a partially erupted tooth and gum cavity start covering the tooth before emerging from gum. Whereas the cause is same in both the conditions that is formation of gum abscess by entrapment of debris and bacteria under the gum tissue.

Pericoronitis: What it Is, What Causes It, and What You Can Do

What are the causes of pericoronitis?

The primary cause of pericoronitis is accumulation of bacteria.

  1. It can develop when wisdom tooth is broken through the gum or erupted.
  2. The erupted space makes the opening for bacteria to enter the tooth and cause an infection.
  3. After having meals and after munching, a bacterial film left on the teeth and entered under the flap of gum around the tooth.
  4. The bacteria are trapped in between the tooth and overlapping gum that is also known as “operculum”.
  5. It starts accumulating under the gum fold and converted into the debris.
  6. After sometime, it starts irritating the gum and lead to pericoronitis.
  7. If left untreated, the infection may extend beyond the jaw to the cheeks and neck and results into the severe pericoronitis.
  8. Active infection is associated with an abscess that contains pus, which has the ability to spread if left unattended.

Is pericoronitis contagious?

Pericoronits is the condition in which the wisdom tooth gets affected only if it is partially erupted. Only then, it can give space to bacteria to enter into the gum cavity.

Just like viruses, you can also pass bacteria back and forth by means of kissing and sharing utensils. Only wisdom tooth can be affected by pericoronitis. The one who removed his/her wisdom tooth removed and their gums are intact, are less prone to catch this infection.

What bacteria cause pericoronitis?

A microscopic examination had been carried out in order to know the responsible bacteria for pericoronitis. We have seen the cultivation of facultative anaerobic microflora such as streptococcus Milleri group (78%), Stomatococcus mucilaginosus (71%) and Rothia dentocariosa (57%).

And we concluded that a well known, streptococci milleri group bacteria, which is known for its ability to cause superlative infections, and these microorganisms are involved in pathogenesis of acute severe pericoronitis of the lower third molar.

What are risk factors for pericoronitis?

Pericoronitis is a disease that mainly affects the young adults in their mid20sandinthepersonswho are experiencing poorly erupting wisdom teeth. Plaque formation is the main risk factor.

Other risk factors include the presence of excess opurculum (gum tissue) overlapping the wisdom tooth and difficult cleaning of wisdom tooth after overlapping of gum tissue.

Is pericoronitis painful?

When the infection exceeds in the jaw and cheeks area, the overlapping area of operculum starts swelling which cause intense pain.

The pain in the pericoronitis is severe and spontaneous. The pain more often aggravated by closing of mouth or unintentional chewing by wisdom tooth.

In some cases of swelling of operculum, opening and closing of the mouth during examination of the mouth, the pain is worsened.

Pain can be exceeds towards ear and cheeks.

Can pericoronitis cause headache?

This second approach can be a good one. Indistinct symptoms involving pain, pressure sensation or headaches are sometimes ultimately attributed to non-tooth conditions.

Can pericoronitis cause ear pain?

When pericoronitis left unseen, the infection in the tooth increases, which cause severe pain in lower jaw and wisdom tooth. This pain can spread to throat and ear.

Can pericoronitis cause bad breath?

The bacteria that is grown the gum cavity in the pericoronitis is responsible for causing bad breath. These bacteria release sulfur-containing compounds, which is called as “volatile sulfur compounds”, (or VSC’s for short).

When the volatile sulphur compounds are increased, they cause bad breath.

When tounge bacteria break down these bacteria, the bad breath gets worse.

Difference between acute and chronic pericoronitis

Acute pericoronitis:

Acute pericoronitis is caused due to trauma from the upper maxillary molar occlusion at the retromolar region. Symptoms of acute pericoronitis are inflammation of operculum, severe redness and soreness, continuous severe localized pain. Localized intra oral swelling occurs.

Pungent odour and halitosis is also most common in patients suffering from acute pericoronitis. Some other symptoms include tenderness and enlargement of lymph node locally, fever and malaise, leucocytosis, dysphagia, pyrexia associated with tachycardia can be seen if the condition left unseen or untreated.

Chronic pericoronitis:

Its presence shows the recurring inflammation and infection in the pericoronal region, and the dull pain in the pericoronal region. Its one of common symptom is halitosis and bad taste in oral cavity.

Difference between pericoronitis and Temporomandibular joint disorder

Pericoronitis is the gum disease in which the erupted wisdom tooth is overlapped by gum tissue that causes swelling in the overlapped tissues, which cause intense pain whereas tempo mandibular joint disorder is the disease, in which patient experience localized pain in the joint, which connect cheekbone and jaw bone. The pain occurs due to joint injury or tooth injury, misalignment of the teeth.


Pericoronitis is the inflammation of the gum tissue surrounding the crown tissue of the wisdom tooth.  It is caused by overlapping of the gum tissue on the erupted wisdom tooth. Whereas temporomandibular disorder is the pain in the cheekbone and jawbone. It is caused by jaw injury, tooth injury, misalignment of the tooth, teeth grinding, poor posture, gum chewing or arthritis.

Signs and symptoms:

In pericoronitis, there is Intense pain in tooth, oral swelling and bad breath, restricted mouth opening, Discharge from pericoronal space, pain in the jaw joint. Where as the symptoms of Temporomandibular joint disorder are Jaw clicking and popping, Ear pain, popping sounds in ears, headaches, sore jaw muscles, locking of jaw joint

What are the signs and symptoms of pericoronitis?

Early stage of pericoronitis is often confused with normal teething. Symptoms of acute pericorornitis are :

  • Severe throbbing pain.
  • Extra oral swelling
  • Restricted mouth opening.
  • Purulent discharge from pericoronal space.
  • Halitosis, leucocytosis and malaise are also common in some cases of pericoronitis.
  • In addition patient may also notice sloughing or ulceration around the operculum.

When left untreated, the infection spread in sublingual and para-pharyngeal spaces, which is followed by dysphagia. In this, the patient has difficulty in swelling food.

Why is my gum swollen around my wisdom tooth?

Pericoronitis diagnosis

Pericoronitis can be diagnosed by symptoms and appearance during a clinical evaluation with a dentist or a oral surgeon. A dental x-ray can be used to check out the other possible causes of the pain or dental decay. It can be diagnosed by the means of:

  • X-ray Examination
  • Oral examination
  • Clinical evaluation by a dentist

Difference between pericoronitis and Temporomandibular joint disorder

Pericoronitits is the gum disease in which the erupted wisdom tooth is overlapped by gum tissue that cause swelling in the overlapped tissues, which cause intense pain.

Whereas tempomandibular joint disorder is the disease, in which patient experience localized pain in the joint, which connect cheekbone and jaw bone. The pain occurs due to joint injury or tooth injury, misalignment of the teeth.


Pericoronitits is the inflammation of the gum tissue surrounding the crown tissue of the wisdom tooth.  It is caused by overlapping of the gum tissue on the erupted wisdom tooth.

Temporomandibular disorder is the pain in the cheekbone and jawbone. It is caused by jaw injury, tooth injury, misalignment of the tooth, teeth grinding, poor posture, gum chewing or arthritis.

Signs and symptoms:

Signs and symptoms of pericoronitis are:

  • Intense pain in tooth
  • Oral swelling and bad breath
  • Restricted mouth opening
  • Discharge from pericoronal space

Whereas signs and symptoms of temporomandibular disorder are:

  • Pain in the jaw joint,
  • Jaw clicking and popping
  • Ear pain
  • Popping sounds in ears
  • Headaches
  • Sore jaw muscles
  • Locking of jaw joint

How can I prevent pericoronitis?

The prevention of pericoronitis can be carried out by preemptive care and regular visit to dentist. The dentist keep a track on the problem spots, keep them clean and diagnose the need for extraction of the overlapping gum.

Pericoronitis treatment

Pericoronitis is the diseases, which require immediate attention due to intense pain and disturbed quality of life.

Depending upon the severity of the condition, pericoronitis can be treated by three methods:

  1. Pain management and infection resolution
  2. Dental surgery
  3. Tooth Extraction

Pain management of pericoronitis

The pain can be reduced by OTC (Over the counter) medications such as acetaminophen or ibuprofen. Painkillers can help with any dental pain from pericoronitis. If the infection is severe, the pain will be intense. If there is no spread of infection, the pain will be localized and less severe.

A course of antibiotics may be recommended by the dentist to treat infection. If there is swelling or fever, oral antibiotics such as amoxicillin or erythromycin can be prescribed.

Dental surgery for pericoronitis

In case of pericoronitis, a minor surgery can be performed, depending upon need and use of tooth. In this, operculum is removed. The operculum is removed in order to easy access and proper cleaning of the infected area. This prevents the accumulation f the bacteria and food debris. Sometimes, gum tissues grow again and cause the same problem again.

It may be recommended to refer a oral surgeon or maxillofacial surgeon if wisdom tooth cause problems, the removal of wisdom tooth.

Removal of tooth in case of pericoronitis

When the wisdom tooth does not erupt completely and poorly impositioned, the removal of tooth is necessary and is most common treatment known. The removal of tooth prevents any kind of future consequences.

In rare cases, the symptoms become so severe that an individual needs to go the hospital emergency room to seek care due to the rapid spread of infection. After treatment of pericoronitis, and removal of tooth, oral hygiene measures may be advised.

Are antibiotics helpful for pericoronitis? What antibiotics should I use?

Drainage of abscess and empirical antibiotic therapy is recommended for severe infections such as pericoronitits and cellulitis. Metronidazole in 250mg dose every 8 hours is recommended for infections in which anaerobic bacteria are implicated, such as pericoronitis, periodontal abscess and ulcerative gingivitis. It is given due to its best pharmacokinetic and pharmacodynamics properties.

The short course antibiotic therapy requires the antibiotics with certain characteristics:

  • Rapid onset of activity
  • Bactericidal activity
  • Easy permeability into tissues
  • Activity against non-dividing bacteria
  • Administration of optimal dose
  • Optimal dosing regimen

Other common used antibiotic in dental practice are amoxicillin which is followed be penicillin. Among the group of penicillin, amoxicillin, amoxicillin and clavulanate combination is used most commonly because penicillin is still the gold standard therapy. A combination of amoxicillin and clavulanic acid has many advantages that includes increased inconvenience, improved compliance and improved tolerability, in a dose over three times daily.

What should I do to maintain oral hygiene in pericoronitis?

  • Erupted wisdom tooth with overlapping gum tissues is very had to clean and non cleaning can result into tooth decay. The erupted wisdom tooth can be treated after checking the reason of infection.
  • After a difficult surgical extraction of lower wisdom tooth, the extraction socket get inflamed, swelled and infectious, which is called as alveolitis. And it is caused by poor oral hygiene.
  • Proper oral hygiene is the key to prevent symptoms. Its proper cleaning should be carried out by using soft electrical or manual toothbrush.
  • One can try small or kids toothbrush for cleaning of wisdom tooth and they should use mouthwash, which contains fluoride. The cleaning with mouthwash is necessary to prevent the spread of infection.
  • When toothache caused by pericoronitis, one should be treated with normal painkillers and mouthwash containing chlorhexidine.

Antiseptics for pericoronitis

The antiseptic gels should be used topically after gentle lifting of gum covering the erupted wisdom tooth.

A mouth rinse containing essential oils (e.g., Listerine Antiseptic) is as effective as chlorhexidine in the treatment of pericoronitis and may result in less calculus accumulation and tooth staining.

listerine pericoronitis

What analgesics are best for pericoronitis?

Analgesics are the other name for painkillers.  Analgesics are of two types:

  • Opioid
  • Non-opioid

Opioid prescription analgesic:

These are referred as narcotics such as morphine derived from opium and are very powerful. They give additional pain relief in high doses but there are other potentially dangerous side effects. These opioids should not be used in dentistry. If needed, It should be used for very short period and for very short time periods due to its potential side effects.

Non-Opioid prescription or OTC analgesics:

Non-opioid analgesics are generally used to control dental pain until definitive treatment can be instigated. These are given pre and post operatively as an adjunct to dental treatment.

Ibuprofen is also considered as best painkiller and should be given before dental procedure as it can help in reducing post operative pain. It acts by blocking the production of pain causing chemicals inside the body. An analgesic should be taken as a recommended dose.

Analgesics acts by two ways i.e. reducing the inflammation or by diminishing the brain’s perception of pain through nervous system. They are considered best painkillers because they increase the pain relieving effect as well as minimal side effects.

The non-opioids analgesic are divided in to two types:

  • Salicylates
  • NSAIDs (Non-steriodal Anti Inflammatory Agents)
  • Acetaminophen


Best known and most commonly used salicylate is Aspirin. It is helpful in reducing pain and fever. Dentists or surgeon interests this medication as it cause thinning of blood and diminished blood clotting. After a dental surgery or tooth extraction, aspirin is not advised.


These painkillers are similar to aspirin due to same mode of action, pharmacological effects and adverse reactions.

It possesses anti-inflammatory properties and has a powerful pain relieving effect as well as action. They are superior over opioids due to better safety profile and it is most useful in density due to its sontrol on mild to moderate pain.

Ibuprofen is an important NSAID which is used in combination of paracetamol for pain relief in toothache.  NSAIDs are available in varying strengths, sometimes used without prescription. The effective dose of ibuprofen is 400-800 mg and higher doses do not have a benefit as far as dental pain relief is concerned. Higher doses are prescribed when there is swelling apparent, as well as pain and the anti-inflammatory effect is important.

Ibuprofen is generally well tolerated and produces some gastro-intestinal in some patients. Ibuprofen can reduce the blood thinning effect of aspirin so patients taking aspirin for cardiovascular protection should avoid it.

Diclofenac is another potent NSAID, as is also aceclofenac which may cause less gastrointestinal side effects.

Acetaminophen/paracetamol for pericoronitis pain relief

Acetaminophen/paracetamol acts more centrally, to block the pain messages in the brain and has little effect in reducing inflammation but is an effective medicine for toothache. It is useful for those who can’t take aspirin or it can be combined with aspirin or a NSAID to greater effect.

A dose of 4-500 mg is commonly used and adequate, although the maximum effective dose for toothache relief is about 1000 mg. An excessive amount of acetaminophen can potentially cause liver damage so this needs to be taken into account, especially when analgesic products combining two or three types are used.

Only when the dose of NSAID and/or paracetamol is at optimum levels, is it usually necessary to consider adding an opioid, and this is fairly rare in most dental problem circumstances.

Operculectomy for pericoronitis

Operculectomy is the surgical procedure of removing the operculum, the flap of gum that partially covers a tooth in pericoronitis. Pericoronitis typically occurs in patients whose wisdom tooth starts to erupt and is most common among young adults.

Operculum is the extending part of the gum tissues that overlap the erupted wisdom tooth. It is a mass of soft tissue and is most commonly associated with lower wisdom tooth.

Sometimes it also covers the permanent molars and some baby teeth. In normal teething, the gum tissue moves back as the tooth continue to erupt and takes its accurate position. Whereas in pericoronitis these gum tissue exceeds and cover the tooth instead to recede. A normal tooth should not be covered with any gum tissue on it chewing surface.

In the case of pericoronitis, the lower wisdom tooth is not able to erupt fully and come out of the gum line.  Also the operculum do not recede fully and cover the wisdom tooth completely and permanently. The upper molar start putting pressure on lower counterparts which cause intense pain and disturbs the quality of life of patient. Therefore, there is a need for operculectomy in case of pericoronitis.

Tooth extraction and pericoronitis

In pericoronitis, the primary aim to get relief from pain associated. An inflammation in the gum tissue surrounding the crown area of tooth occurred due to overlapping of erupted wisdom tooth with operculum. A dental surgery known as operculctomy is done to remove operculum.

But if there is swelling, infection, difficulty in swallowing, fever or intense pain, the wisdom tooth be extracted as soon as possible. After extraction of tooth, proper antibiotics should be taken as prescribed. Warm saltwater rinse and OTC painkillers are also advised in order to get relief from toothache.

Natural remedies for pericoronitis

Swelling in the gum area cause severe toothache. One should seek medical attention immediately in case of excessive pain. But meanwhile you can try some natural painkillers and remedies to avoid pain at home.

