Home Remedies For Vitiligo

Vitiligo is a condition that causes the symptoms that you have exactly described. It is an autoimmune disease that is caused by a defective gene in the cells, marking the onset of the disease genetic destiny. Autoimmune diseases are diseases in which the body’s own immune system launches an attack on it and starts killing off cells in the body that are normal. This kind of a response otherwise is required to fight cancers and other growths in the body, but when the body is unable to distinguish what is a normal cell and what is not, the system goes haywire. This is the cause for disease like vitiligo, diabetes, arthritis and a host of other diseases.

Vitiligo Cure

Having understood what an autoimmune disease is, you will be better able to understand how vitiligo progresses. At a certain trigger point, the autoimmune system will suddenly target the melanocyte cells of the skin. These are the cells that are responsible for the color of the skin and hair by creating a substance called melanin. Melanin is what gives color to the skin and also acts as a natural sun block by absorbing ultraviolet radiation. This puts the regions of your body that have been blanched at increased risk of skin damage, at the cellular level by exposure to ultraviolet radiation. However, as will be discussed shortly, this is also the way to rectify the problem. Until recently, the problem was without cure and largely still is because some of the treatments that are used for the condition in modern medicine require the transplant of melanocyte cells, which is a specialized operation.

Home Remedies For Vitiligo And Treatment

This special procedure was conducted where melanocyte cells, which are basically a form of stem cells, were harvested from another part of the body, grown and then implanted by lasers in the blanched areas of the skin. This is the most successful treatment until date for vitiligo and one that you must ask your dermatologist about, since it is also an experimental procedure. The other is a home remedy-based treatment that has data supporting its benefits. To do this, you need to increase the amount of black pepper you consume dramatically. Then, you need specifically to expose the areas that are blanched to the sun. This has been show to rejuvenate the amount of melanocytes in the skin. You need to be careful that the rest of your normal skin is not exposed and this can be done by the use of sculpted tin foil. Alternatively, you can also use a UV lamp for trying out this method.

Remedial Measures for Facial Edema

In medical terminology a swelling is generally refereed to as Edema. Though facial edema is rather rare, it will be wrong to say that it’s uncommon. Like any other disease, this too may have more than one reason for appearing.
More often than not, it is symbolic of some other malfunctioning in your system that may not be exhibiting any noticeable symptom. Rather than trying to go for a treatment of this disorder, it will be advisable to go for a few medical tests to confirm if there is anything wrong somewhere else in the body.

We all know that the modern medical sciences have made rather helpfully convenient to diagnose the causes of an illness. Once the reason for the disorder is established, treatment comes easier and faster recovery is possible.

The medical evidence so far available indicates that facial edema is the result of high blood pressure caused by some kind of malfunctioning of the kidney due to some disease.

What characteristically happens in such cases is that there is a tremendous retention of water in the body. You necessarily have to adopt means to throw out the excess of water that continues to get stored in your body in such circumstances.

More and More of Water
It may sound a bit odd to know that ideally the most successful way to cope up with the state of water retention is to merely to continue to drink more and more of water. Now try to look at it this way.

The Body has a limited capacity to withhold a certain volume of water. As you consume more and more of water, the excess is thrown out of the system through urine and perspiration till equilibrium is established.

Reduce Salt Intake
As an alternate measure you should make some drastic changes in your diet to disable the body from storing more than necessary water.

You may already be aware that salt has a natural property of being hygroscopic in nature that is it characteristically absorbs water even from the atmosphere. That’s why you would have noticed that under humid conditions, like that during monsoons, it gets wet on its own.

So if you restrict the intake of your salt, water retentive system will not be able to retain so much of it. So, you must cut down the quantity of salt intake by refusing to consume any fast food or other preserved food preparations for the simple reason that salt acts as a preservative too.

Psoriasis

Psoriasis (IPA pronunciation: is a disease which affects the skin and joints. It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of inflammation and excessive skin production. Skin rapidly accumulates at these sites and takes a silvery-white appearance. Psoriasis Symptoms are no always that easy to identify and diagnose. For centuries it has commonly been inadvertently mistaken for leprosy, and for centuries people have been suffering the fall out of this wrong diagnosis. For a full and correct diagnosis you should visit your doctor so he can do the correct analysis and suggest the correct treatments to the patient.

There are five types of Psoriasis to look out for :-

. Plaque Psoriasis

. Guttate Psoriasis

. Inverse Psoriasis

. Erythrodermic Psoriasis

. Pustular Psoriasis

What causes psoriasis?

Research indicates that psoriasis may be a disorder of the immune system. The immune system includes a type of white blood cell, called a T cell, that normally helps protect the body against infection and disease. Scientists now think that psoriasis is related to an abnormal immune system that produces too many of the immune cells, called T cells, in the skin. These T cells trigger the inflammation and excessive skin cell reproduction seen in people with psoriasis. This leads to inflammation and flaking of skin.

What are the symptoms?

Psoriasis usually appears as red, scaly patches that reveal fine silvery scales when scraped or scratched. These patches may itch and feel uncomfortable.

Psoriasis is most common on the knees, elbows and scalp, but can appear anywhere on the body.

Some people with psoriasis become withdrawn and don’t socialise or form relationships because of the way people react to the appearance of their skin.

Diagnosis

There are several forms of psoriasis, and each form has unique characteristics that allow dermatologists to visually identify psoriasis to determine what type, or types, of psoriasis is present. Sometimes a skin biopsy will be performed to confirm the diagnosis.

Is psoriasis contagious?

No. You can’t catch psoriasis from another person or give it to someone by touching them, and you can’t spread it to other parts of your body.

Treatment

Currently, there is no cure for psoriasis. However, there are many treatment options that can clear psoriasis for a period of time.Therapy for psoriasis ranges from conservative to aggressive treatment. Due to the chronic nature of the disease, many patients try several therapies over time. Guttate psoriasis usually is managed more easily and complete remission typically occurs. In addition to standard treatment, patients with guttate psoriasis are given a course of oral antibiotics to eradicate the strep infection.

Sunshine - Sunshine may help to clear psoriasis; in many people it improves dramatically during sunny holidays. Take care, as psoriasis may develop in areas of sunburn, and fair skin exposed to ultraviolet radiation becomes prematurely aged and may develop skin cancer.

Baths - Soaking in warm water with a bath oil or tar solution can soften the psoriasis and lift the scale. Bland soaps or soap substitutes are useful. Antiseptics are not necessary and may irritate.