Salt and Pepper:

One should make a paste from salt and pepper in equal quantities and place it on the infected area. Salt and pepper contains anti-inflammatory and painkilling properties. Apply the mixture and rest it for sometime.


Apart from its great antibiotic and other medical properties, garlic is a great painkiller for toothache. One can crush the garlic, clove and add in the black pepper and salt, and apply the mixture on the affected area.


Clove is considered as one of the best natural remedy for toothache. It contains anesthetic, antioxidant and anti-inflammatory properties due to which clove is known to relieve toothache and combat infections. One can mix clove oil with water to make a mouthwash and then rinse the infected area thoroughly with this mouthwash. You can also soak a cotton ball in clove oil and rub this on infected tooth in order to get relief.


One of the best natural remedy for treating toothache is onion. It contains antimicrobial and antiseptic properties. It is beneficial in killing the bacteria and germs and provides relief from pain. Chew an onion in case of excessive pain, and if chewing is not possible then place an onion slice on the infected tooth.

Salt water:

Gargling with warm salty water is highly advised to get relief from toothache. For this mixture, one can mix warm water with half spoon salt.  Rinse your mouth with the mixture and any inflammation or swelling will reduce. Gargling with this solution is beneficial in killing of germs that may be associated with tooth infection.

What is the cause of excessive sweating? How do you stop sweating?

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What is Diaphoresis and excessive diaphoresis? – Types, Causes and Treatments

Jul 25 2017 Published by under Diseases

What is diaphoresis?

Diaphoresis, which is also known as perspiration or sweating, refers to the production of sweat by sweat glands of mammals. When a person is under conditions of hot temperatures or has undergone body exercises, the sweat glands respond to the changes in the body temperature through vasodilatation.

This process regulates the body temperature where the blood vessels dilate hence getting into close contact with the skin to excrete sweat, therefore, bringing the temperatures of the body to normal.

The sweating mechanism of the body is significantly important to the body as makes it possible for the release of some of the toxic substances within the body as well as helps the body in the cooling mechanism of the body.  This mechanism is a normal body reaction that has an optimum level of reaction over which the body automatically controls itself.

However, excessive diaphoresis is harmful to the body health whereby under some conditions such as drugs avoidance by an addicted person, may lead to sweat glands secreting excessive sweat where the skin may seem to be soaked in perspiration droplets.

Such a condition may expose the body to other infections which may later affect the health condition of a person due to dehydration of body cells. Excessive diaphoresis is much likely to cause other effects such as loss of the body cells turgidity leading to the wrinkled appearance of the skin when not treated for an extended period.

Diaphoresis - Causes, Symptoms, Treatment, Prognosis and Diagnosis

Why is diaphoresis important?

The normal sweating of the body helps in the maintaining the body temperature equilibrium to the external factors as well as cleaning the blood as toxic substances are removed from the blood through sweating. Also, perspiration also keeps the skin healthy by ensuring that the skin poles are always open.

However, at times, the person under excessive diaphoresis may be experiencing such conditions of excessive sweating even when at rest and under normal environmental temperatures. In such a situation, the person is advised to seek medical attention before the condition worsens.

Sweat glands and their types

Human beings have around four million sweat glands which are unevenly distributed throughout the body of a person. About three million of the sweat glands are Eccrine sweat glands and Apocrine glands. Eccrine glands are numerous on the forehead, soles of the feet palms and also on the cheeks.

On the other hand, Apocrine glands are situated in few areas such as on the axilla region and the urogenital area. The Apocrine to Eccrine ratio is the same in the axilla area and distributed in the rest of the body in the ratio of one is to ten glands, which is the reason as to why a person under excessive diaphoresis sweats profusely on the areas where Eccrine glands are located.

When the body temperature is not balanced with the external environmental temperature, the hypothalamus which is the center of thermoregulation controls the temperature of the body through regulation of eccrine glands output and flow of blood to the skin hence balancing the temperature by secretion of sweat. When sweat evaporates from the skin surface, it brings about the cooling effect to the body.

If conditions of excessive diaphoresis, the sweating glands found on the soles and palms and sometimes the axillae, are activated more than the sweat glands found on the rest of the body. The main cause of the activation of the glands is due to emotions which a person may have even when resting.

Different types of diaphoresis

There are three types of diaphoresis. These include intermittent diaphoresis, excessive diaphoresis, and generalized diaphoresis. These have almost alike in all condition but their different if the amount of perspiration excreted and the rate at which the perspiration occur.

These types of diaphoresis involve excessive sweating which is commonly associated with body shock. Some of the common causes of the diaphoresis are menopause, spicy foods, fever, and high temperatures of the environment, shock, hypovolemia and also hyperthyroidism.

Some of the causes of diaphoresis which are not mostly familiar are malaria, tuberculosis, carcinoid syndrome, alcohol, caffeine and more many others. Also, scholars argue that some causes of diaphoresis are sometimes related families with diabetes history. A diabetic person has a high risk of contracting diaphoresis.

Excessive Diaphoresis

Excessive Diaphoresis condition has been common in many people, and most cases it is a possible indication of an ailment or a body disorder or a body attack by a foreign body or a disease causing organism. The condition is much likely displayed in some parts of the body which make the person under the condition to be in discomfort and may destabilize the social capabilities of the victim.

This excessive sweating is mostly noticed on the palms of the victim hence may make the person avoid shaking people and even socializing at a low level.  Other parts of the body where excessive sweat takes place are the armpits, on the cheeks, on the forehead and also the soles of the feet. However, this condition can be diagnosed and be well treated.

Types of Diaphoresis

What are different types of excessive diaphoresis?

Excessive diaphoresis is categorized into three states which the person may be affected and these are:

  1. Primary or the focal diaphoresis
  2. Secondary diaphoresis
  3. General diaphoresis

Primary or the focal diaphoresis

This is a category of the excessive diaphoresis which the person under the condition experience excessive sweating in the primary areas of the body such as the facial area, the palms of the hands and the feet of the person, as well as the armpits of the person, is much likely to be affected. It is also called the idiopathic which refers to the condition as to be unknown.

The conditions segregate all other body parts leaving out the major area of the body to normal condition, the torso, while the specific areas on the body are much affected and excretes much sweat than the other parts of the body. A possible explanation is that the body parts of the affected areas could be having super reactive sweat gland that responds swiftly and much longer to any possible body imbalance.

However, it is also assumed that the condition is much likely to be a genetic factor such that the person in the question could have inherited it from his family lineage. It is a rare condition with a statistical data in which most cases appear at a level of thirty percent of a given population and is more likely to be in people under the age of twenty-five.

The condition could get to adverse level if the person gets to a level which causes sweat to occur more profusely which could lead the person to possible dehydrations.  However, the patient is said to be much likely to have the eczema condition developing upon the primary sweat disorder.

Secondary diaphoresis

In contrast to the first condition of the sweating disorder, this type of diaphoresis is much focused on the particular part of the focal body part that makes it outstanding and sweating more profusely than the rest of the body.  The secondary body disorder is much likely to be having a possible reason and effect of the sweat disorder and is a possible symptom of another ailment.  This is because of none symmetrical nature of the condition.

The general type of excessive diaphoresis

The general type of diaphoresis is equally different from the rest as this one affects the entire body making the person under the condition to sweat all over the body.  Unlike the primary state, the general condition is likely to be caused by a medical condition that makes the person sweat all over his body.

It is equally treatable like the secondary type, but the treatment depends on the aftermath tests to establish the medical cause of the excessive sweating.  Devious hormonal imbalance, an infection to the spinal cord or a side effect from certain medicines is part of the possible causes of the general type of sweat infection.

What is evaporation?

When the body temperature rises over 98.6F or when the body realizes that the surrounding temperature is above the body temperature, the body starts to sweat. The radiation, convection and conduction modes of heat transfer remove more heat from the body than bringing to the body through the skin.

Since there supposed to be an equal outward transfer of heat, the evaporation of sweat remains the only mechanism to transfer the heat from the body for evaporative cooling to take place. Even when a person is unaware of perspiration occurring in the body, various scholars assert that about 600 grams of sweat are lost per day from the skin.

During a hot day, sweat evaporates from the skin taking the little heat with it, hence cooling the body. Sweat usually evaporates from the body surface when there is a little water in the air. Therefore, when there is much humidity surrounding the body, no sweat can evaporate out of the skin since the air is already saturated with water molecules hence can hold no more of sweat.

When the environment surrounding the body is dry, sweat evaporates quickly taking away some of the body heat. As more amounts of sweat evaporate, the air surrounding the body become humid hence reduces the rate of sweating. The more humid the air becomes, the more the skin reduces its rates of sweating.

Relations between nervous system and diaphoresis

The Sympathetic Nervous System which is abbreviated as SNS is one of the two divisions of Autonomic Nervous System in which the second is Parasympathetic Nervous System abbreviated as PSNS. The Autonomic Nervous System is responsible for regulation of unconscious actions of the body. The SNS major purpose is the stimulation of the ‘fight or flight’ body response.

The reaction starts in the amygdala hence triggering the neural response which takes place in the hypothalamus. The first reaction is then followed by the activation of an anterior part of the pituitary gland which leads to secretion of Adrenocorticotropic hormone commonly abbreviated as ACTH.

The adrenal gland is also activated at the same time releasing a hormone called epinephrine which is a chemical messenger that leads to productions of cortisol hormone. Cortisol hormone increases the blood sugar and blood pressure which leads to increases blood flow hence causing diaphoresis. Increased functioning of SNS leads to excessive diaphoresis.

Also, when body temperature goes beyond 98.6F (about 37Celsius), hypothalamus bring the temperature to normal by triggering the sweat mechanism. Increased temperatures lead to excessive diaphoresis.

What is cold sweating?

A body of a person usually produces sweat to keep itself fresh and cool. Sweating in most cases occurs due to exertion such as exercises or even in hot environments. However, cold sweating occurs due to anxiety or fear. The sweating occurs all over a sudden resulting in a cool and damp skin.

Cold sweating occurs as a response to the body reaction due to stress brought about by ‘fight or flight’ mechanism which assists the body to react when in dangerous conditions. Sometimes cold sweating occurs at night in nightmares when a person is asleep. To the individuals who have prolonged stress, sweating can be one of the symptoms.

Cold sweating is not a problem in medical basis, but at times it can be a sign of severe conditions that may need medical attention. Some of the conditions are a serious injury that causes great pain, shock, heart attack, breathing problems and also a little amount of sugar in the blood.

Is blood sweating real?

Yes, it is very rare condition which is called hematohydrosis. This is a body condition where the body of the individual suffering sweats blood. It is however very rare condition where the individual under the state releases sweat in the form of blood in the facial part of the body.

The common diagnosis knowledge about the condition is that it is not said to be fatal of anyway and there are no specific body conditions that result from blood sweats that could be emergency cases in the body make up.

The natural conditions of the body are that whenever there is heat or any form of a body threat causing an imbalance of the body, there normally is a natural way that the body reacts to the condition releasing specific substances that counter the condition making it get back the equilibrium at a speedy rate.

The production of the adrenaline and the cortisol is among the common body responses that the body reacts in response to countering other foreign body threats and attacks. This in return makes the body produce enough hormonal substances and strength that makes the body ready to counter any foreign attack and threat, conditions that make the body stable from any damage or effect of the threat.

However, in the blood sweat condition, the body tends to fail in the proper body response, and this could result to the blood capillaries bursting and consequently causing the sweat glands to release blood as sweat. In the eventual treatment of this condition, the medical facilitator tends to address the possible condition that could be causing the sweat to ooze out of the skin.

However, there are also the necessity of checking the blood count to confirm the stability if the blood as well as the blood platelets and any possibility of having a blood disorder. Possible medical checkups done are the ultrasound checks of the liver and the kidney to confirm optimum working of the body organs within the body as well as the use of depressants for the case of depression and fear.

Dehydration caused by Diaphoresis

As the body sweats, it releases an equal amount of water that is needed to cool the body and therefore the water should be replaced in the body through drinks. When the water is not replaced, the body may become dehydrated as it lacks enough water for the body cells to function normally. Increased dehydrations bring about dizziness and headaches and in severe cases can lead to serious sickness.

Lack of enough water in the body is a possible cause of dehydration and headaches that could be severe and intolerable. A migraine is a possible result of the dehydration which could be as a result of insufficient water in the body.

This, however, can also be translated as a result of heavy sweating in the body of an individual which momentarily leads to loss of water in the body of the patient and therefore the acute headaches. In most of the sweat cases, the major resulting condition that comes along with the condition is dehydration, a situation that makes it important to address the loss of water mass in the body of the person under the state.

The common solution to this condition is the simple intake of water at a normal rate of at least a glass of water at a time, which progressively returns the body to normal state swiftly. Besides the intake of water, pain relievers like the ibuprofen are also recommended in the intake alongside the water intake.

It is also recommended to the intake of electrolytes which are the essential minerals that the body requires for the optimum functioning of the body. The electrolytes are ingested in the normal food intakes, however; these minerals when supplied through drinking water make the recovery of the person under the condition to be quite rapid and effectively reached.

It should be noted that over-hydration of the patient could also be unpleasant as such could lead vomiting and unpleasant wellness of the patient. Among the pain relievers medicinal values, those drugs that contain caffeine are unpleasant in this state and are therefore not advised to use in the treatment of the condition.

Caffeine is also among the substances that cause dehydration and the pain relievers that contain caffeine are not advised in the treatment of the condition.

Causes of excessive diaphoresis

Excessive diaphoresis in most cases is a possible symptom of a medical condition within the body as to which it would be reacting from. Some of the conditions are much possibly fatal in the event of being left unattended to and have to be diagnosed with an immediate effect.

Big bodied people are commonly known to produce more sweat due to the bigger body mass which commonly reacts in its high production of high body heat.  Besides, there are major causes of excessive diaphoresis in the body which are the major and common causes of the excessive sweating.

Hyperthyroidism as a cause of excessive diaphoresis

This is a body condition in which the body produces a lot of thyroxine hormone as a result of the thyroid gland overreacting to the prevailing condition.  The production of thyroxine hormone leads to increase in the metabolic rates causing the body to overreact in a specific way resulting in phenomena such as excessive sweating.

This also leads to speeding up of the rate of the heart which could most possibly make the person develop nervousness and body instability.  The body instability would make the person become more shaking and therefore quite unstable. These body reactions and changes would most commonly result to overall unrest and difficult in sleep.

The unrest which is anxiety and lack of enough sleep are very much possible to result in weight loss in the person under the condition.  An important treatment of the condition is the most preferable and the proposed mode of overcoming Hyperthyroidism in the administering of the anti-thyroid in the initial levels of the treatment. The state is therefore not regarded as an emergency in the eventful medication provision but a continuous state that is treatable progressively.

Diabetes as a cause of excessive diaphoresis

Hypoglycemia is a body condition of a low blood sugar level which is fatal and has adverse effects before the fatality. Sweating is a sign of the possible infection of the condition. The low blood sugar level is a condition which affects many people and is referred to as diabetes. However, it is one of the types of diabetes.

The excessive sweating in Diabetes is a possible effect that would result in an-hydration and therefore anxiety, the body instability which could cause tremors and body shake. However, it is also important to note that diabetes is a body condition that is fatal and the low blood sugar levels must be attended to restore the level to equilibrium swiftly. Heavy sweating in diabetes also leads to dizziness and unstable ability in speaking.

Excessive diaphoresis is normally a problem to the people living with diabetes. The people normally experience three types of diaphoresis.

Hyperhidrosis: this is a situation where an individual undergoes excessive diaphoresis without exercises or change in temperatures. It occurs in low glucose level in the blood is low (hypoglycemia). When the glucose level reduces, a fight or flight reaction is triggered in the body. Excess norepinephrine and adrenaline hormones are produced hence causing excess diaphoresis. After the blood sugars come back to normal the diaphoresis stops.

Gustatory: This type of diaphoresis is normally caused by the food taken by an individual and usually occurs on the neck and the face areas. This condition is normally experienced by individuals who have autonomic neuropathy of diabetes which results from nerves damage.

This sweating is triggered by thinking about food or when drinking or eating. It occurs on the neck, scalp, and face and it is easily noticeable. This type of diaphoresis is induced by a stimulant hitting the taste buds which may occur when smelling food or when the food hits the stomach.

Night sweats: This sweating occurs due to a low level of glucose in the blood in the night. The factors that are likely to cause the low glucose levels are exercising when about to sleep at night, due to various insulin types used at night or evening or taking alcohol at night.

Heart Attack as a cause of excessive diaphoresis

Myocardial infarction which is a condition of the heart is a relative heart condition that results from the damage or the total dysfunction of a section of the muscle.  The clogging in any of the arteries of the heart results to possible interfering of the oxygenated blood flow to all the parts of the heart which could most possibly lead to myocardial infarction.

Blood flows at a high rate to compensate for the oxygen hence leading to excessive diaphoresis. Excessive sweating is among the symptoms that would be as a result of the heart attack besides discomforts in the chest and pain. The condition is an emergency that in the case of the sweating symptom and possible note of the state then the patient should be given an immediate medical attention.

Pregnancy as a cause of excessive diaphoresis

There usually are various hormonal changes and a hormonal increase in production within the body during pregnancy that triggers a series of reactions of the body concerning the particular secretion.

The different hormonal increase within the body causes an increase in the metabolic rate which in return results in a corresponding increase in the body temperature which automatically triggers an increase in the rate of sweating.  Similarly, there normally is an increase in the body mass which results in the increase in the sweating. However, the increase in the rate of body sweat during pregnancy is not of a possible concern that would cause any emergency attention.

Anaphylaxis as a cause of excessive diaphoresis

This disease is fatal though usually rare. Allergy reactions are usually at a normal rate, and the body easily returns to normal after a short period. Since the disease is associated with respiratory arrest, the individual normally experiences diaphoresis as they to breath. The sweating results from sudden metabolic activities in the body as the patient struggle to breathe.

However, there are allergy body reactions that are quite severe and in most cases interfere with the systematic reaction of the body especially immediately the body is made prone to the substance over which the body is allergic to.  This condition also results in other effects such as dehydration which could cause loss of consciousness and itchy skin. Anaphylaxis can also cause a change in the airways causing them to narrow, phenomena that could cause difficulty in breathing of the patient.

Anxiety as a cause of excessive diaphoresis

Diaphoresis is one of the significant symptoms of anxiety. Sweating is regarded as a natural response to stress related to fighting or flight body reaction mechanism. When a person suffers anxiety, sweating becomes one of the effects. In most cases, sweating due to anxiety are minor, but sometimes a person may experience excessive sweating due to a severe anxiety disorder.

In such situations, medical attention should be attended to. Sometimes when a person is undergoing anxiety, due to nervousness, the fight or flight system quickly alerts relevant body glands to produce a hormone.

The hormone triggers blood flow and heart rate to increase and sweating then activated to cool down the body failure to which the body will be in excessive heat that may damage the body tissues. In this case, diaphoresis is normal, but when the anxiety is high, it leads to excessive diaphoresis of the body.

Acute Febrile Illness as a cause of excessive diaphoresis

An Acute Febrile illness which involves rapid onsets of the corresponding fever and other symptoms such as joint and muscle pains, chills and headaches are commonly found in the subtropical and tropical areas.

This illness increases the body temperature which triggers hypothalamus so as to regulate the temperature to normal. When a person has the illness for an extended period, the hypothalamus is triggered more hence leading to excessive diaphoresis.

Gout as a cause of excessive diaphoresis

Diaphoresis is commonly found in people have a gout condition which mainly attacks males who have over 60 years of age who experiences blood pressure and are undergoing allopurinol medication.

Even though ladies have more sweat glands than men, men experience diaphoresis more than ladies due to various activities believed to be undertaken by men. People diagnosed with gout usually experience excessive diaphoresis due to nervousness in their body as nervousness is among the causes of the condition.

As gout often results from uric acid high levels in the bloodstream, the acid is mainly removed from the body through urination though sometimes is removes through perspiration also. The more the levels of uric acid in the blood the more the blood try to eliminate it out.

When the victim takes in more fluid and does exercises, the uric acid is removed through excessive diaphoresis to clean the blood by the elimination of the toxic substance from the body. People suffering from gout are advised to take a lot of water, and other fluids since reduced water in the body caused dehydration, which then increases the level of uric acid. Therefore a lot of water has to be taken to clear the acid.

Lymphoma as a cause of excessive diaphoresis

There are few symptoms or changes which are specific to lymphoma. As a result, lymphoma becomes very hard to diagnose. The seriousness of the symptoms of lymphoma usually depends on the organ involved and the part of the body where the condition started. Diaphoresis is one of the symptoms.

Diaphoresis is substantially found in males who are over 60 years old and are suffering from lymphoma especially Hodgkin’s Lymphoma. The diaphoresis is mainly found in males who also are under polaramine medication and have difficile colitis type of Clostridium.

Research shows that majority of the people suffering from Hodgkin’s lymphoma experience excessive diaphoresis due to their increased depression condition and pains which trigger sweat gland.

Obesity as a cause of excessive diaphoresis

Different studies show that obesity and excessive perspiration normally go hand in hand. The bodies of the people who are overweight usually work more than those that have normal weight. Prolonged working of body organs, tissues and cells are often associated with a significant loss of fluids from the body and an increased body temperature as well.

The exercises induce physiological changes in the body which result in hyperthermia, sodium imbalance and also dehydration as it happens obese people. These conditions are followed by impaired action in aerobic performance levels and many health problems.

Obesity may sometimes be related to alteration in physiological exercise responses. Since obese people have large body areas and an increased number of sweat glands, the lose a lot of body fluids through diaphoresis.

Since their body organs work more to cater for the needs of the body, there are increased physiological activities which lead to overheating of the body. So as to regulate the body temperature to normal, excessive diaphoresis takes place as a result.

Parkinson’s disease as a cause of excessive diaphoresis

In people who have Parkinson’s (PD) excessive diaphoresis is the biggest problem and in most cases, it puts a significant damper in the lifestyle of the victim. The excessive diaphoresis is due to increased physiological activities of the body as well as anxiety.

Studies show that excessive diaphoresis resulting from Parkinson’s disease typically concur with reduced activation of the glands responsible for sweating on the palms and asserts that axial hyperhidrosis can be a phenomenon for compensating for decreased extremities of sympathetic functions.

People with the disease, sweat mainly on the sole of the feet as sweat drenches from the rest of the body parts especially at night. The excessive diaphoresis is regarded as wearing off symptoms for the people having the disease upon taking the required dosage. In some cases, some of the people with PD perspire little, due to the effects of Parkinson’s anticholinergic medications such as trihexyphenidyl and procyclidine.

Rheumatoid Arthritis as a cause of excessive diaphoresis

Rheumatoid Arthritis is associated with inflammation of joints resulting in much pain and swollen condition. It involves extreme diaphoresis from neck; face and on the head which are accompanied by a bright-red heating rash that normally spread on the sweating regions and an overheating feeling in the entire body. Some of the patients describe the symptoms as a ‘body cooking feeling.’

The feelings are hard to bear especially under increased diaphoresis. The hair on the head appears as if soaked in water within a few minutes after it has been dried.

Coffee as a cause of excessive diaphoresis

Coffee being a stimulant stimulates the nervous system which in response increases the heart rate, increases the blood pressure in the body and also activates the sweat glands. More energy is produced as diaphoresis increases. Coffee not only stimulates the body but also boosts the body temperature by triggering the sweat glands naturally.

Alcohol as a cause of excessive diaphoresis

Drinking of alcohol usually causes dilation of blood vessels which then trigger the sweating process. Night sweating can also be caused by the withdrawal of alcohol or intolerance of alcohol. Alcohol is mostly metabolized in the liver as small amounts are broken down in the stomach lining.

According to the information obtained from the University of George Washington, only around 10% of the alcohol content is taken into the body leaves the body through perspiration, breathing process, and urine. The rest amount of alcohol is then broken down into various byproducts through the body metabolism in the liver. Diaphoresis caused by alcohol withdrawal is usually temporary.

Insulin shot as a cause of excessive diaphoresis

Insulin injection is meant to control the amounts of sugar in the blood of the people who are suffering from type 1 diabetes. Since insulin is a hormone, it triggers diaphoresis in the body of diabetic people. Upon injection of insulin to the body, energy is produced with increases the body temperature hence triggering the sweat glands to excrete sweat.

Excessive diaphoresis to the body upon injection of the insulin depends on the body condition of the victim and the period of usage of the hormone. A person who is using the hormonal injection for the first time may experience excessive diaphoresis compared to the one that is applied to the injection.

Drugs that may cause excessive diaphoresis

There are a significant number of non-prescription and prescription drugs that cause excessive diaphoresis as one of the side effects. Some of the drugs that induce sweating are Desipramine, Nortriptyline, pilocarpine, protriptyline, Zinc supplements, acetylcholine, albuterol, bacitracin, and ciprofloxacin among others. Below are different groups of drugs that has been shown to cause excessive diaphoresis (sweating):

Analgesics and excessive diaphoresis

Excessive diaphoresis is one of the various side effects of  NSAIDs and other analgesic pain medications. The patient may experience regular sweating while taking these drugs, or in some cases  may experience excessive sweating which is most commonly associated with withdrawal symptoms after abrupt discontinuation of opioid drugs.

The International Hyperhidrosis Society has a long list of analgesics that may provoke sweating in some patients, the most common are: celecoxib (Celebrex), fentanyl-based drugs, Methadone, Vicodin, OxyContin, Vioxx, Ultram, prescription Aleve and prescription Midol.

Cardiovascular drugs and excessive diaphoresis

Some drugs that are used for treating cardiovascular disorders are known to cause sweating, however in a small number of patients. The International Hyperhidrosis Society lists 17 classes of different cardiovascular drugs that has sweating as a side effect including: amlodipine (Norvasc), doxazosin (Cardura), lisinopril (Zestril), bumetanide (Bumex), digoxin (Digitek), ramipril (Altrace) and several nifedipine and verapamil based drugs.

Antidepressants and excessive diaphoresis

According to the International Hyperhidrosis Society, different antidepressant group of drugs may cause excessive sweating as a side effect. By brand name, the SSRIs antidepressants that may cause sweating are: Celexa, Paxil, Prozac, Symbyax, Luvox, Lexapro and Zoloft.

The SNRIs antidepressants that cause sweating are Cymbalta and Effexor. Additionally, the neuropsychiatric drug Norpramin is known to provoke sweating in a significant portion of patients.

Hormonal Drugs and excessive diaphoresis

While excessive sweating may be a side effect of different hormonal imbalances, some drugs given to patients with such may also increase sweating. According to The International Hyperhidrosis Society, 14 classes of hormonal drugs that may cause sweating as a side effect, including epinephrine-based drugs, thyroid regulators, testosterone drugs, Depo-Provera birth control pills,  and vasopressins.

Is excess sweating caused by Ecstasy (MDMA) serious?

Ecstasy (MDMA) is commonly know as recreational drug most commonly used on parties and raves due to its effects of increased empathy, euphoria, heightened sensations and physical activity.

Ecstasy can o cause vomiting and/or diarrhea as side effect. So, prolonged physical activity, vomiting, and/or diarrhea can contribute to intense sweating or loss of fluids leading to dehydration (when sodium levels in the body are too high) and sodium loss through sweat.

Additionally, ecstasy can also provoke water retention by stimulating Vasopressin release which is an anti-diuretic hormone that regulates blood pressure and water retention.

Thus, when sodium levels are too high, the body will become dehydrated and you will likely sweating and feel thirsty. Vasopressin is then released to allow for more water to pass through your kidneys. Consequently, when sodium levels become too low in the body, vasopressin is no longer released and kidneys absorb less amount of water so you will urinate more.

Vasopressin is released because you have taken the drug and not because you are dehydrated. So, your body retains more water than it would normally, making sodium levels to low, and more provoking hyponatremia.

Some ecstasy recreational users drink too much water without sufficiently replacing loss of sodium and this puts them at risk for not only to dehydration but also life treating condition called cerebral edema (swelling of brain cells), coma and death.

The good news is that for individuals suffering from low levels of sodium in the body, treatment with intravascular fluids can help stabilize sodium levels and reduce brain cell swelling.

So, if you or someone that you know chooses for recreational use of ecstasy, you can reduce the likelihood of low sodium levels and eventual dehydration by drinking water slowly except guzzling a lot at once however you feel thirsty and by including salty snacks, sports drinks, or juice to help replenish electrolytes such as sodium.

Treatment of Diaphoresis

It is with every importance that whenever the level of sweating goes up or whenever at any instance a person starts sweating at a specific body part, then the person should find a medical check immediately as this could be a possible cause of an infection.

The most common symptoms that so easily accompany the heavy sweating is the loss of body water content such that results to dehydration and this could cause nausea and possible vomiting conditions. Heart palpitation and the change in the color of the skin to paleness are among the most probable effects and causes of heavy sweats.

Specific treatments of diaphoresis coincide with the different conditions of the body which are making the sweating levels to escalate.  Antiperspirants are among the major resolutions of countering excessive sweating especially in the armpits, a similar one that contains aluminum chloride substance at a level of not more that fifteen percent which could be harmful to the body.

In the abnormal sweats of the palms and the feet, the anticholinergic medications are the possible drugs that are administered to the suffering individuals.

Antiperspirants and diaphoresis

Roll on, and deodorants are the common products that are used in the common effort of overcoming the effect of sweat and the possible odors that are produced by the sweating, which is very unpleasant with the person exhibiting the condition. These products are the commonly referred to as Antiperspirants and are used in the personal effort in maintaining the personal hygiene and cleanliness.

The products have special substances that normally input in them during the commercial manufacture such that they help in the overcoming of sweat discomforts and unpleasant smells that come along with the sweats.

The products in their mechanism, clog the pores of the sweat glands and in a specific way eliminates over sweating or rather minimize the rate of sweating in an individual. This could also be in the form of creams, sprays and powder foam.

antiperspirant doesn't stop me sweating

How Antiperspirants work?

It is important to take note of the difference between the antiperspirants and deodorant which is basically in their mechanism of their functionality and objectivity. The Antiperspirants has got the antimicrobial substances which in its functioning it enables them to eliminate sweat from the reaching the surface of the skin.

Besides, they suppress the bacterial activeness in the sweat and reduce it top, minimal levels, substances that are responsible for the odor sweats. However, the deodorants function differently due to their solitude content of the antimicrobial substances by which they function by eliminating the odor alone but do not control the level sweat that reaches the skin surface.

The aluminum salts in antiperspirants are the functional units of the antiperspirants which work by dissolving the sweat on the face of the skin and make the surface of the skin as well as armpits supple and well of sufficient moisture.

This substance after it has dissolved on the surface of the skin, it results in the formation of a gel which forms some clogging mechanism which significantly suppresses the amount of sweat being released through the glands and so the very minimal amount of sweat reaches the surface of the skin.

On an immediate wash of the skin, the antiperspirants get washed away from the surface of the skin through the re-application of the same improves both the skin softness, reduce the possibility of sweating and keeps the person fresh. However, the antiperspirants keep the body fresh and help in reducing the body sweats, but they do not influence the ability of the body to control its body temperature.

Constituents of antiperspirants

Most of the ingredients within the antiperspirants are constituted of Aluminum salts which are joined up into other elements to make up compounds of aluminum within the antiperspirants. They work together in the combination formula to ensure there is no flow of sweat to the surface of the skin.

The condition of excessive sweating is controlled and treated by the aluminum salt compound made of the aluminum and chlorine in a compound formation resulting to Aluminum Chloride which is a strong salt. The mechanism formation of the salt in the aluminum chloride is the definitive reason on how the compound successfully works out by the salt effect in it to eliminate sweat and other possible smell on the skin.

There are also the Aluminum Chlorohydrates which is the chemical formation of the roll on as the gels are made up of the aluminum zirconium. The salts are professionally made to control the sweating effect such that they would keep the user fresh and sweat free.

However, there are possible defects of these salts like inflammation which can cause some skin irritation of the skin but the treatment and the overcome of the irritation is provided for in the general instruction on the products.

Best antiperspirants for excess diaphoresis

Since sweat glands are more active at night, antiperspirants are mostly recommended to be used before bed. The best antiperspirants are those that are dual-action performance, fragrance-free, long-lasting results, and skin comfort and stain prevention. Their specific names are Certain Dri, sweat block and clinical strength among other.