Prevention

There is no known prevention. Keeping skin clean and moist and avoiding your specific psoriasis triggers may help reduce the number of flare-ups.

Doctors recommend daily baths or showers for persons with psoriasis. Avoid scrubbing too hard, because this can irritate the skin and trigger an attack.

Diabetes Mellitus Cure

During recent times, diabetes has affected lot of people especially people between the age of around 50 years. Because it has no cure, it has become a chronic disease. This simply means that if you are diagnosed with the diabetes, you have to bear it till the end of your life. There is no cause of alarm because treatment of this disease starts with the big amount of lifestyle changes and meaning that you can still live the life to fullest.

The treatment of the diabetes mellitus is dependant on the nature of the disease and to treat this disease it is really necessary for one to get the knowledge about the disease. There are two types of diabetes namely DM-I and DM-II. The only difference between this two is that I the DM-I, the pancreas stops producing the insulin, the hormones that lowers the glucose in the blood. In the DM-II, even though pancreas produces some amount of insulin, body may utilize the insulin very poorly.

As it has already been known that this disease can’t be cured fully, the treatment of this disease has been aimed basically to prevent the further complications in the body. It is good to change some areas of the life style as this disease is going to be there till the end of the life. The first step to take is to limit the sugar intake and this is applicable for the all kinds of diabetes. This doesn’t simply mean that to avoid adding sugar in the tea or to avoid eating chocolates because there are so many other glucose sources that can create the high level blood sugar. Such sources are either natural or artificial that when digested causes an increase in the blood sugar. One such example is grapes that are having high sugar contents. And this is the reason why they are selected to make wines, just because of their naturally high sugar contents. One example of artificial food that is having high blood sugar is bread. Even though it doesn’t taste sweet, it has lots of carbohydrates and the end product of the carbohydrate digestion is glucose.

The insulin is the best way to cure the diabetes mellitus and this is more applied to the patients of DM-I type due to the nature of the disease. In the DM-II type, the oral hypoglycemic could be used to stimulate the insulin production from the beta cells of pancreas. The DM-I type of diabetes can be cured with the oral hypoglycemic but it is impossible to cure the DM-I type of diabetes because there are no beta cells available in the body to stimulate the production of insulin.

Another effective way to treat the diabetes mellitus for DM-II type is reduction of fat food and daily exercise. It is already proven that the regular exercise improves the use of insulin in the body while the reduction of fat food reduces the complications in the heart. It is also a good thing to avoid smoking as smoking is also closely attached it the heart diseases and it can increase the chances of heart attack as well of cancer.

Eczema-A SKIN PROBLEM

Eczema is the most annoying ailment that people experience. Approximately, almost ten to twenty percent of all of the inhabitants around the world have been suffering from eczema. When you’re experiencing this disease, your skin will turn itchy, red, and will become blistering.

How your skin turns into inflamed because of irritants present in the environment is believed as the reason of the eczema occurrence. Besides, other physical conditions become the following reason of this skin disease. In fact, every person can undergo eczema although a person with a family history of it prone to experience it than other people.

No Cure

In the recent time, the remedy for eczema eludes mankind though the condition can be treated so that immediate relief is impending. The main function of the skin of course is to put off infections and illness from affecting us. Though, when such potentials become compromised because of oversensitive irritants (external) or triggers as they are also referred to as, then a reaction that then turns into eczema results.

Eczema is also known to affect infants and children. Definitely, adults can be affected by this kind of skin illness. However, in the case of infants, the disease is seen on their cheeks, forearms, scalp, forehead and legs. In other cases, there will be patches that will turn red in color and which will itch a lot as well and these patches are recognized to increase on the face, neck, inside of one’s ankles, elbows, as well as on the knees.

There are also dissimilar forms of eczema. In fact, how it develops depends to a great deal on the form and nature of the irritant. One of the commonest types of eczema is known as atopic dermatitis. It will cause the patient to also risk developing asthma and food allergies as well as come down with hay fever.

Another kind of such skin disease is the one recognized as occupational eczema in which allergic reactions may occur due to the nature of the environment at a person’s workplace. Yet another kind of this ailment is known as nummular eczema in which you’ll notice splotched skin which condition can be further exacerbated if one continues to wear tight fitting clothes that will only assist in irritating the skin further.

Although eczema cannot be relieved, there are several remedies available to you. With this, you’ll be able to avert your skin ailment to develop or avoid your problem going to worst. All you need to do is having your lifestyle changes.

VINEGAR-toenail infection

Many people suggest vinegar as an effective solution for toenail fungus treatment. However the question that needs to be answered is how it could be useful for treating the toenail fungus. Of course there are many other ways for treating the toenail fungus including allopathic, homeopathic, and home medicines. However, till date the vinegar continues to be one of the most trusted solutions for healing toenail fungus infections.

Types of vinegar and their effects

Various types of vinegar are used as remedies for toenail fungus infections. Different types of vinegar includes common white vinegar, apple cider vinegar, and red vinegar. In any case, vinegar constitutes the cheapest and most easily available treatment for toenail fungus infections. It not only prevents the fungal infections but also stops them from spreading further in the most effective manner. Some of the forms of vinegar that are used for the purpose include malt, wine, cane, raising, coconut, rice, apple cider, beer, and honey vinegar etc.

How fungus works

When fungus affects any part of your body, especially the toenails or fingernails, it changes the PH value of your skin. The skin becomes alkaline and the inner tissues of the nail are adversely affected because of the change in PH. The surrounding cuticles are affected by alkaline and they cause irritation in your skin. Sometimes the irritation is in the form of itches and some times you could suffer a little initial pain.

Vinegar affects

Vinegar contains acidic elements and it helps in relieving the itches and pains. This acidic nature of vinegar is also one of the best solutions for combating the fungus affects. Microorganism that causes fungus will not survive in acidic environments. Since vinegar contains acid it provides effective prevention against the fungus attacks. That is why vinegar is widely used for fungus treatment by the naturopath, cosmetologists and those who practice alternate medicinal treatments. Vinegar has been used for fungus treatments and various other ailments since the ancient ages. Chinese people used it to prevent the spread of virus. In ancient Greece also it was commonly used in the treatment for toenail infection. Apple cider vinegar is also very useful in treating fungus and it is very popular nowadays.

Why use vinegar?