Antimicrobials in antiperspirants

The skin in its function produces sweat in response to the body temperature cooling mechanism. The sweat in a way gets back to the skin pores but generates some smell which is a definite indication of bacteria within the sweat and the skin effect on coming together in contact.

The bacterial effect of the sweat producing smell is prompt as to why the Antiperspirants are formulated with microbial which fight the bacteria to eliminating the sweat smell.

Other constituents of antiperspirants

Fragrance and moisturizers are among other substances that are contained in the antiperspirants and roll on which help in providing the body with a good fragrance smell in the quest to eliminate the odor smell. The fragrance also helps in moisturizing the skin by spreading some oily substance on the surface of the skin and therefore making the skin soft and supple.

There are also the parabens which are the common preservatives used in the antiperspirants however, the latter is less likely used due to the self-preserving ability of the antiperspirants. There are also the propellants which help in providing the pressure of the product within the package container. This is of great use during the use of the product during the application.

Alcohol is also inclusive of the ingredients within the container due to its ability to drying faster so that on the use of the product, the antiperspirant dries up very fast.

Aluminum in Antiperspirant: Is it bad?

Aluminum which is the most commonly used element in antiperspirants is used in the general make-up of the compounds used in the antiperspirants. These compounds work with an easy mechanism of getting rid of sweat on the surface of the skin by simply blocking the pores of the sweat glands.

In this mechanism, there usually is a possibility of the aluminum compounds being taken in by the skin pores which could be harmful to the skin and the entire body. There usually would be the possible reaction of the body on the intake of these compounds to the inside of the body and most possibly resulting to infections and diseases like cancer and most likely to the breast as it is in this case.

The major researches are done on the effect of aluminum salts within the antiperspirants, it has been found over aluminum as to be having adverse effects on the body parts under contact of the compounds and more so the aluminum chlorides.

These aluminum chlorides over time become the harboring conditions and the possible causes of cancer which is driven to the body tissues, to the breast and later could easily spread to the whole part of the body as cancerous cells. The mechanism of blocking the pores of the skin on the elimination of sweat makes the skin to develop a condition which significantly promotes the growth of cancerous cells of the applied parts.

On a long-term study of the effects of aluminum chlorides, it is established that the compounds not only results in cancerous cells but after a long time of its use, there are other adverse effects that develop and have a harmful effect on the body. This is a condition that should not be ignored at all but should be checked with every concern as it could easily lead to the degeneration of the entire body and the breakdown of the body system.

The use of the Aluminum Chloride in the antiperspirants is very much a threat to life and is likened to the use of the asbestos which is purely carcinogenic and is banned and gotten rid of. The use of the aluminum salts in the antiperspirants is carcinogenic and is, therefore, being raised to the high global platforms.

The call for the act on the salts of aluminum compounds is told that it should not take long before the decision to face it off the market platform. The effects are statistically hugely fatal, and many of its users are prone to cancer attacks and effects that it should be acted upon to avoid the aluminum salts products.

The effect and the rate at which the aluminum salts promote the good ground for the growth and developing of the cancer cells is very high and is escalating to higher rates day after day.

This has now made it to the non-governmental organizations and individual medics to call upon the members of the public to avoid the salts of aluminum compounds which are used in the manufacture of the products for antiperspirants. The growth of cancer cells is normally said to be as a result of germs encompassing a cell that should be treated and be attended to at a quicker moment immediately its realization.

However, if the condition is not diagnosed quickly, then this easily leads to the further growth of the cancerous cells and the developing into an adverse disease. However in this case, instead of taking charge and treatment of the cells causing cancer, the aluminum salts further make it favorable for the further developing of the cancerous cells at the sweat glands.

However, the aluminum is also said to be having other infections on the body that are less talked about like the effects of the disease on the breast. Similarly, the effect is very much likely to also cause headaches to the user of the aluminum salts antiperspirants. These effects are also likely to result in brain infections and diseases of the brain which are very likely to result in mental issues and even death cases.

The general proposal is to all the users of the deodorants and the antiperspirants to avoid all the products that are made of the aluminum salts as these are very much fatal and catastrophic.  Other products are equally good which are used as the antiperspirants that should be made use of in the quest for the use of sweat eliminating and management products.

The use of antiperspirants is also encouraged and is supported, but the use of aluminum salts antiperspirants is discouraged. The industrial production if aluminum products are very toxic to the people who use it and are likened to the asbestos which is very much accessible.

Quite attractive with good work on its use, the effects of asbestos is very much harmful and devastating that it had to be banned forever for its use and any products of asbestos discouraged.

Medical treatments for excessive diaphoresis

Since some antiperspirants don assists much in diaphoresis on the feet and hands, some medications can be used instead. There are a high number of oral medical prescriptions that can be used to reduce or to do away with excessive diaphoresis completely. They work in differently in the body to limit sweating. The medications lessen the diaphoresis by prevention of sweat glands stimulation hence reducing excessive diaphoresis.

Oral medications for hyperhidrosis best suits the individuals who have particular types of excessive diaphoresis such as craniofacial hyperhidrosis, generalized hyperhidrosis and those who had unsuccessful therapies such like antiperspirants, Botox, and iontophoresis.

Some of the medications are; Anticholinergics such as oxybutynin, propantheline, glycopyrrolate and benztropine and others; and Benzodiazepine and Beta Blocker such as propranolol which works by various physical anxiety manifestations.

Iontophoresis: For this treatment, the victim usually sits on a shallow tray by feet, hands or both. The tray contains water onto which a small current passes through it. The person under treatment sits there for about 30 minutes. The process is believed to assist in blocking sweat reaching the surface of the skin.

Botulinum toxin: This treatment involves the injection of botulinum toxin which is also used for wrinkles treatment. Botulinum toxin A which is commonly known as Botox is approved for treating excessive diaphoresis on the underarms, palms and the sole of the feet. Botox function is to prevent the activation of the release of chemicals the signal sweat glands.

Anticholinergic drugs: If antiperspirants, iontophoresis, and Botox do not work, anticholinergic oral drugs can use. The drug stops the activation of various sweat glands but has serious side effects such as heart palpitation, blurred vision, and urinary problems.

Surgery: this type of treatment is only recommended for the individuals who have severe excessive diaphoresis where other treatments have failed to respond. This involves plastic surgery where doctors may scrap the sweat glands, cut or suction them out.

Other than the use of drugs and medication, other methods to minimize excessive diaphoresis can be employed. They include wearing light clothes, bathing daily using antibacterial soaps, use of shoe inserts and underarm liners for sweat absorption and also avoidance of hot drinks such as coffee, avoidance of alcohol and spicy foods.

Tips for avoiding excess diaphoresis

Some of the tips which are useful for stopping excessive diaphoresis are:

  • Use higher strength antiperspirants and deodorants
  • Use deodorants application at the right time
  • Changes the footwear often
  • Dust sweat away regularly

What are the different types of phobias? What is the most common phobia in the world?

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Phobias: Definition, Classification, Prevalence, Development, Types

Jul 24 2017 Published by under Phobias

What is phobia?

Phobia (from Greek φόβος phobos, “fear”) is defined as a persistent, abnormal, irrational or in some cases disabling fear of activity, situation or specific object that leads to a definite desire of avoiding it. In medicine it is classified as a type of anxiety disorder characterized with rapid onset of fear and present for more than 6 months.

The phobic person will intensively go to great lengths and do abnormal things in order to avoid the potential cause of fear, typically to a level far greater than the actual danger posed. In cases where object or situation which are primary source of phobia cannot be avoided, the affected person will have important distress.

People who have phobias most commonly realize that their fear is irrational; however they are powerless to do anything about it. Such fears can interfere with their school, work and personal relationships. Sometimes phobia can be accompanies with panic attack or if it is specific phobia (e.g fear of blood) nausea, vomiting, trouble with breathing, fainting, loss of consciousness and other symptoms may also occur.

What is a specific phobia?

Phobia classification

According to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) phobias are considered as a subtype of anxiety disorder and are divided into 3 groups:

  • Agoraphobia with or without panic attacks – defined as irrational anxiety about being in places from which escape might be difficult or embarrassing. The word itself means “fear of open spaces” Patients with agoraphobia have a fear of being in large crowds or trapped outside the home. They often avoid all social situations and stay inside their homes. Many patients with agoraphobia fear that they will eventually get panic attack in a place where they can’t escape. Patients with chronic agoraphobia may have fear they will have a medical emergency in a public or where no help is available.
  • Social phobia defined as irrational anxiety elicited by exposure to certain types of social or performance situations, also leading to avoidance behavior. A social phobia can be in some cases so severe that the simplest social interactions, such as answering the telephone or ordering at a restaurant can cause panic. Those with social phobia often avoid public situations in order not to get embarrassed.
  • Specific phobia defined as persistent and irrational fear in the presence of some specific stimulus which commonly elicits avoidance of that stimulus, i.e., withdrawal.

There are 5 subtypes of specific phobias:

  • Animal type – caused by animals or insects
  • Natural environment type – cased by environmental stimuli, such as storms, heights, or water
  • Blood-injection-injury type – caused by witnessing some invasive medical procedure
  • Situational type – caused by a specific situation, such as elevators, tunnels, bridges, public transportation, flying, driving, or enclosed spaces
  • Other type – caused from all different stimuli, such as of choking, vomiting, or contracting an illness, etc.
Arachnophobia (fear of spiders): specific type of phobia

Arachnophobia (fear of spiders): specific type of phobia

Phobia prevalence

According to NIMH, about 11.5 million adults worldwide which is about 8.0% adults suffer from some kind of phobia.

Phobias are shown to be common psychiatric disorders. Nearly 11 % of the U.S. population which is about 25 million people may suffer from a phobia at least once during their lifetime.

Just in the U.S. about 6.8 % of the population, (about 15 million adults) suffer from social phobia annually. It has been shown that social phobias typically start at about 13 years of age. Worldwide, annual prevalence of social phobia is estimated to be about 4.5 % while lifetime prevalence is approximately 3.6 %. However, rates are different from country to country.

For example, only 0.53 % of South Koreans suffer from social phobias compared to the the number of people in Russian region Udmurtia, where it has been estimated that almost 45% suffer from social phobias. Rates of social phobia appear to somewhat reduced from ages of 18 to 64, with a marked drop after the age of 65.

Agoraphobia may begin suddenly or gradually, usually between adolescence and mid-thirties. About 2/3 of patients with agoraphobia are women. Epidemiology studies found that rates of agoraphobia are not so much different between countries as those of other types of phobia.

In the U.S. and around the world the prevalence of agoraphobia without panic attacks is about 0.8 %. So it is about of 1.8 million U.S. adults with agoraphobia. But, 40 % of these cases are diagnosed as severe. The rates of agoraphobia accompanied with panic attack are a little bit higher and is about 1.1%. Rates of agoraphobia appear to be stable at ages of 18 to 64. Rates drop off in the elderly.

Specific phobia usually begins in childhood, around the age of seven. According to data, in the U.S. a fear of animals is the most common specific phobia, with dogs, snakes, and bugs at the top of the list.

In the U.S., it is considered that 9 % of adults have specific phobia, with 22 % of diagnosed cases labeled as severe. 15% of children between the ages of 13-18 have specific phobia, however only 0.6 % are considered as severe cases. But the rates are different from country to country and may vary from the bravest 0.2 % in Northern Ireland to approximately 9% of most frightened in the United States.

Women are known to be 2-4 times more likely compared to men in specific phobia development. Rates appear to be increased somewhat from ages 18-64. In elderly the prevalence of specific phobias appears to drop dramatically.

Top 10 most prevalent phobias

Most common phobias by prevalence in the U.S. are:

  1. Glossophobia – The fear of public speaking affecting approximately 74% of population
  2. Necrophobia – The fear of death affecting approximately 68% of population
  3. Arachnophobia – The Fear of spiders affecting approximately 30.5% of population
  4. Achluophobia, Scotophobia or Myctophobia – The fear of darkness affecting approximately 11% of population
  5. Acrophobia – The fear of heights affecting approximately 10% of population
  6. Sociophobia, social phobia – Fear of people or social situations affecting approximately 7.9% of population
  7. Aerophobia – The fear of flying affecting approximately 6.5% of population
  8. Claustrophobia – The fear of small spaces affecting approximately 2.5% of population
  9. Agoraphobia – The fear of open spaces affecting approximately 2.2% of population
  10. Brontophobia – The Fear of thunder and lightning affecting approximately 2% of population

What are most typical signs and symptoms of phobias?

The most common symptom accompanied with phobia is a panic attack. Features of a panic attack include:

  • shortness of breath
  • pounding or racing heart
  • rapid speech or inability to speak
  • upset stomach or nausea
  • dry mouth
  • elevated blood pressure
  • chest pain or tightness
  • trembling or shaking
  • choking sensation
  • dizziness or lightheadedness
  • profuse sweating
  • sense of impending doom

A person with a phobia may or may not have panic attacks for accurate diagnosis.

How phobias develop?

The certain cause and mechanism of phobias development is not yet known. There are various theories, but they can be all classified into following 3 categories:

  • psychoanalytic
  • learning-based
  • biological

Psychoanalytic theory of phobia development

According to Sigmund Freud pioneering structural theory, phobias may be related with three stages of conscience:

  • id
  • ego
  • superego

The id is the most primitive and instinctive part of the mind and may be behind primitive emotions such as fear and anxiety. The superego is the selfless higher state of conscience, with value of judgments and the concept of guilt. The ego is known to be rational moderator between the two. A significant part of the ego is to control the impulses of the id.

how do phobias develop through classical conditioning

In accordance to this theory, phobias are caused by anxiety reactions of the id that have been repressed by the ego. So, it can be said that the feared object is not the original subject of the fear.

Learning theory of phobia development

The learning theory contains a set of theories based on doctrines of behaviorism and cognitive theory. Ivan Pavlov who developed the learning theory showed that dogs could be trained to salivate when a bell rung. Since then, numerous theories of human behavior have been developed.

According to this theory, phobias will develop when fear reactions are punished or reinforced. Both punishment and reinforcement can be positive or negative. Positive reinforcement can be exhibition of something which is positive, including a parent rewarding his child for staying away from a snake.

Positive punishment is the presentation of something negative or unfavorable to prevent that behavior from happening again, such as a child being bitten by a snake.

Biological theory of phobia development

This theory is based on neuropsychology, which is a part of psychology that is dedicated to studying the structure and function of the brain.

Neuropsychologists have been researched and identified specific genes that may play an important role in the development of phobias. Although more researches are needed it is known that certain drugs may affect the chemistry of the brain and be helpful in treating phobias. Most of these therapies are proposed to help anxiety relief by increasing the level of a neurotransmitter serotonin.

Who are at most high risks of phobias?

Patients who have a genetic predisposition to anxiety are at higher risk for developing phobias. Age, gender and socioeconomic may be risk factors for certain phobias. E.g. women are at more high risk to have animal phobias. Those with a low socioeconomic status are at higher risk to have social phobias. Men make up the majority of those with dentist and doctor phobias.

Phobias treatment options

Treatment for phobias may include therapeutic techniques such as cognitive behavioral therapy, medications, or a combination of these two.

Cognitive-Behavioral therapy

Cognitive behavioral therapy or shortly CBT is the most commonly used therapeutic option for phobias. CBT includes exposure to the primary source of the fear in a controlled setting. This treatment can decondition people and reduce anxiety.

The treatment is based on identifying and changing negative thoughts, wrong beliefs, and negative reactions to fear. New CBT techniques use virtual reality technology to safely expose people to the sources of their phobias.


Anti-anxiety drugs and antidepressants can help calm both emotional and physical reactions to fear. Often, the combination of medication and professional therapy makes the biggest difference. If you have a phobia, it’s critical that you seek treatment. Overcoming phobias can be difficult, but there’s hope. With the right treatment, you can learn to manage your fears and lead a productive, fulfilling life.

Phobias from A-Z

Following list include majority of phobias:


  • Ablutophobia – The fear of bathing, washing, or cleaning
  • Acousticophobia – The fear of loud noise – a type of phonophobia
  • Acrophobia – The fear of heights
  • Aerophobia – The fear of flying
  • Agoraphobia – The fear of open places
  • Agyrophobia – The fear of crossing streets
  • Aichmophobia – The fear of needles, knifes and other sharp or pointed objects
  • Ailurophobia – The fear of cats
  • Algophobia – The fear of physical pain
  • Amychophobia – The fear of being scratched
  • Androphobia – The fear of adult men
  • Anthropophobia – The fear of people or the group of people, a type of social phobia
  • Aquaphobia – The fear of water. Not the same as hydrophobia. Averse to scientific chemical reactions with water
  • Arachnophobia – The fear of spiders
  • Astraphobia – The fear of weather storms, specifically thunder and lightning
  • Autophobia – The fear of isolation
  • Aviophobia, aviatophobia – The fear of flying


  • Basophobia – The fear related with astasia-abasia (fear of walking/standing erect) and a fear of falling
  • Blood-injection-injury type phobia – a subtype of specific phobias


  • Chemophobia – The fear of chemicals
  • Chiroptophobia – The fear of bats
  • Chromophobia, chromatophobia – The fear of colors
  • Chronophobia – The fear of time and time moving forward
  • Cibophobia, sitophobia – The neurological aversion to food, similar to anorexia nervosa
  • Claustrophobia – The fear of having no escape and being closed in
  • Coimetrophobia – The fear of cemeteries
  • Colorphobia – Th fear or a very strong aversion towards a particular color
  • Coprophobia – The fear of feces or action of defecation
  • Coulrophobia – The fear of clowns
  • Cyberphobia – The fear of computers and of learning new technologies
  • Cynophobia – The fear of dogs


  • Decidophobia – The fear of making decisions
  • Demonophobia, daemonophobia – The fear of demons
  • Dentophobia, odontophobia – The fear of dentists and dental procedures
  • Dromophobia – The fear of crossing streets
  • Dysmorphophobia – A phobic obsession with a real or imaginary body defect


  • Eurotophobia – Aversion to female genitals
  • Emetophobia – The fear of vomiting
  • Enochlophobia – The fear of crowds
  • Ephebiphobia – The fear of youth people
  • Ergophobia, ergasiophobia – The fear of working, doing activities, or a surgeon’s fear of operating
  • Erotophobia – The fear of sexual love or sexual abuse
  • Erythrophobia – The fear of the color red, or fear of blushing


  • Frigophobia – The fear of becoming too cold


  • Gamophobia – The fear of cohabitation, marriage or nuptials
  • Gelotophobia – The fear of being laughed at
  • Gephyrophobia – The fear of bridges
  • Genophobia, coitophobia – The fear of sexual intercourse
  • Gerascophobia – The fear of growing old or aging
  • Gerontophobia – The fear of the elderly
  • Globophobia – The fear of balloons
  • Glossophobia – The fear of speaking in public or of trying to speak, probably most common type of phobia
  • Gynophobia – The fear of women


  • Halitophobia – The fear of bad breath
  • Haphephobia – The fear of being touched
  • Hedonophobia – The fear of obtaining pleasure
  • Heliophobia – The fear of the sun or sunlight
  • Hemophobia, haemophobia – The fear of blood
  • Hexakosioihexekontahexaphobia – The typical irational fear of the number 666
  • Hoplophobia – The fear of firearms
  • Hypnophobia, somniphobia – The fear of falling sleep or sleep


  • Ichthyophobia – The fear of fish, also including fear of eating fish, or fear of dead fish


  • Koumpounophobia – The fear of buttons


  • Lilapsophobia – The fear of hurricanes or tornadoes


  • Mageirocophobia – The fear of cooking
  • Melanophobia – The fear of black color
  • Melissophobia, apiphobia – The fear of bees
  • Monophobia – The fear of being isolated or alone
  • Musophobia/murophobia/suriphobia – The fear of mice or rats
  • Myrmecophobia – The fear of ants
  • Mysophobia – The fear of germs, dirt or being contaminated


  • Necrophobia – The fear of death
  • Neophobia/cainophobia/cainotophobia/centophobia/kainolophobia/kainophobia, metathesiophobia or prosophobia – The fear of newness, changes, progress and novelty
  • Nomophobia – The fear of being out of mobile phone contact
  • Nosocomephobia – The fear of hospitals
  • Nosophobia – The fear of contracting a disease
  • Nostophobia, ecophobia – The fear of returning home
  • Numerophobia – Fear of numbers, or certain number
  • Nyctophobia/achluophobia/lygophobia/scotophobia – Fear of the dark


  • Oikophobia – The fear of home surroundings and household appliances
  • Oneirophobia – The fear of dreams or to dream
  • Ophthalmophobia – The fear of being stared at
  • Osmophobia, olfactophobia – The fear of odors


  • Panphobia – Fear of everything and constant fear of an unknown cause
  • Pedophobia – The fear of children
  • Phagophobia – The fear of swallowing
  • Phallophobia – The fear of erections
  • Pharmacophobia – The fear of drugs or medication
  • Phasmophobia – The fear of ghosts or phantoms
  • Philophobia – The fear of love
  • Phobophobia – The fear of fear itself or fear of having some phobia
  • Phonophobia – The fear of loud sounds or voices
  • Pogonophobia – The fear of beards
  • Pornophobia – The fear or averse of pornography
  • Pyrophobia – The fear of fire


  • Radiophobia – The fear of radioactivity or X-rays


  • Scopophobia – The fear of being looked by somoene
  • Sexophobia – The fear of sexual organs or sexual activities
  • Siderodromophobia – The fear of trains or railroads
  • Sociophobia – The fear of people or social situations, type of social phobia
  • Spectrophobia – The fear of mirrors
  • Stasiphobia – The fear of standing or walking


  • Taphophobia, taphephobia – The fear of the grave, or fear of eventually being graved while still alive
  • Technophobia – The fear of advanced technology
  • Telephone phobia – The fear of making or taking telephone calls
  • Teratophobia – The fear of disfigured people
  • Tetraphobia – The fear of the number 4
  • Thalassophobia – The fear of the sea, or ocean
  • Thanatophobia – The fear of dying
  • Thermophobia – The fear of high temperatures
  • Tokophobia – The fear of childbirth or pregnancy
  • Toxiphobia – The fear of being poisoned
  • Traumatophobia – The fear of having an injury
  • Trichophobia – The fear of hair loss
  • Triskaidekaphobia, terdekaphobia – The fear of the number 13
  • Trypanophobia, belonephobia, enetophobia – The fear of needles or injections
  • Trypophobia – The fear of holes or textures with a pattern of holes e.g fear of sponges


  • Workplace phobia – The fear of the workplace


  • Xanthophobia – The fear of yellow color
  • Xenophobia – Fear of strangers, foreigners, or aliens

Most common animal phobias

Animal phobias belong to the group of specific phobias, and some of the most common are following:

  • Ailurophobia – The fear or aversion to cats
  • Apiphobia – The fear or aversion to bees (also called as melissophobia)
  • Arachnophobia – The fear or aversion to arachnids
  • Batrachophobia – The fear or aversion to amphibians
  • Chiroptophobia – The fear or aversion to bats
  • Cynophobia – The fear or aversion to dogs
  • Entomophobia – The fear or aversion to insects
  • Equinophobia, hippophobia – The fear or aversion to horses
  • Herpetophobia – The fear or aversion to reptiles or amphibians
  • Ichthyophobia – The fear or aversion to fish
  • Murophobia – The fear or aversion to mice or rats
  • Ophidiophobia – The fear or aversion to snakes
  • Ornithophobia – The fear or aversion to birds
  • Ranidaphobia – The fear or aversion to frogs
  • Scoleciphobia – The fear or aversion to worms
  • Zoophobia – The fear or aversion to animals

Racist, xenophobic, anti-cultural, anti-national, and anti-ethnic phobias

Most common anti-ethnic or anti-demographic phobias are:

  • Americanophobia – The fear of Americans
  • Europhobia – The fear of Europeans
  • Francophobia – The fear of French
  • Hispanophobia – The fear of Spanish or hispanic populations
  • Christianophobia – The fear of Christians and Christianity
  • Islamophobia – The fear of Islamic religion or islamists

Similar types of these phobias are:

  • Albanophobia – The fear of Albanians
  • Anglophobia – The fear of England or English culture
  • Germanophobia – The fear of Germans
  • Hinduphobia – The fear of Hindus
  • Indophobia – The fear of India or Indian culture
  • Judeophobia – The fear of Jews
  • Nipponophobia – The fear of the Japanese
  • Koryophobia – The fear of Koreans
  • Polonophobia – The fear of Polish
  • Russophobia – The fear of Russians
  • Shiaphobia – The fear of Shiites
  • Sinophobia – The fear of Chinese people
  • Sunniphobia – The fear of Sunnis
  • Turcophobia – The fear of Turks
  • Xenophobia – The fear of foreigners

Phobias against different categories of people may include:

  • Biphobia – The fear of bisexuality or bisexuals
  • Ephebiphobia – The fear of youth
  • Gerontophobia, gerascophobia – The fear of aging or the elderly
  • Heterophobia – The fear of heterosexuals
  • Homophobia – The fear of homosexuality and homosexuals
  • Lesbophobia – The fear of lesbians
  • Pedophobia – The fear of children
  • Psychophobia – The fear of mental illness or the mentally ill patients
  • Transphobia – The fear of transgender people

What is the medical term of Odynophagia? What are causes of Odynophagia?

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Odynophagia – Medical Term, Signs and symptoms, Causes, Treatments, Vs dysphagia

Jul 22 2017 Published by under Diseases

What is odynophagia? What is the meaning of Odynophagia?

Odynophagia (from odyno which means “pain” + phago meaning “to eat“) is a pain produced during swallowing. The pain is felt in the throat or mouth and may occur with or without presence of swallowing difficulties. Most patients describe pain as an ache or burning sensation or in some cases as a sharp pain that spreads to the back. Odynophagia may also be associated to pathology of larynx and swallowing reflex.

odynophagia medical definition

Odynophagia signs and symptoms

Odynophagia (pain during swallowing) may be present together with dysphagia (difficulty with swallowing) or may just exist on its own with a regular swallowing reflex and without regurgitation.

In some cases odynophagia may also be a manifestation of condition called stomatodynia, which is defined as a pain in the mouth. In this case, the pain is getting worse during swallowing. Pain produced during swallowing may also be noticed after consumption of hot foods or drinks. In some cases, swallowing may be manifested with some issues and minor pain early in the morning after awakening and may be reduced during the day.

Hot foods and drinks that may result with pain after swallowing are good indicator that there may be severe lesions in the throat such as ulcers. Morning odynophagia may be accompanied with intense gastroesophageal reflux disease (GERD) provoking reflux pharyngitis. A chronic sore throat after waking up in the morning is another symptom of reflux pharyngitis.

Sometimes, odynophagia may be also accompanied with difficulty breathing also known as dyspnea or dysphonia (whispering voice, hoarse voice) may be typical of pathology within the trachea, larynx a partial obstruction of the throat.

odynophagia differential diagnosis

What is the difference between odynophagia and dysphagia?

Odynophagia is a pain after swallowing, while dysphagia is a difficulty during swallowing. Odynophagia may or may not be accompanied with dysphagia. Both, odynophagia and dysphagia may indicate an abnormality that can be either benign or malignant and should be further worked up and evaluated.

What is globus sensation? Are globus sensation and odynophagia the same?

No, odynophagia and globus sensation are not the same. Globus sensation is the term used for a feeling of a lump in throat even though there is no present lump when the throat is examined. The sensation usually come and goes and it does not interfere with drinking and eating.

What are the causes of odynophagia?

Various causes may lead to odynophagia, from the easiest one such as hot drinks or food to the very serious life treating conditions.

Infection and odynophagia

Acute or chronic infections of the mouth (stomatitis), tonsils and throat (tonsillopharyngitis), epiglottis (epiglottitis) and esophagus (esophagitis) may result in odynophagia. Odynophagia is more noticeable in severe infections accompanied with or without dysphagia. Many patients with chronic infection of the throat, mouth or esophagus may only report odynophagia as the main symptom. Such infections may also cause sores, abscesses, ulcers or diffuse inflammation. Infective pathogens that commonly cause odynophagia are:

  • Oral candidiasis
  • HIV infection
  • Cytomegalovirus (CMV)
  • Epstein-Barr (EBV)
  • Any infectious cause of an acute or chronic sore throat
  • Herpes simplex virus (HSV)

Inflammation and odynophagia

Although it is most commonly caused by infection, inflammation of different tissues and organs may also cause painful swallowing. Inflammation of tonsils and the esophagus is commonly related with odynophagia.

Foreign objects and odynophagia

Although most foreign objects that get stuck in throat will cause you to choke, rarely an object may be sized enough not to interfere with breathing but may cause pain while swallowing. A fish bone is a good example.

Esophageal disorders and odynophagia

Different esophagus disorder may be present with odynophagia. Chest pain is commonly present as a result of esophagus pain. In some cases, patients frequently and quite incorrectly, report the symptoms of odynophagia, although it is related to the involuntary esophageal stage of swallowing. Following esophageal disorders may lead to odynophagia:

  • Achalasia
  • Esophageal spasms – diffuse or nutcracker syndrome
  • Esophageal tears/perforation
  • Esophageal ulcers
  • Esophageal webs
  • GERD
  • Zenker’s diverticulum

Ulcers and odynophagia

Ulcers of the throat and esophagus can make swallowing incredibly painful, especially when food is involved.

Tumors and odynophagia

Tumors, both malign and benign, can cause significant tissues with swallowing as they may obstruct anything coming down the throat and may also cause pain.

Other causes of odynophagia

Other causes of odynophagia are:

  • Very hot or cold food and drinks
  • Taking certain medications
  • Tobacco
  • Alcohol
  • Drug abuse
  • Trauma of the mouth, throat, or tongue

Odynophagia diagnosis

Except evident clinical manifestation that can been confirmed during anamnesis and physical examination there are no other no specific tests or exams that can be used. Your health provider can confirm the diagnosis of odynophagia by identifying the issues based on what the symptoms you have been experiencing. If cancer is suspected as the underlying cause biopsy may be needed for confirmation.

Odynophagia treatment

Two-step management approach is the best option for odynophagia because in that way you will treat both the underlying cause and the symptoms together. In the case of odynophagia caused by cancer in that case the treatment for odynophagia and cancer would most likely be prolonged.

Adequate treatment of odynophagia caused by cancer may involve both chemotherapy and radiation to help the malign tumor become smaller but may also help to stop the cancer cells from spreading, depending on how intense it is and where is the location of cancer as to the exact treatment used. Surgery may also need to be performed to remove the tumor.

odynophagia treatment guidelines

Esophageal cancer with different stages

Other options for treating the underlying cause of odynophagia may include:

  • Surgical removal of ulcers that causes odynophagia
  • Oral forms of nasal decongestants and antibiotics may be prescribed in the case of upper respiratory or throat infection
  • In the case of gastroesophageal acid reflux disease you can take OTC medications like antacids. In severe cases your healthcare provider may prescribe you IPP such as omeprazole or pantoprazole.
  • Peppermint, alcohol, tobacco and caffeine may make symptoms worse, because any of these provoke acid reflux. Once the underlying cause of odynophagia is treated, it will start to ease up.

What is renal azotemia? How to treat azotemia

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Azotemia – Definition, Development, Types, Diagnosis, Treatments

Jul 21 2017 Published by under Diseases

What is azotemia?

The word azotemia is made up of two words, ‘azot’ means nitrogen and ’emia’ means in blood. It is a laboratory abnormality which is characterized by urea nitrogen and creatinine increased above a normal range. It is a type of nephrotoxicity and in severe conditions can adversely affect the kidneys and lead to renal failure in patients.

How does azotemia develop?

Each kidney consists of approximately 1 million units known as nephrons, which are primarily involved in the formation of urine. This formation of urine is to ensure that the body is eliminating and getting rid of metabolic products and even excess water just with the aim to maintain an internal environment i.e. homeostasis. The process of forming of urine involves the following processes

  • Filtration at the glomerular rate
  • Selective reabsorption at the site of renal tubules
  • Secretion in tubules by the cells into this filtrate

Perturbation in any of the above processes will impair the excretory function, resulting in azotemia.

The quantity of glomerular filtrate produced each minute by all nephrons from both kidneys is known as glomerular filtration rate (GFR).  The normal GFR value is 125mL/min (women have 10% less than men). On an average, about 99% of the filtrate is reabsorbed and the remaining is excreted in form of urine.