Many reasons can be extended in support of vinegar use for combating the toenail fungus or any such affects. One of them is, vinegar is easy to get item and it is easier to apply. You neither require any assistance nor any expert services for using vinegar on the affected toenail. Vinegar does not have any harmful side affects like the regular medications or many other treatments used as remedial measures for fungus affects. You have to dry out your toenails and this should be done as soon as possible after the treatment with vinegar. This is the only precaution you need to take after applying vinegar. Apple cider vinegar can also reduce inflammation that might have occurred due to the toenail fungus affects. It can also work very well when combined with hydrogen peroxide or H2O2.

It is better

Experts have the common view that, using vinegar directly on the base of your affected nail twice a day will be even better than soaking your feet. Vinegar remains in place quite long enough to be effective. Even two drops of vinegar regularly applied could be very good for curing toenail fungus. You must however remember that early treatment is the best treatment and delay could cause problems and health hazards.

ARTHRITIS

Introduction

One of the most commonly misunderstood conditions among people is arthritis..Often the word, “arthritis,” brings to mind a future that includes crippled and twisted joints. However “arthritis” is an all-inclusive word that encompasses many different conditions from the benign to the severe. For our purposes we will restrict this discussion to the most common forms of arthritis.

Osteoarthritis and Chiropractic Care

Osteoarthritis, degenerative arthritis, or degenerative joint disease (DJD) are the labels for the most common form of arthritis, which is also called, spondylosis, if it occurs in the spine. This form of arthritis is not limited to humans, but occurs in all mammals, and is due to the deterioration of the cartilage that covers the joint surfaces. Degenerative changes in the joint takes place when joint cartilage is damaged and causes stress to the sensitive bone tissue that is ordinarily protected by the cartilage. Sometimes the bone around the joint will proliferate and make osteophytes, or what are more commonly called bone spurs. These spurs can create painful irritation to other tissues surrounding the joint, thus complicating the already distressing condition.

The most common areas of the body that develop degenerative joints are in the spine, principally in the lower neck and lower back, the knees, the hips and the fingers. Previous trauma, certain occupations and activities, weight, diet, and heredity all appear to influence both the onset and severity of DJD.

The symptoms of DJD always involve some degree of pain and/or stiffness in the body part involved. As the condition progresses there can be loss of mobility, particularly when weight-bearing joints such as hips or knees are involved. As a last resort joints can be surgically replaced with synthetic devices. This should be done only in severe cases where the joint is measurably worn and movement is unattainable without severe pain.

Prevention is always the best option, beginning at an early age.

* Making sure that all injuries to joints are properly treated will help to avoid future problems.
* People involved in occupations that necessitate standing or walking should wear proper shoes that offer good support and shock absorption.
* Weight loss through proper diet will help to decrease stress on weight-bearing body joints.

* Care should be taken to protect knees from pain aad strain when kneeling on hard surfaces.

* The natural vitamins, minerals, and antioxidants provided by fruits and vegetables are vital for healthy joints and a healthy body.

Recently there have been some studies that reveal that the nutritional supplement, Glucosamine, can help with DJD and may actually help rebuild joint cartilage. However, it must be used over an extended period and does not work in all conditions.

Chiropractic adjustments are not only sound, but an effectual treatment for arthritis, and can assist in restoring proper mobility and function to the spinal joints, thereby giving patients great relief. Your Chicago chiropractor has many of years of experience in helping people with arthritis pain. In addition, chiropractic modalities such as joint mobilization, ultrasound, cold laser therapy, massage and electro-therapy may be used to aid in the treatment of painful and stiff joints. Occasionally, a brace is necessary to support the joint and relieve pain. A chiropractor may suggest exercises such as stretching, yoga, tai chi and other gentle mobilizing activities to help maintain arthritic joints.

Gout

Gouty arthritis is produced by increased levels of uric acid in the blood and the accumulation of uric acid crystals in the joints. The most common joints are the big toes, the knees, ankles and wrists, and is often characterized by acute pain and swelling. Most people who develop gout are predisposed through heredity, though episodes are more often than not brought on by binge eating of inflammatory foods, when dehydrated or fasting, or after a major surgery or illness. Foods that must be avoided have a natural substance called Purines that are metabolized in the liver to form uric acid. Those with this condition cannot effectively metabolize uric acid, thus the accumulation in the bloodstream and the subsequent joint problems. The foods most connected with high purine content are: red meat especially organ meat, certain seafood, legumes, mushrooms and other foods as well. There are other dietary restrictions that must be followed including the avoidance of alcohol.

Rheumatoid Arthritis

Rheumatoid arthritis, a chronic inflammatory disease, is systemic in nature and thought to be created by immune system dysfunction. The most common joints affected are the small joints of the hands and fingers, the feet, knees, and shoulder, although other areas of the body can be affected as well. The condition is generally associated with morning stiffness that is aggravated by motion. Additional symptoms can include general malaise and fatigue, and in its more advanced stages other systems of the body may be affected. Rheumatoid arthritis can be easily identified through specific blood tests. Though, currently, there is no cure, in addition to medication and vitamin and diet therapy, treatment should include chiropractic manipulations to mobilize joints and help to relieve the pain and stiffness accompanying this disease. Additional modalities such as ultrasound, heat, electro-therapy, and massage may also be beneficial. Your Chicago chiropractor is dedicated to assisting people in getting relief from the pain and suffering associated with arthritis