What is uremia?

Uremia is a condition in which urea appears in urine. Even though urea is a major component that is actively excreted in urine but in such a condition, excess amounts of nitrogenous products including those obtained from amino acids and protein metabolism are excreted. Uremia is a pathological demonstration of severe azotemia. This can cause damage which can be pre renal, renal or post renal.

Types of Azotemia

Presently, azotemia has been classified in 3 different types. These classes are: prerenal azotemia, intrarenal azotemia and postrenal azotemia. This classification is done on the basis of the site of the renal system which is affected.

three types of azotemia

Prerenal Azotemia

Prerenal azotemia occurs due to a decrease in glomerular filtration rate (GFR) which occurs due to disturbances in circulatory system ultimately causing decreased renal perfusion.

If the renal perfusion decreases, it can worsen the condition of the patient as it can cause hypervolemia, cardiac diseases. As a result of insufficient blood flow excess of nitrogen occurs in the blood. This has been the most common cause of failure of kidneys especially in hospitalized patients.

When the volume or pressure of blood is decreased, the baroreceptor reflexes which are present in aortic arch and carotid sinuses are activated. As a result there is activation of sympathetic system resulting in the vasoconstriction of renal afferent arterioles and secretion of rennin through β1 receptors.

This constriction of the arterioles leads to decrease in intraglomerular pressure and a proportional decrease in GFR is observed. Reduced blood flow results in production of renin, which converts angiotensin I to angiotensin II. Angiotensin II secretion further stimulates the secretion of aldosterone. Raised levels of aldosterone in kidney result in the absorption of salt and water, more specifically in the regions of distal collecting tubules.

Furthermore, when the blood flow to kidneys is decreased or a decrease in pressure is sensed, a non-osmotic stimulus is activated that includes the production of anti-diuretic hormone from the hypothalamus. ADH exerts its effect in the collecting duct in the region of medulla for water reabsorption.

However, through unidentified mechanisms, sympathetic system is activated which leads to enhanced tubular reabsorption of salt and water as well as BUN, uric acid, creatinine, bicarbonate and calcium molecules in proximal region. As a result of this, the total salt and water retention is decreased and as an outcome of which decreased urinary excretion of sodium is observed.

Conditions that cause prerenal azotemia

Conditions that reduce the blood flow to the kidney may cause pre-renal azotemia. Examples include; burns, loss of blood volume, heat exposure, decreased fluid intake, long term vomiting, diarrhea and even chronic bleeding.

Pre renal azotemia can even occur in those conditions where the heart is unable to pump enough blood such as heart failure or septic shock.

Finally, condition in which there is disruption in the blood flow to the kidneys will also cause pre-renal azotemia.

Intrarenal azotemia

Intrarenal azotemia is also identified as acute renal failure (ARF), renal-renal failure and acute kidney injury (AKI). It is distinguished by the excess accumulation of nitrogen in blood which is basically due to the damaged kidneys and their disturbed functions.

There are various definitions, including an increase in serum creatinine levels of 30% from baseline or sudden decrease in output below 500mL/day. AKI is basically non-oliguric; a condition when the output falls below 500mL/day, ARF is oliguric. Any kind of AKI can be so severe that it virtually stops the formation; this condition is called anuria (<100mL/day).

Some of the recent studies have shown and indicated that the nonoliguric forms of AKI are correlated with less morbidity and mortality than is oliguric AKI. More studies have also demonstrated that volume expansion, renal vasodilators and some of the potent diuretic agents have the ability to covert oliguric AKI to non oliguric AKI. However, this is only possible when these drugs are administered early.

The pathophysiology of both oliguric and non-oliguric acute kidney injury depends on the site of the injury. In acute tubular necrosis (ATN), the functional decrease in the ability of the tubules is due to epithelial damage.

As a result, the reabsorption of salt, water and other electrolytes like sodium, bicarbonate is declined. Additionally, the excretion of acid and potassium is also impaired. In severe cases, the tubular lumen is filled with epithelial casts causing intraluminal obstruction and hence resulting in a decline in GFR.

Net effect is a loss of urinary concentrating ability, as an outcome of which there is low osmolality, low specific gravity, high urinary sodium and often hypokalemia tubular acidosis is seen. On the other hand, if prerenal azotemia is superimposed, the specific gravity, sodium content and hence osmolality may be misleading.

Glomerulonephritits or vasculitis is proposed in the presence of hematuria, red blood cells, white blood cells, granular and cellular casts, and even unpredictable amount of proteinuria. Nephrotic syndromes, however is not allied inflammation and if proteinuria is seen, it is greater than 3.5g/24h. Some patients with nephrotic syndrome may present with acute renal failure.

Destruction of capillary construction in the kidneys either due to edema or obstruction of tubules from protein casts, also a decline in effective has been suggested as the mechanisms for the progression of ARF in patients suffering from nephrotic syndrome.

Conditions that cause intra-renal azotemia

Acute vascular diseases which include malignant hypertension, scleroderma renal crisis and several other conditions, all of which might cause renal hypoperfusion and even ischemia lead to azotemia. Apart from this bilateral renal artery stenosis might also lead to intra renal azotemia.

How does bilateral renal artery stenosis lead to azotemia?

In bilateral renal artery stenosis, maintenance of sufficient intraglomerular pressure for filtration process depends on efferent arteriolar vasoconstriction.

Azotemia occurs when angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) cause the dilation of efferent arterioles leading to a decline intraglomerular pressure and filtration. It is due to this effect that ARBs and ACE inhibitors contraindicated in bilateral renal artery stenosis.

Moreover, in addition to the accumulation of urea creatinine and other waste products, a progressive reduction in glomerular filtration rate results in the following

  • A decrease in the production of red blood cells causing anemia and also in the blood levels of vitamin D3 causing hypocalcaemia, renal osteodystroply
  • Decrease in acid, potassium and water and salt excretion leading to acidosis, hypertension, and edema.
  • Dysfunctioning of platelets, this may cause to enhanced bleeding tendencies.

Several classes of medicines have been majorly involved kidney damage. These include aminoglycoside toxicity, anti-fungal drugs, chemotherapy agents such as lithium toxicity and cisplatin toxicity, biological therapies, ACE inhibitors, radiological contrasts and few NSAIDs.

It has been found that some of the medical conditions such as pyelonephritis and diabetes can also cause intra renal azotemia in patients.

how is azotemia measured

Renal stenosis on CT angiogram

Post-renal azotemia

Post-renal azotemia is a condition when an excess of blood nitrogen occurs due to the blockage in the kidneys as a result of which it prevents the urine to excrete out from the renal urinary system. It also causes painful urination. Hindrance to flow leads to reversal in the Starling forces which is responsible for the glomerular filtration.

Progressive bilateral obstruction causes hydronephrosis with a rise in Bowman capsular hydrostatic pressure and blockage in the tubules that leads to gradual decrease in and ultimately is the stoppage of glomerular filtration, acidosis, hypokalemia, fluid overload and azotemia. Blockage maybe due to any of the following reasons: stone, infection, enlarged prostate gland (in elderly male patients) or even a tumor (both malignant and benign).

Azotemia is rarely caused by bilateral obstruction. Evidence is present that if complete obstruction is present at the ureteral site, it can be recovered within a time span of 48 hours of the onset, and relatively a complete upturn of the glomerular filtration rate can be achieved within a week. However, after a span of 12 weeks, little or no recovery is possible.

Moreover, complete or chronic obstruction of ureter can cause tubular atrophy or irreversible renal fibrosis. If the collecting system is enclosed by retroperitoneal tumor or fibrosis, chances for hydronephrosis may be absent.

How does pre-existing kidney disease influence azotemia development?

According to reports, the incidence of hospital acquired or even community acquired acute renal failure has shown a variable pattern. In a study carried, it is responsible for approximately 1% of hospital readmissions.

In chronic kidney disease, gradually worsening azotemia leads to end stage renal disease thus making it important for the patient to have dialysis or undergo kidney transplantation. Kidney transplant is often recommended in patients who are already going through other chronic medical conditions such as diabetes, hypertension, cystic kidney disease, glomerulonephritis and other commonly occurring kidney diseases.

Which populations are at a higher risk of developing azotemia?

According to demographic survey, the frequency of occurrence in males was 56% whereas in females it was found nearly 44%. If we looked according to age groups, the highest rate was found in those people aging between 65-75 years and the lowest was among children between 0-19 years.

Racial distribution showed that azotemia was more common in white people followed by black and Asians.

Prognosis of azotemia

The prognosis of azotemia due to AKI/ARF is poor and is highly dependent on the original disease and to which extent the organs are damaged in that disease. However, in patients without an underlying disease, the mortality rate is low around 7-23% as compared to those who are admitted in hospital in intensive care unit (ICU) on a ventilator. Mortality rate for such patients have dangerously increased up to 80%.

The prognosis of chronic kidney disease greatly depends upon the etiology. Patients going through diabetic kidney disease, ischemic nephropathy (i.e. large vessel arterial occlusive disease) have a tendency for the worsening of the conditions from azotemia to end stage renal disease.

Diagnosis of Azotemia

History for azotemia diagnosis

It is important to know as early as possible if the azotemia is either acute or chronic and whether it is caused due to prerenal, intra renal or post renal factors. This is essential in determining the treatment and further stopping the progression of disease. Evaluation of azotemia clinically, requires a complete history, physical examination and other laboratory tests.

Patients experiencing prerenal azotemia have typical history of diarrhea, vomiting, heat exhaustion, sweat loss, concurrent illness that disturb their tendency to eat and drink according to the need of body, liver disease, hemorrhage, congestive heart failure and even polyuria.

Patients going through intra renal azotemia may have the history of polyuria, proteinuria, nocturia, shock and edema. Other reasons include hereditary linkage or systemic diseases like diabetes, hypertension, and systemic lupus erythematosus, various collagen vascular diseases, hepatitis B, hepatitis C, syphilis, AIDs.

After a comprehensive history has been taken, it is important to look for nephrotoxic medications like antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin converting enzyme (ACE) inhibitors, diuretics and selective herbal treatments. Chemical exposure given to cancer patients and drug abuse especially those consuming through intravenous routes also cause nephrotoxicity.

Patients who have post renal azotemia often have a history of benign prostatic hypertrophy, renal colic, dysuria, frequency, hesitancy, pelvic malignancy.

Physical Examination for azotemia diagnosis

In suspected patients of prerenal azotemia, look out for tachycardia, orthostatic hypotension when the systolic blood pressure drops down to more than 20 mm Hg or diastolic drop more than 10mm Hg, signs of dehydration, including dry mucus membrane, loss of skin turgidity, loss of sweat, and signs of congestive heart failure or hepatic insufficiencies.

In patients who have been suspected with intra renal azotemia, look for hypertension and its end organ side effects, like hypertensive retinopathy and left ventricular hypertrophy, rash, joint swelling or joint tenderness, abnormalities in hearing, abdominal bruits, palpable kidneys and pericardial rub. Pericardial rub is a characteristic sign of uremia. However, occurrence of uremic pericarditits requires immediate dialysis.

Post renal azotemia in which obstruction is seen, a palpable bladder is observed which is dull to percussion and the presence of mass in pelvic or rectal regions is seen when digital examination is done.

Diagnostic Considerations for azotemia

Besides differential diagnosis which is done, it is necessary to monitor and evaluate the causes of increased levels of BUN and creatinine levels. Even though these are unrelated to kidney disease but these must be considered. The causes might be

  • Ketoacidosis
  • Steroids
  • Large intake of protein meal
  • Total parenteral nutrition
  • Hemorrhage especial in gastrointestinal tract
  • Certain medications

Laboratory procedures for azotemia

For the start of evaluation, the first step is to obtain a complete blood count (CBC), a biochemical profile, urinalysis, and urine electrolyte concentrations. These tests give hints on determining the original cause of azotemia.

Diagnostic indices are used to differentiate among prerenal azotemia, intra renal azotemia and post renal azotemia. Even though such indices are useful but because it is not in the compulsion workup plan demand, these tests are not performed on every patient.

Relationship should always be established with the patients’ baseline values in order to identify the pattern’s consistency whether it is increasing or decreasing in the circulating volume. Medically, there are limitations to everything. Even in case of diagnostic indices, there are limits in certain medical conditions. Examples include

  • Anemia ( hematocrit value)
  • Hypocalcaemia (serum calcium)
  • Decreased muscle mass (serum creatinine)
  • Liver diseases (blood nitrogen urea, total protein and albumin)
  • Use of diuretics (urine sodium)

Prerenal Azotemia: in this, the hemoconcentration outcome is the increased hematocrit value and total protein/ albumin, bicarbonate, uric acid and calcium levels from baseline values.

  • Oliguria (urine volume < 500mL/day) or anuria (< 100mL/day)
  • High specific gravity (> 1.015)
  • Normal urinary sediment
  • Low urinary Na (<20mEq/L)

When volume depletion is more dominant, amplified proximal tubular reabsorption usually results in azotemia. Along with azotemia, hypernatremia, and increased levels of calcium, bicarbonate and uric acid leads to rise in the values of hematocrit values, albumin and total protein. It has been observed that these values vary widely.

One of other major determinant for differentiating between prerenal azotemia and acute tubular necrosis is fractional excretion of sodium (FENa).  A value below 1% proposes a prerenal cause like volume depletion. Above 2% suggests the presence of acute tubular necrosis. As FENa is dependent on the fact that reabsorption is enhanced in the setting of the volume depletion, use of diuretics may raise the value of FENa even volume depletion is present.

Intrarenal Azotemia: in this, anemia, hypocalcaemia, thrombocytopenia, and elevated anion gap metabolic acidosis may be present.

  • Low specific gravity of urine (<1.015)
  • Presence of active urinary sediment
  • High excretion of sodium in urine (>40mEq)
  • FENa >5%
  • Plasma BUN to creatinine ratio less than 20
  • Low osmolality of urine.

Patients suffering from chronic CKD, their renal ultrasonography usually show small kidneys. However, in some cases of CKD kidneys may be of normal size or even enlarged. This is usually the case with HIV nephropathy, diabetes and renal amyloidosis. Patients with polycystic kidney disease are recommended to undergo renal sonogram for the confirmation of diagnosis.

Postrenal Azotemia: Set of urinary indices in this condition which is due to complete bilateral blockage is not really useful in diagnosing the medical condition. The prime finding in this is the anuria, which may or may not be accompanied by hypertension.

If partial ureteral blockage is present, urine flow may be present. Foley’s catheter must be inserted in the initial steps of evaluation. This is done to confirm that there is no obstruction at the bottom of urinary bladder.

When obstruction occurs unilaterally, it gradually progresses to azotemia. It occurs acutely like in cases of obstruction from calculi or hematoma causing renal colic. It can also be chronic and does not show any symptoms leading to the formation of hydronephrosis.

Bilateral obstruction may be linked with azotemia in the presence of normal urine flow. Patient who are given maneuvers have an increased urine output because of which they show an increased pressure in the collecting ducts and possibilities are that they may even feel pain.

Along with azotemia, polyuria, type 1 renal tubular acidosis, with hypercalcaemia, hypokalemia and even a prostatic pelvic tumor and in turn raised prostate specific antigens (PSA) levels hints towards post renal azotemia. Renal ultrasonography is the test of choice for excluding the obstructive uropathy.

Ultrasonography for azotemia

This is used for determining the size of kidneys and echogenicity which is an important consideration in renal biopsy. It also helps in the differentiation of cystic lesions from solid lesions and in the spotting of kidney stones. Doppler ultrasonography identifies the vascular flow of kidneys which can be useful for renal artery stenosis.

Other procedures for azotemia diagnosis

Besides ultrasonography, other techniques are used in evaluation of the clinical condition. These include Computed tomography (CT) scan, Magnetic Imagining Resonance (MRI), abdominal radiography, pyelography and angiography. Recently new techniques are derived such as radionuclide involved studies. Renal biopsy is also recommended.

Each of these procedures has their own limitations and uses. Their recommendation is highly dependent on the doctor who is checking the patient.

Renal Biopsy has certain contraindications such as when the size of kidneys is smaller than normal, severe consistent hypertension, hydronephrosis, multiple cysts or tumors, renal or peri renal infections. It is also not recommended in patients who not showing cooperation.

Pharmacological & Supportive therapy for azotemia

Azotemia treatment depend on whcih type of azotemia is manifested

Prerenal azotemia treatment

Prerenal Azotemia: if the reason behind the volume depletion is water loss, the levels of serum sodium raises up to 10mEq from normal. The fluid which is to be administered to the patient should be a hypotonic solution for example, 0.5% saline or 5% dextrose solution in distilled water (D5W). The patients are counseled and encouraged to drink more and more water via oral route. If not possible, nasogastric route is utilized.

Serum sodium levels are constantly monitored every other 6-8 hours and fluid replacement therapy should be such that serum sodium levels are maintained to avoid reaching the precipitous decline. In cases of volume depletion due to chronic or excessive bleeding, it is required to administer IV saline and transfusion for maintaining the pressure.

Fluid loss in diarrhea needs to be replaced by normal saline but when normal anion gap metabolic acidosis occurs; bicarbonate in 0.5% normal saline should be given.

When there is decreased effective arterial volume of blood due to the shunting of the system either due to failure of liver or septic shock it results in a number of problems such as reduced oncotic pressure, raised vascular permeability and more salt and water reabsorption.

In such cases, effective treatment of sepsis is possible with antibiotics and for hypotension, epinephrine and nor epinephrine is required. If the treatment is proper, it may improve the oncotic pressure and bring the vascular permeability back to normal. The net outcome is better renal perfusion, and preventing the shunting of the system.

Intrarenal azotemia treatment

Intrarenal Azotemia: Acute kidney disease; in case of ischemic or nephrotoxic kidney injuries, which occur due to shock. Shock can be hypovolemic, cardiogenic or even septic shock. The initial plan is to reinstate volume and pressure both.  This can be done by fluid replacement therapy and vasopressors. If the patient experiences oliguria or anuria in shock, crystalloids should be immediately administered as bolus.

However, if even after the administration of around 2L of liquid in a short time, no recovery is seen a high dose of furosemide at 100-160mg is prescribed to the patient. If the patient is unable to improve even after 6 hours put the patient on dialysis.

Albumin can be given along with furosemide to augment the diuretic effect. Albumin is basically to increase the bounding between drug and protein and fasten its delivery through organic anion transporter. The renal failure stage can last for 7- 21days if proper treatment is given immediately.

Chronic kidney disease and azotemia treatment

Chronic kidney disease: these patients are advised to undergo dialysis and even kidney transplant is severe cases. According to some studies, it has been seen that patient can recover in short duration after renal replacement therapy.

The progression of disease can be slowed down by controlling the concurrent diseases such as diabetes, proteinuria, and hypertension. Other measures include limiting the protein & phosphate intake. Other medical conditions like anemia, acidosis should be treated first and then replacement therapy should be initiated.

Postrenal azotemia treatment

Postrenal azotemia: opening of the obstruction should be the core of the therapy. When anuria is present, catheter should be inserted in the bladder.

When there is obstruction in ureters and it has caused hydronephrosis, either unilateral or bilateral stenting is done. The revival of the renal function is done within 7-10 days but it depends on the severity of the condition.

In extreme cases, full recovery is not possible so only a partial recovery is seen. Around 500-1000ml/min of urine flow occurs postoperatively. Yet, a large amount of salt and water is wasted during the process, dehydration may occur. For such patients, normal saline and potassium chloride (to treat hypokalemia) is recommended. Monitoring is necessary otherwise the patient may become hypotensive.

Medicines used for azotemia treatment

The main target should be to maximize the renal blood flow and keep a balance of urine output. The following are drugs that are given in patients with azotemia.

  • Diuretics: these are helpful in inducing diuresis i.e. increase in urine output and also in the management of edema and hypertension. The urine flow is increased by inhibition of Na & Cl in different sites of nephrons
  • Furosemide: (drug of choice as a diuretic.)
  • Hydrochlorothiazide: its best use is in hypertension
  • Chlorothiazide
  • Metazolene (prescribes in combination to furosemide in highly dangerous edematous situation and also to promote the diuretic effect of furosemide. It is also a better drug in the disturbed renal function)
  • Volume Expanders: these help in raising the plasma oncotic pressure and helps in the movement of the fluid from interstitial space to intravascular space.
  • Albumin (it is given either in form of 5% solution in 250ml or 25% solution in 50mL, which depends on the condition of patient and severity of the disease when the patient’s body is unable to produce its own albumin protein to a normal level)
  • Corticosteroids: these are potent immunosuppressant & anti-inflammatory agents and reduce the inflammation by reducing the cellular and humoral response
  • Prednisone
  • Prednisolone
  • Methylprednisolone
  • Alpha/ Beta adrenergic agonists: they show their effect mainly by causing dilation of the vasculature and consequently perfusion gets improved.
  • Dopamine (caution must be taken while deciding the dose because above a specific dose, this drug acts as a potent vasoconstrictor, which might worsen the condition)

What is the cause of nummular eczema? Is there a cure for nummular eczema?

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Nummular eczema – Definition, Complications, Causes, Treatments and Pictures – Baby

Jul 20 2017 Published by under Diseases

What is nummular eczema?

Nummular (means coin-shaped) eczema or nummular dermatitis or discoid eczema is a rare inflammatory skin form of eczema characterized with coin-shaped/discoid and itchy spots or patches on the skin. It usually appears after a skin injury including: burns, abrasions or insect bite. 1 or many patches may affect the skin that can last for weeks or months.

The condition aims to be chronic, with reappearances and exacerbations that may last several years. The exact cause of nummular eczema isn’t known. However, the skin condition is most common among people with a history of asthma, allergies or atopic dermatitis. The prevalence of this condition is rare and is around 2 per 1,000 people. It is more prevalent in men than in women.

It can be most commonly seen in males and females of around 50-65 years of age or in women of around 15-25 years of age. It is rare in children. Nummular eczema may never be healed completely. However, it can be treated with different lifestyle changes and medical treatment. Different from other types of eczemas, it is very rare and difficult to treat.

nummular eczema looks like ringworm

How nummular eczema looks like? What are typical manifestations?

Following characteristics are typical for nummular eczema:

  • Nummular eczema can be described as round or oval erythematous plaques. They are most often localized on extremities, particularly on the legs. However, they may also occur on the hands, trunk or feet. The face and scalp are usually not involved.
  • Lesions are typically symmetrical.
  • The lesions begin to appear as erythematous or violaceous vesicles or papules. They then coalesce forming confluent plaques.
  • Due to excoriation, erosions may appear over the lesions, and itch may become very intense.
  • Initial lesions, especially vesicles, are often infected with staphylococci, producing yellowish crust. Intense infections, with the signs of cellulitis surrounding the plaques, need oral antibiotics treatment.
  • After some days, plaques usually become dry, crusty and more violaceous, particularly when they are localized above the knee.
  • The lesions become macules after some time, usually with brown hyperpigmentation caused by inflammation. It progressively lightens, and the pigment will probably never fade, particularly when they are below the knee.
  • Plaques may be cleared in the center and be similar to tinea corporis.
  • Intensity of the condition usually varies rather than being constant.
  • The skin eruptions are very itchy; they may also burn or sting. Itching is always the most intensive at night.
  • It has been showed that nummular eczema has seasonal difference in intensity. It is the worse during dry and cold weather and better in warm and humid conditions.

The mechanism of nummular eczema development

There is no exact cause for defining true mechanism of nummular eczema developing, but there are some theories.

One study found that elderly patients with nummular eczema had higher sensitivity to environmental aeroallergens compared to controls. Impaired cutaneous barrier in the case of nummular eczema may also cause increased vulnerability to allergic contact dermatitis to materials such as metals, soaps, and chemicals.

The other study identified neurogenic factors that may lead to inflammation in both atopic dermatitis and nummular eczema by examining the correlation between mast cells and sensory nerves and recognizing the supply of neuropeptides compounds in the skin (epidermis and upper dermis) of patients with nummular eczema.

It has been proposed that release of histamine and other inflammatory substances from mast cells may cause pruritus due to interaction with neural C-fibers. Furthermore, substance P and calcitonin gene-related peptide fibers were obviously increased in lesion samples when compared with nonlesional samples in patients with nummular eczema. These neuropeptides compounds may stimulate release of other cytokines and further promote inflammation.

What are the possible causes of nummular eczema?

The true cause and mechanism of causing nummular eczema is yet unknown. However it has been proposed that sensitivity plays an important role in some cases. A person with nummular eczema may be sensitive to:

  • Metals, including nickel and rarely mercury that can be found in dental fillings.
  • Formaldehyde
  • Medicines, such as topical neomycin

The best way to avoid nummular eczema is to avoid contact with substances that may lead to hypersensitivity reactions. Findings also suggest that except sensitivity the incidence of nummular dermatitis may be increased if you live in a cold, dry climate or have:

  • Very dry skin (xerosis)
  • Different type of eczema, for example atopic dermatitis or stasis dermatitis.
  • Poor blood flow and/or swelling in the legs.
  • Injured your skin caused by insect bite, contact with chemicals, or abrasion
  • Bacterial skin infection
  • Taken certain drugs such as isotretinoin or interferon. Isotretinoin, that is used to treat severe acne, may increase the risk for this skin problem. Interferon can cause as a side effect severe widespread nummular eczema.

Nummular eczema diagnosis

In most cases, the typical appearance of nummular eczema is quite characteristic that diagnosis can be confirmed already after physical examination. In some cases following laboratory procedures can be done in order to confirm the diagnosis:

  • Bacterial swabs may confirm Staphylococcus aureus colonization or infection.
  • Scrapings are usually taken for mycology, as nummular eczema can be misdiagnosed with tinea corporis or ringworm infection.
  • Patch testing is sometimes needed in order to see if the contact allergy is responsible for this eczema. In most cases no specific allergy can be found.

Nummular eczema differential diagnosis

Nummular eczema is very similar to following skin conditions, thus in order to avoid misdiagnosis, differential diagnosis should be considered:

  • Tinea corporis. This condition usually has only a few vesicles that are raised narrow border and scale on the outside of the plaque.
  • Other forms of dermatitis, including atopic dermatitis and asteatotic eczema are very similar but fortunately treatment is similar.
  • Contact dermatitis may sometimes show a similar pattern.
  • Lichen simplex chronicus often occurs on the lower extremities, neck, scalp, or on the scrotum. The main difference from nummular eczema is that it is lichenified or thickened by chronic scratching, and often has no clear border.
  • Stasis dermatitis may occur concurrently on the lower extremities and venous stasis may lead to the development of both conditions.
  • Plaques of psoriasis are often found elbows, knees and the scalp. The scale is usually thick and silver.

What are the complications of nummular eczema?

Following complication may occur:

  • Secondary infection
  • Excoriation or infection may leave permanent scars.
  • Lesions on the lower extremities may leave permanent brown macules.

What should I do to reduce nummular eczema relapses?

In order to reduce nummular eczema reoccurrence following tips may be helpful:

  • Use moisturizers in order to keep the skin well hydrated.
  • Take cool or lukewarm bathes, avoid hot one. Do not use soap. Oils should be added to the bath.
  • After a bath or shower, dry the skin and apply an emollient.
  • Wear loose clothes of materials that do not irritate.
  • A room humidifier may be helpful, especially those with central heating or air conditioning.

Apply oil such as Alpha-Keri oil or Neutrogena body oil to the skin at the end of ones shower. Vaseline is also very helpful if not too oily. Do not take more than 2 baths or shower a day. Soap may irritate and dry off the skin, so keep it away from the eczema. When bathing reduce the use of soap to the face, genital area, armpits and feet. For soap, use Oil of Olay, Cetaphil, Dove or Basis.

Avoid contact with rough clothing such as wool. Cotton clothes (100%) are recommended. When laundering, use no fabric softener, such as Kling or dryer sheets. Wash the clothes using dye free, fragrance free detergents with sign “All free” detergent. It is possible to find a treatment routine that controls nummular eczema, thus it is very important to avoid all potential materials that you are hypersensitive to.

Nummular eczema treatment

The general guidelines for nummular eczema are:

  • Rehydration of the skin is recommended
  • Treating infection with antibiotics
  • Reducing inflammation
  • Patients should shower in cold water or take a cold/lukewarm bath 1-2 a day.
  • Moisturizers or medicated topical preparations should be used to cover the water in the skin. If medication is applied on damp skin it helps seal it and aids penetration.
  • Topical corticosteroids very efficiently reduce inflammation. Usually mild ones are recommendable but in severe disease, stronger corticosteroids may be required and in most severe cases, oral steroids are required. Mild topical corticosteroids such as hydrocortisone are safe for daily use if necessary. Strong corticosteroids should not be used during a period longer than 2 weeks, more than 2 times a day.
  • Intralesional steroid injection is sometimes injected into one or two mostly persistent areas of discoid eczema. This treatment is unsuitable for multiple lesions.
  • Ointments aim to be more effective than creams. Topical applications effects can be improved by occlusion or by applying ointment on wet skin that has been soaking and has not been dried.
  • Tacrolimus and pimecrolimus can be used as an alternative for steroid-resistant cases.
  • If secondary infection occurs then topical antibiotics such as flucloxacilin are needed. Oral antibiotics such as dicloxacillin, cephalexin, or erythromycin that are effective against staphylococci and streptococci infections are recommended.
  • Severe pruritus that may be very unpleasant and cause sleep disturbance is typical for nummular eczema. Antihistamines may be very effective in that case. As the pruritus is often not directly associated with histamine, the sedative effect is more important than the antihistamine action so the older, 1st generation antihistamines are recommended. A higher dose at night will aid sleep.
  • Tar preparations may be helpful for inflammation relief, particularly in older, thickened, scaly plaques.
  • After the eruption has been resolved, patients should continue with aggressive hydration in order to reduce relapses especially in dry climates.
  • Moisturizers for sensitive skin can be administrated
  • Petroleum jelly can be also applied to damp skin after showering.
  • Resting in a moist and cool environment helps, whilst a hot dry environment worsens the symptoms
  • Sunlight or phototherapy can be considered for intense chronic cases. Phototherapy several times weekly during the period of 6–12 weeks can reduce degree and severity of nummular eczema. UV radiation may relieve inflammatory activity within the skin but there is risk of heat worsening the pruritus and UV has its own disadvantages such as provoking carcinogenesis.
  • Persistent and intensive nummular eczema can be treated with immunosuppressant drugs such as methotrexate, azathioprine or cyclosporine. Studies showed that children responded well to methotrexate therapy.

Emollients for nummular eczema

An emollient or moisturizing cream or ointment is very important if the surface of the chronic patches is dry and scaly. These preparations should be applied to unaffected skin, especially if dryness is severe. The emollient should be continued even after the patches have cleared and the corticosteroid preparation has been discontinued.

Emollient creams for nummular eczema

Emollient creams are essentially moisturizers that are very important for eczema treatment. The more you use emollients the less steroid creams or other aggressive products you will need. Emollients work by filling the gaps between the skin cells so they can fill with water and swell up again.

Patients with eczema should use emollient cream very frequently, almost every hour if the skin is very dry, all over their body, even where the skin isn’t affected. Apply after bathing, while water is still trapped in the skin, for extra hydration. Emollients with a higher oil are better moisturizers but also greasy.

Those with mild nummular eczema should try light emollients such as Oilatum lotion and E45. For moderate nummular eczema, more oily products should be used such as: Aveeno cream, E45 cream, DiproBase cream, Dexeryl and Oilatum. For severe eczema Hydromol ointment, Diprobase ointment, 50/50, are recommended.

creams for nummular eczema

Emolients with urea for nummular eczema

Urea absorbs water to the skin. There are some studies suggesting that urea creams are more effective than typical emollients, however urea products have not been examined well in children. However, it has to be known that when urea is applied on very dry skin it can irritate the skin so you might need to apply regular emollient cream first. Products you may try are: Balneum Plus, Balneum cream, Aquadrate, Calmurid and Eucerin urea cream.

Is Eucerin good for people with eczema?

Herpetic whitlow (whitlow finger) in Adults: Condition, Treatments, and Pictures

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Herpetic whitlow – What is, Causes, Symptoms, Treatments and Pictures, Is it contagious?