NATURE CURE

Nature cure is a constructive method of treatment which aims at removing the basic cause of
disease through the rational use of the elements freely available in nature. It is not only a system
of healing, but also a way of life, in tune with the internal vital forces or natural elements
comprising the human body. It is a complete revolution in the art and science of living.
Although the term ‘ naturopathy’ is of relatively recent origin, the philosophical basis and several
of the methods of nature cure treatments are ancient. It was practised in ancient Egypt, Greece
and Rome. Hippocrates, the father of medicine ( 460-357 B.C.) strongly advocated it. India, it
appears, was much further advanced in older days in natural healing system than other
countries of the world. There are references in India’s ancient sacred books about the extensive
use of nature’s excellent healing agents such as air, earth, water and sun. The Great Baths of
the Indus Valley civilisation as discovered at Mohenjodaro in old Sind testifies to the use of water
for curative purposes in ancient India.
The modern methods of nature cure originated in Germany in 1822, when Vincent Priessnitz
established the first hydropathic establishment there. With his great success in water cure, the
idea of drugless healing spread throughout the civilised world and many medical practitioners
throughout the civilised world and many medical practitioners from America and other countries
became his enthusiastic students and disciples. These students subsequently enlarged and
developed the various methods of natural healing in their own way. The whole mass of
knowledge was later collected under one name, Naturopathy. The credit for the name
Naturopathy goes to Dr. Benedict Lust ( 1872 - 1945), and hence he is called the Father of
Naturopathy.
Nature cure is based on the realisation that man is born healthy and strong and that he can stay
as such as living in accordance with the laws of nature. Even if born with some inherited
affliction, the individual can eliminate it by putting to the best use the natural agents of healing.
Fresh air, sunshine, a proper diet, exercise, scientific relaxation, constructive thinking and the
right mental attitude, along with prayer and meditation all play their part in keeping a sound mind
in a sound body.
Nature cure believes that disease is an abnormal condition of the body resulting from the
violation of the natural laws. Every such violation has repercussions on the human system in the
shape of lowered vitality, irregularities of the blood and lymph and the accumulation of waste
matter and toxins. Thus, through a faulty diet it is not the digestive system alone which is
adversely affected. When toxins accumulate, other organs such as the bowels, kidneys, skin and
lungs are overworked and cannot get rid of these harmful substances as quickly as they are
produced.
Besides this, mental and emotional disturbances cause imbalances of the vital electric field
within which cell metabolism takes place, producing toxins. When the soil of this electric filed is
undisturbed, disease-causing germs can live in it without multiplying or producing toxins. It is
only when it is disturbed or when the blood is polluted with toxic waste that the germs multiply
and become harmful.
Basic Principles
The whole philosophy and practice of nature cure is built on three basic principles. These
principles are based on the conclusions reached from over a century of effective naturopathic
treatment of diseases in Germany, America and Great Britain. They have been tested and
proved over and over again by the results obtained

The first and most basic principle of nature cure is that all forms of disease are due to the same
cause, namely, the accumulations of waste materials and bodily refuse in the system. These
waste materials in the healthy individual are removed from the system through the organs of
elimination. But in the diseased person, they are steadily piling up in the body through years of
faulty habits of living such as wrong feeding, improper care of the body and habits contributing to
enervation and nervous exhaustion such as worry, overwork and excesses of all kinds. It follows
from this basic principle that the only way to cure disease is to employ methods which will
enable the system to throw off these toxic accumulations. All natural treatments are actually
directed towards this end.
The second basic principle of nature cure is that all acute diseases such as fevers, colds,
inflammations, digestive disturbances and skin eruptions are nothing more than self-initiated
efforts on the part of the body to throw off the accumulated waste materials and that all chronic
diseases such as heart disease, diabetes, rheumatism, asthma, kidney disorders, are the results
of continued suppression of the acute diseases through harmful methods such as drugs,
vaccines, narcotics and gland extracts.
The third principle of nature cure is that the body contains an eleborate healing mechanism
which has the power to bring about a return to normal condition of health, provided right
methods are employed to enable it to do so. In other words, the power to cure disease lies within
the body itself and not in the hands of the doctor.
Nature Cure vs Modern System
The modern medical system treats the symptoms and suppresses the disease but does little to
ascertain the real cause. Toxic drugs which may suppress or relieve some ailments usually have
harmful side-effects. Drugs usually hinder the self-healing efforts of the body and make recovery
more difficult. According to the late Sir William Osler, an eminent physician and surgeon, when
drugs are used, the patient has to recover twice - once from the illness, and once from the drug.
Drugs cannot cure diseases; disease continues. It is only its pattern that changes. Drugs also
produce dietary deficiencies by destroying nutrients, using them up, and preventing their
absorption. Moreover, the toxicity they produce occurs at a time when the body is least capable
of coping with it. The power to restore health thus lies not in drugs,but in nature.
The approach of modern system is more on combative lines after the disease has set in,
whereas nature cure system lays greater emphasis on preventive method and adopts measures
to attain and maintain health and prevent disease. The modern medical system treats each
disease as a separate entity, requiring specific drug for its cure, whereas the nature cure system
treats the organism as a whole and seeks to restore harmony to the whole of the patient’s being.

Methods of Nature Cure
The nature cure system aims at the readjustment of the human system from abnormal to normal
conditions and functions, and adopts methods of cure which are in conformity with the
constructive principles of nature. Such methods remove from the system the accumulation of
toxic matter and poisons without in any way injuring the vital organs of the body. They also
stimulate the organs of elimination and purification to better functioning.
To cure disease, the first and foremost requirement is to regulate the diet. To get rid of
accumulated toxins and restore the equilibrium of the system, it is desirable to completely
exclude acid-forming foods, including proteins, starches and fats, for a week or more and to
confine the diet to fresh fruits which will disinfect the stomach and alimentary canal. If the body is
overloaded with morbid matter, as in acute disease, a complete fast for a few days may be
necessary for the elimination of toxins. Fruit juice may, however, be taken during a fast. A simple
rule is : do not eat when you are sick, stick to a light diet of fresh fruits. Wait for the return of the
usual healthy appetite. Loss of appetite is Nature’s warning that no burden should be placed on
the digestive organs. Alkaline foods such as raw vegetables and sprouted whole grain cereals
may be added after a week of a fruits-only diet.
Another important factor in the cure of diseases by natural methods is to stimulate the vitality of
the body. This can be achieved by using water in various ways and at varying temperatures in
the form of packs or baths. The application of cold water, especially to the abdomen, the seat of
most diseases, and to the sexual organs, through a cold sitting ( hip) bath immediately lowers
body heat and stimulates the nervous system. In the form of wet packs, hydrotherapy offers a
simple natural method of abating fevers and reducing pain and inflammation without any harmful
side-effects. Warm water applications, on the other hand, are relaxing.

Other natural methods useful in the cure of diseases are air and sunbaths, exercise and
massage. Air and sunbaths revive dead skin and help maintain it in a normal condition. Exercise,
especially yogic asanas,promotes inner health and harmony and helps eliminate all tension :
physical, mental and emotional. Massage tones up the nervous system and quickens blood
circulation and the metabolic process.

Thus a well-balanced diet, sufficient physical exercise, the observation of the other laws of
well-being such as fresh air, plenty of sunlight, pure drinking water,scrupulous cleanliness,
adequate rest and right mental attitude can ensure proper health and prevent disease.