Jul 19 2017 Published by under Diseases

What is herpetic whitlow?

Herpes whitlow is an infection caused by Herpes simplex virus also known as “cold sore virus”, on the skin near the nail of the thumb or the index finger. The infected finger is known as whitlow finger and an abscess at the end of the finger can be seen.

Here are some features of herpes whitlow:

  1. An intensely painful infection of hands involving fingers mainly terminal phalanx.
  2. Herpes whitlow is more prominent than HSV-2, and approximately 60% of cases suffered from it.
  3. Its symptoms are sometimes referred as “periungual lesions” or lesions around ungual (nail) area.
  4. The virus responsible for herpes gets in through mucous membranes i.e. the moist skin inside the mouth and genital areas.
  5. The virus can be spread by broken skin or lesions on to the fingers, hands, and knees when comes in direct contact with infected person.
  6. A finger sore is also called as a herpetic whitlow.

herpetic whitlow on finger, Causes, Symptoms, Treatments and Pictures, Is it contagious?

How is herpetic whitlow transmitted?

Herpetic whitlow is a transmittable disease and is transmitted by direct contact only. Its transmission is occurred by means of mouth to mouth (mainly by saliva) and ulcerations. It can also be spread even when they are not visible.

The mucous membranes and the moist areas are the most prone areas of the infections. It cannot transmit by indirect contact such as doorknobs or by your petted dog. One should cover it with a bandage until it heals completely, as per physician’s advice. A direct contact is always required for transmission of this virus.

If the infection is left open in the air, even then there are least chances of transmission of this disease. Open and wet lesions are highly contagious. If a person has oral herpes then there are minimal chances of contracting herpes genitalia at the same time. People suffering from immunodeficiency disorders such as AIDS are more vulnerable to herpetic whitlow and the symptoms are more difficult to overcome.

The transmission of this virus is minimal from a pregnant mother to her baby at the time of delivery. Herpes whitlow infection is also common among medical professionals and the risk of catching the herpes virus can be reduced by wearing gloves while examining and treating patients.

What is the mechanism of herpes virus infection development?

The virus is passed directly from the affected area of skin (which could be the genitals, face or hands), by direct skin to skin contact, with friction, when the virus is present.

It can be passed from the face from one person to the genitals of another (or genitals to face) through oral sex when the virus is active.

You can pass it on from the affected area, when the virus is present on the skin surface: from the first warning signs that a recurrence is starting (tingles, burning skin sensations, aches, stabbing pains), through the time when there are sores or blisters, until they have healed and fresh skin has grown back.

About six in ten adults by age 25 carry herpes simplex virus type 1 and one in ten carries type 2. Even more, people carry herpes simplex virus in older age groups – but most don’t know. Only around one in three of those infected – with either type – is aware of this.

Is herpes incurable?

Yes, herpes is incurable. It is a worldwide epidemic. There is no cure for HSV-1. However, medications such as acyclovir (antiviral) are prescribed to reduce the potency of the virus inside the patient’s body.

Herpes is transmitted sexually and lasts for a lifetime. The most affected ones are women as per a survey because the transmission from a man to woman is easier than from woman to man.

What can cause herpetic whitlow?

  • Direct contact with Herpes simplex virus is the main cause of Herpetic Whitlow.
  • There are two types of Herpes simplex virus: HSV 1 and HSV 2.
  • Herpetic whitlow is often associated with oral herpes and often caused by HSV-1 and also called as “cold sores” or “fever blisters”
  • In rare cases, herpetic whitlow can be caused by HSV-2, the virus responsible for genital herpes.
  • Broken skin such as cuts, sores, a torn cuticle or lesions is most common cause to spread the infection.
  • In rare cases, HSV-2 can be passed from mother to child during childbirth, if the pregnant mother developed the lesions shortly before giving the birth.

How is herpes virus spread on hands?

As the virus of herpes whitlow is most prone to moist areas or the mucus membranes, so people who work in certain professions, are more prone to this infection.

  • Herpes virus does well in moist environments, so people who work in moist conditions like hairdressers, medical and dental workers and thumb sucking children are at high risk of getting the herpes infection.
  • The person who use to do “nail biting” are at higher risk of getting the infection. Nail biting can cause small wounds around the nail and due to moist environment of the mouth, the chance of getting the infection is quite high.
  • The chance of re-infection on any other parts of the body after the first episode is very less. It cannot even spread while applying topical creams on the infected areas.
  • People who are suffering from herpes whitlow should seek immediate medical attention. The herpes infection can spread to entire hand that is very hard to treat and sometimes even requires hand surgery.
  • During your first outbreak of herpes infection, you may notice it in more than one place of the body, such as hands and genital area. Because infected hands can also be involved in sexual activity and chances of transmission is always more at moist areas.

Is herpetic whitlow contagious? Can I transmit herpes virus infection if I have herpetic whitlow?

Herpetic whitlow is extremely contagious. It can last for the lifetime if someone acquires it from childhood. The virus, when active can transmit from genitalia of one person to others, or even by face or mouth during oral sex.

Yes, you can transmit the herpes virus infection from the infected area (such as skin or genitalia).

Can sex transmit the herpetic whitlow?

One can get herpes from the infected person by means of vagina, anus or via oral sex.

The liquid and fluid in herpes lesions carry the herpes simplex virus. This fluid can cause the infection. The infection can also cause skin surface because in viral shedding the infection spread to your sex partner.

It is known that HSV-1 is responsible for genital herpes only, whereas HSV-2 can be passed by vaginal and anal sex. HSV-2 cannot survive on non-living things so one cannot get it from a toilet seat and hot tub.

What are signs and symptoms of herpetic whitlow?

The first warning signs of herpes are tingles, burning sensations, aches, and stabbing pains. Symptoms of herpes infection do not result immediately after attack of virus. The virus remains in the incubation in the affected area – growing there but remain undetectable. It may remain undetectable for about two to twenty days.

Initial symptoms of herpetic whitlow may include:

  • a tingling feeling in the affected area
  • pain and swelling of a finger
  • fever and discomfort (in some cases)

These symptoms are usually followed by:

  • sudden pain around the nail
  • redness (erythema), swelling and warmth around the nail
  • the development of small, barely visible blisters around the nail
  • swelling of the lymph glands in nearby areas such as the elbow and armpit (in some cases)

Over the next 7-10 days, the typical symptoms are:

  • swelling, heat, and a burning sensation in the affected digit
  • The development of visible, blister-like grouped sacs of opaque fluid called vesicles around the nail and on the tip of the finger

Herpetic whitlow diagnosis

Following 4 periods are typical for herpetic whitlow diagnosis:

Incubation period: Herpetic whitlow is an infection in which virus needs to inoculate on the host for some time and after inoculation, the virus starts showing symptoms. Just like, in all mucocutaneous infections, the initiation of herpetic whitlow is caused by viral inoculation of the host through exposure to infected body fluids. The exposure may be caused by a break in the skin, open lesions or via torn cuticle.

Symptomatic period: An incubation period of 2-20 days is common after initial exposure. An early symptom of fever and malaise can be seen. The most often-initial symptoms are pain and burning or tingling of the infected finger. Other symptoms include erythema, edema, and the development of 1- to 3-mm grouped vesicles on an erythematous base, which is followed by next 7-10 days of initial symptoms. These vesicles may ulcerate or rupture and usually contain a clear fluid, although the fluid may appear cloudy or bloody.

Healing period: After a period of 10-14 days, symptoms of infection begin to improve and lesions crust over and heal. After improvement in lesions, viral shedding is believed. After 5 to 7 days complete resolution occurs.

Recurrent period: Herpetic Whitlow is mainly characterized by primary infection, which is followed by a latent period with subsequent recurrences. The symptoms usually occur in primary infection. In 20-50% of cases, milder and short duration recurrences have been observed.

Difference between herpetic whitlow, paronychia, and cellulitis 

Following clinical features can be used for herpetic whitlow, paronychia, and cellulitis differentiation:

  • Herpetic whitlow is an infection of thumb or finger mainly index finger. Paronychia is an infection of nail or nail bed. Cellulitis is the infection of deeper layer of the skin.
  • Herpetic whitlow is caused by a virus named Herpes simplex. Paronychia and cellulitis are caused by bacteria.
  • Herpetic whitlow infection is localized on finger. Paronychia infection is localized nail or nail bed. Cellulitis infection can spread through the body very quickly.
  • One can observe clear to yellow lesions with an erythematous base on the fingers or hands in the case of herpetic whitlow. One can observe opaque, purulent fluid along the nail bed, and often surrounded by erythema in the case of paronychia. Cellulitis causes an area of skin (mainly affect lower leg) to suddenly become red ,hot ,swollen ,painful, and tender.
  • Direct transmission from saliva to the hand causes whitlow, patients usually shed virus those are present with whitlow in the case of herpetic whitlow. The bacteria that cause paronychia and cellulitis often live harmlessly on the skin, but they can lead to an infection if they get into a break in your skin.
  • Herpetic whitlow is treated with antiviral drugs. Along with the antibiotics, the incision and drainage is necessary due to increased pressure of the paronychia. Main treatment of cellulitis is antibiotics.

Difference between herpetic whitlow, paronychia, and cellulitis

How long herpetic whitlow lasts?

Herpes whitlow is the infection where the area near the nail of the thumb or the finger gets infected. When you first see the symptoms of herpetic whitlow that is called as primary infection. The symptoms of the herpes infection last between 7 to 10 days. After 10 days, the blisters of the infections begin to heal and it begins to crust and heal symptoms starts to improve.

Herpes encephalitis caused by herpetic whitlow

Whitlow is very important to treat properly because if left untreated it can cause super infection such as herpetic encephalitis (herpes infection in brain).

Herpes encephalitis is a severe brain disease and if left untreated, it can prove fatal over 70%. It can cause respiratory arrest within first 24-72 hours. Acyclovir, a potent antiviral agent beneficial in improving survival rates, along with rapid diagnostic tests, acyclovir also reduced complication rates. Acyclovir is proved so beneficial that the favorable outcome occurred in patients, who are treated with acyclovir within 2 days of getting the infection.

Herpes can also spread in a newborn if a mother is infected with herpes, at the time of delivery and neonatal herpes can cause a range of painful symptoms in the neonate. It can spread to the brain and central nervous system causing encephalitis and meningitis. It can cause mental retardation, cerebral palsy, and death.

How do you treat herpetic whitlow?

Herpes infection is a condition that lasts for seven to ten days but in severe conditions it should be treated with several medications:

Antiviral medications:

  • Acyclovir is best known antiviral drug for the treatment of herpes infection.
  • A dose of 200 mg should be administered for five times a day and 400 mg for three times a day for 5 to 7 days.
  • The treatment should be started within 48 hours of symptoms, as after this period, antiviral will not show any effect.
  • Antiviral drugs are beneficial only for healing herpes, it is neither a cure for herpes nor it is beneficial in preventing future recurrence of herpes infection.
  • A whitlow can be resolves itself in a time period of 2 to 3 weeks.

What are some antiviral agents for herpetic whitlow?

Herpetic whitlow is self-treated disease, and the treatment for this disease provides symptomatic relief. An antiviral drug in the treatment of herpes infection is unlikely to have any effect. These agents may provide a symptomatic relief but one cannot achieve proper cure with these medications. Antiviral drugs do not prevent future outbreaks of herpes simplex infection.

Herpetic whitlow is different from bacterial Whitlow and other infectious diseases because both require different treatment. Antiviral medication effectively used for reducing the duration of symptoms in primary herpes infection and beneficial in preventing recurrent episodes. However, there are no controlled studies showing the optimal doses of antiviral agents for treating herpetic whitlow.

Acyclovir for herpetic whitlow

Herpetic whitlow  is  a cutaneous  manifestation  of  a herpes  simplex  infection and its treatment  with acyclovir  therapy is a widely used chemotherapeutic  alternative.  Acyclovir  is  an  interesting  antiviral  agent that is metabolized by virus-infected cells and very little of the drug is metabolized by normal human cells. Acyclovir can be considered as a effective therapy but not a proper cure for herpes simplex infection.

  • Mechanism of acyclovir involves its interference with only active viral DNA synthesis due to which it would not have any effect on the latent virus.
  • It is a poor prophylactic agent because it is not able to prevent latent infection from becoming an active infection.
  • Acyclovir in injectable form is most effective in treating herpes simplex and has more profound antiviral effect when given by intravenous route.
  • Acyclovir as a topical ointment has minimal antiviral effect; moreover, this ointment can decrease the amount of virus, which keeps, on shedding in herpes simplex.
  • Whereas topical form known to shortens the duration of symptoms in primary infections; it acts on the virus by interfering with DNA replication and prevents the occurrence of further symptoms.
  • The oral form of acyclovir is beneficial in treating recurrences of genital herpes simplex viral infection.
  • If started initially, immediately after onset of symptoms, oral acyclovir inhibits HSV-1 and HSV-2 thereby prevents recurrences of herpes infection and inhibits

acyclovir cream for herpetic whitlow

Famciclovir for herpetic whitlow

  • Famciclovir is another antiviral agent that has a role in the prevention of HSV infection.
  • It acts by transforming into panciclovir and inhibits viral polymerase thereby inhibits viral DNA replication (involved in DNA synthesis).
  • Famcyclovir is effectively used against herpes simplex and varicella-zoaster virus. However, the dose adjustment is needed in patients with renal insufficiency or hepatic disease.
  • It is considered superior over valacyclovir (a prodrug of acyclovir) because of superior bioavailability (77% for famciclovir vs 54% valacyclovir).
  • Possesses longer intracellular half-life, superior efficacy in localized infection, potential for reducing the viral latency in the primary infection.

Valacyclovir for herpetic whitlow

  • Valacyclovir is an oral prodrug formulation of acyclovir that provides up to 5 times greater acyclovir bioavailability.
  • Valacyclovir effectively suppresses recurrent herpes labialis outbreaks when administered more conveniently as 500 mg once a day over 4 months.
  • An effective therapy for ocular HSV infections due to improved bioavailability of acyclovir when administered orally.
  • Once daily dose is beneficial in suppressive management of recurrent genital herpes.
  • It is as effective as acyclovir in primary and recurrent infections with an advantage of convenient dosage regimen.

Does herpetic whitlow need any surgery treatments?

Herpes simplex virus causes cutaneous lesions, which are acquired by skin, contact; humans are the only host of this virus. Few characteristics of herpes lesions are painful swelling, erythema, vesicles and ulcerations that are responsible for severe pain. Paronychium, eponychium and subungual matrix are the main areas of cutaneous infection.

Immobilization and elevation of affected digit, unroofing of blebs and use of topical antibiotics known to provide little relief.  In surgical treatment, pain can be relieved immediately by removing the portion over affected nail bed by means of decompression of nail bed. Simple perforation of the nail over the involved matrix also provided the reduction in pain, which is when followed by nail removal, alleviated all severe pain.

Natural remedies for herpetic whitlow

Ice packs are superior than any remedy for reducing herpes pain to maximal extent.


  1. A soaked cotton ball with some baking soda on it, is beneficial in providing relief in herpes infected area. One should use fresh cotton balls every time treating with this method.
  2. A solution of lukewarm water and oatmeal/cornstarch should be made and cotton ball should be soaked in this solution. An application of this solution is useful in relieve itching of sores.

Application of extracts:

  1. Carrot extract is a great remedy that provides relief in swelling and pain associated with herpes lesions. In this, one should wrap grated carrots in a cloth and place them on affected area.
  2. Grape extract, honey, olive oil, olive leaf extract, marshmallow roots, and tea tree oil is beneficial in facilitating the process of healing of lesions and sores.
  3. Another best home remedy is application of tea bags. Tea bags possess powerful anti-inflammatory and antiviral properties that are beneficial in relieving herpes sores.
  4. A poultice made up of a cup of hot olive oil and some lavender oil + bees wax is a great remedy to get rid of outbreaks of herpes at home. Application of this poultice after cooling provides great relief to patient suffering from herpes.

Essential Oils:

  1. A mixture of eucalyptus oil and bergamot oil is beneficial in treating herpes sores.
  2. Herpes can be cured by using herbal teas like peppermint tea, chamomile tea, black tea. Symptoms such fever and pain can be reduced to a great extent with these herbal teas.

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