NIPER EXAM PATTERN & SYLLABUS

Entrance pattern:
Well entrance consists of 200 questions in 2 hours. (Please check it in Brochure). Well questions will be very easy so no need to go in depth of the topic. Basic concepts based questions are asked. M. Pharma branches and M.B.A. has a common entrance paper. So read some general knowledge aspects also…………….
This syllabus is just like GATE entrance but more specific in Basic Chemistry instead of medicinal chemistry.
Specialization subjects: What to study?
Medicinal chemistry and Bulk Drugs (Pharmaceutical Technology)
IUPAC nomenclature, R and S nomenclature, E and Z isomerism, atropiisomerism, Conformations
Hybridization, aromaticity, Huckel’s rule reaction mechanisms- Electrophilic, Nucleophilic, SN1, SN2, SNi, Elimination E1 E2 etc.
Ester hydrolysis, Aac1 Aac2……all eight mechanisms (Jerry march) Markovnikoves rule, Bredts rule, Stereoselectivity, stereospecificity, regioselectivity, chemoselectivity, chirality, stereochemistry, conformations, rearrangements, acids and bases.
Imine-enamine Tautomerism, keto-enol tautomerism, pericyclic reactions, racemic mixture, resolution methods.
Amino acids proteins, various methods for amino acid detection, Ninhydrin test, peptide sequencing, structures of amino acids, essential and nonessential amino acids,
Introduction to thermal methods of analysis like, TGA, DSC, DTA etc.
Carbohydrates classification, osazone test, mutarotation, etc,
Various Heterocycles, Heterocycle synthesis, reactions.
Introduction to Redox reactions.
Spectroscopy: (basics specially): Very very IMP topic. NMR, and C-NMR ranges from Morrison & Boyd or Pavia Mass -Basic concepts about various peaks M+1, molecular ion, base peak etc. (Silverstein) IR - Frequencies of various groups specially carbonyls. UV
Chromatography: Details of every chromatographic method.
Reaction kinetics, first second third and pseudo first order reactions, radio labeling for determination of mechanism.
Common condensation reactions like Aldol, Claisen Perkin, Dickmann, Darzen etc.
Other reactions like Cannizarro’s reaction, Prins reaction, especially reactions of carbonyl compounds.
References:
1. Jerry March
2. Morrison and Boyd (ESPECIALLY Peptide and Carbohydrate chemistry)
3. I. L. Finar Vol-I and Vol-II (Heterocyclic chemistry and organic synthesis)
4. Eliel
Natural Products:
In natural products more stress should be given on phytochemistry part rather than biological aspects.
Methods of extraction, isolation and characterization of natural products. Various separation techniques used for isolation of natural products.
Biosynthetic pathways.
Primary metabolites, their examples.
Secondary metabolites, various classes of secondary metabolites (e.g. Alkaloids, glycosides, tannins, lignans, saponins, lipids, flavonoids, coumarins, anthocyanidines etc.). Here most imp. Part is chemistry of these classes.
Important therapeutic classes: antidiabetics, hepatoprotectives, immmunomodulators, neutraceuticals, natural products for gynecological disorders, anti-cancer, anti-viral (mainly anti-HIV), adaptogens etc.
Dietary antioxidants, Marine natural products, Plant growth regulators.
Spectroscopy: Basic concepts of UV, NMR, IR and Mass spectroscopy. Give more stress on IR and NMR.
Stereochemistry: Basic concepts.
Fischer, sawhorse and newmon projection formulaes.
Biological sources of important classes of natural products. (Selected ones only)
Standardization of natural products.
What is difference between natural products and pharmacognosy?
References:
1. For various therapeutic classes: Trease and Evans
2. For spectroscopy: Silverstein, Pavia, Kemp.
3. For stereochemistry: I.L. Finar vol-II
Pharmacology and toxicology:
Pharmacokinetics, pharmacodynamics, pharmacological effect, desired, undesired, toxic, adverse effects.
Bioavailability, bioequivalence, various factors of ADME. (From Bramhankar)
Drug metabolism: various pathways and other details.
Drug interactions, agonist, antagonist, partial agonist, protein binding, drug distribution, distribution volume, excretion pathways etc.
Pharmacological screening: general principles, various screening models, screening methodologies (in vitro and in vivo tests).
Mechanism of drug action, drug-receptor interaction.
Various adrenergic, cholinergic and other receptors
Detailed study of CNS pharmacology
Study of basis of threshold areas of work in NIPER in pharmacology dept. mentioned in brochure.
Diseases: study of the pharmacology of the diseases and drugs used with mode of action especially of diabetes, malaria, leishmaniasis, TB, hypertension, myocardial ischemia, inflammation, and immunomodualtion.
Chemotherapy and pathophysiology- knowledge of antibiotics, their mode of action and the microorganisms responsible for various common diseases.
Bioassay methods, various requirements. Brief knowledge of the statistical tests.
References:
1. Rang and Dale (ALL CHEMOTHERAPY CLASSES OF DRUGS. IF YOU READ THE WHOLE BOOK, then nothing else is needed)
2. F. S. K. Barar
3. Wilson and Griswold (for Mechanism)
4. Kasture (for Bioassay and Screening)
Pharmaceutics and formulation (Pharmaceuticl Technology)
Drug delivery systems (DDS): NDDS models, osmotic pumps, various release patterns eg. Controlled release, delayed release. Sustained release etc., order of release. Oral controlled DDS, factors affecting controlled release.
Carriers in DDS: polymers and their classification, types, carbohydrates, surfactants, proteins, lipids, prodrugs etc.
Transdermal drug delivery systems (TDDS): principles, absorption enhancers, evaluation of TDDS.
Parenterals: requirements, advantages, disadvantages, release pattern, route of drug delivery.
Drug targeting: microspheres, nano particles, liposomes, monoclonal antibodies, etc.
Preformulation detailed.
Complexation, solubilization, polymerization, viscosity measurements.
Dosage form development- stages, implications of dosage form.
Additives of formulation, types, examples, advantages, disadvantages, drug excipient interaction, incompatibility, various types of incompatibilities.
Dosage forms: solid (tablets, capsules, pills etc), liquid (emulsion, suspension etc), sterile (injectables), aerosols. Principles, advantages, disadvantages and problems.
Coating - in detail.
Packaging: materials, labeling etc. Types of containers (e.g. Tamper-proof containers)
In process controls, Product specification, documentation.
Compartmental modeling. (From Bramhankar)
Bioavailability, bioequivalence studies. Methods of improvement of oral bioavailability.
Evaluation of formulation, principles and methods of release control in oral formulations.
References:
1. Lachmann (ALL new and old techniques in Pharmaceutical Industry)
2. Alfred Martin (ALL physical chemistry BASICS)
3. Remington’s Pharmaceutical Sciences
4. Notes of Gudsurkar Sir (Most important)
5. Banker series.
6. other: Bramhankar, , Liberman Series
Pharmaceutical analysis:
Stability testing of pharmaceuticals, various stability tests, kinetic studies, shelf life determination, thermal stability, formulation stability.
Various analytical techniques
Tests: physical and chemical tests, limit tests, microbiological tests, biological tests, disintegration and dissolution tests.
Spectroscopic methods; UV, NMR, IR, MS, FT-IR, FT-NMR, ATR (Attenuated Total Reflectance), FT-Raman- basics and applications.
Thermal techniques: DSC, DTA, TGA, etc.
Particle sizing: law of diffraction.
Electrophoresis: capillary electrophoresis.
Chromatography- detailed.
QA and QC: GLP, TQM, ISO system.
Preformulation, cyclodextrin inclusion compounds
Solubility: pH, pka, surfactant HLB values, Rheology.
Crystallinity, polymorphism, solvates and hydrates, crystal habits, porosity, surface area flow properties.
Dosage forms, Stages of dosage form development
Osmolality, osmolarity, osmotic pressure, conductivity, Preservatives, Media for bioassay.
References:
1. Willard
2. Silverstein (Mass Spectroscopy)
3. William Kemp (NMR)
4. Pavia (for spectroscopy)
5. Others like Alfred Martin, Chatwal (UV), Garry Christen (Chemical Methods)
Biotechnology:, Pharmaceutical technology biotechnology
Genetic Engg: Gene expression, mutation, replication, transcription, translation, recombination, bacteriophages.
Cloning: methods, isolation of nucleic acids, enzymes in cloning (restriction endonucleases, DNA ligase, DNA gyrase, polymerases etc...), functions of these enzymes, Pallindromes.
Fermentation: fermenters, fermentation process, its regulation, conditions, bioprocessors, various enzymes in fermentation technology. Fermentation of Antibiotics, vitamins, amino acids, hydroxy acids such as lactic acid etc. Chemical engg. aspects realated to fermentation
Gene therapy: methods and applications.
Monoclonal antibodies, insulin, interferons, enkephalins, angiotensin analogues and other peptides.
References:
1. Vyas and Dixit
2. IP Appendices
Practice of Pharmacy:
The best part for the preparation for this best reference for this would be Remington’s Pharmaceutical Sciences. This branch is quite new here, so till dates students of branch used to do case study of prescriptions in Fortis hospital, PGI Chandigarh and govt. college chd... This is much like pharmacology and drug-drug interactions and different interactions are emphasized. Diabetes, heart diseases are main area of study……….
Pharmacoinformatics:
Terminologies related with new emerging informatics e.g. proteomics, genomics, QSAR (2D, 3D, regression, correlation).
References:
Foye, Williams and Lemke, Medicinal chemistry, 5th/6th edition, chapter 1-6. (Computational drug design and molecular modeling).
Others:
Statistics, general mathematics and aptitude questions. Use MBA entrance test books like CET or CAT in MBA. Additionally some general awareness questions.
NIPER’s thrust areas are:
Microbial and viral diseases: Yeast, and fungi.
Parasitic and tropical diseases: Malaria, Leishmaniasis, amoebiasis, etc.
Metabolic Disorders: Diabetes
Strokes
Peptide and carbohydrate chemistry.
Genomics and proteomics: yeast and fungi
Hormonal disorders: TRH related diseases.

credit goes to:-www.niperjee.blogspot.com

YOGA IN TREATMENT OF ASTHMA

Dr. Swami Shankardevananda Saraswati MBBS

Asthma is a symbol for many different diseases. When I was young I had very bad asthma, and this had a great effect on my physical, emotional and mental well-being. I was crippled by it. In so many-ways it distorted my lifestyle, and prevented me from doing the things I wanted. But I was very fortunate and came to yoga. A few years ago, I started doing some basic practices, and today I am completely cured.

Western medicine does not believe there is a cure for asthma. I know this from personal experience and from my teachers in medicine. This applies to many other diseases, among them cancer, diabetes and high blood pressure. In his ashram, Swamiji has helped all of these through yoga. There is a possibility of recovery even for so called incurable diseases. Now it is just a matter of showing the medical world the potential of yoga and Swamiji’s teaching.

The title ‘Asthma and Yoga’ is in itself the start of something very important for us all. In this we see the combination or union of two different concepts or ideals of healing. One is in the medical word ‘asthma’, and the other is in the Sanskrit word ‘yoga’. Here we see the union of east and west. Having been cured of my disease through this union and after six years of rigorous training, I hope to see medicine remove its limited boundaries and incorporate the wonderful system of yoga.

Asthma is a disease of the respiratory system. What does it mean to have a disease like asthma? What is the respiratory system all about? To start off, the most basic component is the lungs, but there are also many other factors : nose, trachea, ribcage, muscles, shoulders. These components all join together to make breathing easy and relaxed. But, what most of us are missing, and what I missed for so long, was an awareness of just what is going on. Once you become aware that you are breathing all the time, you start to realise how absolutely fantastic and complex, yet how simple a process it is.

This is what medical science has done. It has made us aware of our body, while yoga can make us aware of our mind and spirit. So, once we become aware that we have a respiratory tract, that we have an intricate body to utilise to the fullest, then through the techniques of yoga we can fulfil our potential. The respiratory system is just one part. There are other organs in the body just as fantastic or even more so. The brain, the heart, the hand, the digestive system, the tongue, nose, ears, eyes, all these things. If we think about it, they make us the most wonderful creation on this earth. So why do we get sick? Why do we get things like asthma? It’s a difficult question but we must try to answer it for ourselves. To do this, first we must sort out and become aware of the different parts of the body. Only then can we more fully begin to appreciate and understand what we have.

We know that pranayama is the means to control the mind and relax the body. The lungs are our means of receiving life. We plug into life through our noses, because it is through them that we should breathe. We are plugged into the vast sea of life by breathing which maintains individual life. The moment we stop breathing we have three minutes of life left, unless one is a highly accomplished yogi. Asthma prevents us from plugging into this sea of life properly. It is an incredibly debilitating disease. With control, willpower, determination and regular practice, asthma can be cured. It takes time. It took me many years; and even when I thought I was cured, I wasn’t.

The time has come for everyone to start working seriously on their bodies and minds to eliminate the diseases we all have, and come to wholeness and integration, which is union.

Courtesy: Yoga Magazine, February 1977

GOOD QUALITY OF SLEEP

Insomnia is a symptom, not a disease. Insomnia can have many causes, but the biggest cause is due to stress. Stress related to work, school, health or family concerns. Depression is the second biggest cause. The use of stimulants, including caffeine, alcohol, nicotine or other over-the-counter or prescription medications will also cause insomnia. Prescription drugs, including some antidepressant, high blood pressure and steroid medications, can interfere with sleep. Many over-the-counter medications, including some brands of aspirin, decongestants and weight loss products, contain caffeine and other stimulants. Change in your environment or work schedule and even long-term use of sleep medications will actually interrupt your sleep cycle. Medical problems, including fibromyalgia or complex diseases of the nerves and muscles can make it very difficult to fall asleep and stay asleep. Behavioral insomnia, occurs when you worry excessively about not being able to sleep well and try too hard to fall asleep. Most people with this condition sleep better when they’re away from their usual sleep environment. Best Sleep Tips 1. Sleep. That wonderful but sometimes elusive state of bliss and rejuvenation! I think it is most important to go to sleep with a “Quiet Mind”. Sometimes this is difficult to do. We all have trouble now and then. Sometimes, we are even afraid of knowing that we have to go to sleep. 2. Fear can be an underlining problem in many cases. There are many ways to quiet the mind. Doing 15 to 30 minutes of meditation or yoga can be very helpful. You must allow yourself to be distracted or get into your meditation or yoga and “let go” of the days thoughts…see Meditation. 3. Try tiring yourself out during the day, so that by the time you are ready for bed you are yearning for that pillow! Try exercise during the day to exhaust the muscles and mind. The moving is good when we are depressed too! It gets the blood flowing and makes us move past many issues. Pack your day with lots to do. Errands, class, shopping…whatever you can find to keep you busy. 4. Valerian Root is a wonderful, natural sleep assistanting herb and is considered the ‘valium’ of the herbal world. Herbal tea, half hour before bed, is wonderful for relaxing the digestive system if you are nervous or upset. Chamomile is great for this as well as Kava and Hops. Try brewing these herbs seperate or even together for a wonderful prescription for sleep! See Herbal Teas 5. Reading a book before bed is also good. This can direct your mind to a different place. 6. Diffusing essential oils of Lavender, Chamomile, or Clary Sage are all wonderful to induce a relaxed state and the soothing scents will calm your senses. See Aromatherapy 7. If you are taking a pain killer, be careful for many pain relievers actually have caffeine in them. Perhaps you may want to consider Willow Bark for pain. 8. Remember, we choose our thoughts, our thoughts do not choose us. Believe that this is so. To Believe is a powerful thing. The Universe supports ALL that WE CHOOSE to Believe. So do not torture your mind with troubled thoughts which will not allow you to sleep and are only distructive in the long run. 9. Block out light. To increase the quality of your sleep, research has shown that by blocking out light in your bedroom, you can improve your sleep pattern. If you can see your hand in front of your face, after the lights are off, then it is light enough to affect melatonin production. Melatonin is a hormone secreted at night by the pineal gland. The pineal gland is a small organ in the brain sensitive to light levels. 10. Eat Earlier. Eat at least three hours before bedtime. The further away you eat from the time you go to sleep, the better it is for you to have a better night’s sleep. Managing Your Sleep Sleep allows our body to rejuvenate and repair! Don’t Smoke: Besides the fact that it can cause lung cancer and is the second leading cause of death for both men and women, nicotine is a stimulant and can make it difficult to fall asleep and stay asleep. Limit Stimulants: Caffeine, alcohol, some aspirin and many over-the-counter and prescription drugs disrupt sleep. Avoid drinking caffeine or alcoholic beverages for several hours before bedtime. Although alcohol may initially act as a sedative, it can interrupt normal sleep patterns. Limit Your Nap Time: If you are having trouble sleeping at night, try not to nap during the day because you will throw off your body clock and make it even more difficult to sleep at night. If you are feeling especially tired, and feel as if you absolutely must nap, be sure to sleep no more than 15-30 minutes, earlier in the day. window.google_render_ad(); Keep a Regular Schedule: Keeping a regular schedule will help your body expect sleep at the same time each day. Try to go to bed and wake up at the same time everyday, even on the weekends. Oversleeping to make up for a poor night’s sleep, even a couple of nights, can reset your body clock and make it harder for you to get to sleep at night.

Ginseng — Nature’s Anti-Inflammatory?

Laboratory experiments have demonstrated the immunological effects of ginseng. Researchers writing in BioMed Central’s open access Journal of Translational Medicine have shown that the herb, much used in traditional Chinese and other Asian medicine, does have anti-inflammatory effects.

Allan Lau led a team of researchers from the University of Hong Kong who identified seven ginseng constituents, ginsenosides, which showed immune-suppressive effects. He said, “The anti-inflammatory role of ginseng may be due to the combined effects of these ginsenosides, targeting different levels of immunological activity, and so contributing to the diverse actions of ginseng in humans”.

The scientists treated human immune cells with different extracts of ginseng. They found that of the nine ginsenosides they identified, seven could selectively inhibit expression of the inflammatory gene CXCL-10. Lau concludes, “Further studies will be needed to examine the potential beneficial effects of ginsenosides in the management of acute and chronic inflammatory diseases in humans”.

Uniquely, the researchers were able to holistically test the ginseng extract’s immune effects by using sophisticated purification technologies to identify individual constituents and define their bioactivity using genomics and bioactivity assays. After that, they reconstituted them back into a whole extract with definable individual ginsenosides for re-confirmation of effects. This potentially opens up a vigorous methodology to study medicinal herbs with state-of-the-art technologies.

VIT-K

Vitamin Ê also is a fat-soluble vitamin, and it is used in the liver in the manufacture of prothrombin, an essential factor in the clotting of blood.

Vitamin Ê occurs in green vegetables, and also some of the bacteria which normally live in the bowel manufacture this vitamin which we absorb and use.

An excess of Vitamin Ê has not been shown to cause any serious side-effects.

Vitamin C, or ascorbic acid, has occupied a lot of interest recently, not only for its effect in preventing the common cold but because of its actions generally in human nutrition.

Vitamin Ñ is widely distributed through many foodstuffs. The green vegetables, citrus fruits and potatoes contain considerable quantities.

This vitamin is necessary for the proper development of connective tissue in the body, especially the coverings of blood vessels.

Lack of ascorbic acid produces scurvy, with bleeding in the gums and other soft tissues, failure of wound-healing, and poor resistance to infection.

SWINE FLU....SERIOUS PROBLEM

That’s not an alarmist type of statement – it is true. This figure actually comes from the experts at the Centers for Disease Control and Prevention, which estimates the real number of cases all throughout the country as about 100,000. The fact is that they only have about 4,700 documented or reported cases as of Friday. As for the number of deaths, only five so far have been reported and attributed to swine flu.

The good news is that experts also say that this recent outbreak of swine flu is not as bad as it could be, and is in fact quite mild. AJC has this report:

Many Causes of Acne

There are Many Causes of Acne

1) Heredity

2) Cosmetics and Products
Fatty ingredients such as waxes and oils can clog pores.

3) Oily skin

4) Diet
Fast food and processed food can cause acne. Excessive salt and sugar, fats, and msg have also been known to trigger acne breakouts.

5) Clogged Pores

6) Bacteria

7) Hormones
The male hormone testosterone cause an increase in oil production. These hormones increase during puberty, when teen acne is first evident. In females, acne is not as severe because they produce less testosterone.

8) Stress
Stress causes hormonal fluctuations and increased sebum production.

9) Environmental Irritants
Touching the face, using the phone, wearing hats, dirty
pillows, and makeup are examples of ordinary environmental causes of acne.

Hyperhidrosis

What is Hyperhidrosis?

Hyperhidrosis is excessive sweating beyond physiologic sweating which results in profuse sweating of the palms, underarms (axillae), feet (plantar) and face. It is of unknown etiology and afflicts in one form or another, 10% of the population. Primary hyperhidrosis is a common disorder that causes excesive sweating in the palms, axilla and soles of the feet. It results from excessive cholinergic stimulation of the eccrine glands from the sympathetic trunk.

What is known about hyperhidrosis is that it causes severe occupational, emotional and social distress.

Patients describe hyperhidrosis of the palms as so debilitating that it interferes with their social interaction with others. They cannot shake hands with others for fear of "sweating" and "turning off" business acquaintances or friends, social friends and sexual mates. The simple prospect of someone extending a hand for a handshake causes more emotional stress, indeed making the hyperhidrosis worse.

Others complain of sweating in the face and scalp, or simply "blushing" excessively. This response is quick in onset and last minutes. Often, patients remark that they feel the "blushing" and it bothers them very much, making a social interaction quite disabling from an emotional standpoint.

In large reported series, 15% to as much of 50% of patients with hyperhidrosis have a family history of hyperhidrosis.

Is There A Stigma Associated with Hyperhidrosis?

Definitely yes. As a matter of fact, it depends on the severity and location of hyperhidrosis or facial blushing.

In a survey conducted at the Center for Less Invasive Cardiac Surgery and Robotic Heart Surgery at kaleida Health, 50 consecutive patients were surveyed regarding this subeject and found to have significant social phobias associated with having hyperhidrosis.

We found that the problems were most significant for palmar hyperhidrosis as it interfered with the most common form of initial interpersonal interaction, namely the handshake.

Next were patients who suffered from both facial blushing and palmar hyperhidrosis. The facial blushing seemed to have alerted the person itself of the problem during interaction with others, made them uncomfortable, and sometimes limited their initiative to go out and say hello to people in business or social situations.

Next most commonly stigmatized group were patients who had facial hyperhidrosis alone. These were the minority in terms of number as patients with facial blushing also typically have assciated palmar and axillary hyperhidrosis.

In summary, patients have different mechanisms to deal with hyperhidrosis in social situations. Most with axillary and palmar hyperhidrosis hide their hands under their arms, behind their backs or placed under their thighs to prevent the "handshake." Many hide their hands in long sleeve shirts to cover the palms and have quick access to dry their hands before the mandatory "handshake." Others will always have a cold drink in their hands and pretend that their hands were cold and clammy because the drink was in their hands. In our study, defense mechanisms existed in over 92 % of studied patients.

What can be done for Hyperhidrosis?

Surgical Intervention

Hyperhidrosis surgery has come a long way in the last decade. Traditionally, large incisions were made in the chest to surgically interrupt the sympathetic trunk, all in an effort to treat hyperhidrosis.

With the advent of minimally invasive techniques to work in the chest via endoscopes and surgical instruments, Dr. Karmanoukian and other cardiothoracic surgeons who have taken an interest in endoscopic thoracic sympathectomy have evolved a procedure which is very effective in treating patients with sweating of the hands, underarms, face, scalp as well as patients that have facial blushing.

Dr. Karamanoukian has seen over and over again, how debilitating hyperhidrosis is to both young and adult patients. Given his area of expertise in robotic surgery, he has used this technology to further minimize the surgical trauma associated with treating hyperhidrosis. Dr. Karamanoukian is the author of a dozen books in cardiac surgery and thorcic surgery. He has also written 3 books that specifically deal with topics relating to Board Certification in Cardiothoracic Surgery. He has also authored more than 130 scientific articles in the field of cardiothoracic surgery and robotics. He is Board Certified in both General and Thoracic Surgery with a specific interest in advanced endoscopic surgery and robotic surgery.

The Surgical Answer: Endoscopic Thoracic Sympathectomy

This is the most durable treatment for hyperhidrosis in experienced hands. Clipping the thoracic sympathetic trunk at the appropriate levels will immediately eliminate hyperhidrosis. It is quite dramatic to see a patient wake up from anesthesia and to take note of a dry hand or axilla. With modification of the level of sympathectomy, compensatory hyperhidrosis is also minimized or eliminated.

Medical Therapy

Astringents

Conservative medical treatments such as Drysol and Drionics are the initial treatment for hyperhidrosis. These medications are astringents that dry up the sweat glands.

Topical Antiperspirants

These agents are applied directly to the skin in the affected areas of the body and can cause skin irritation. They are quite messy on clothing and unfortunately, have short periods of efficacy, requiring frequent reapplications.

Anticholinergic Medications

Anticholinergic medications aim to suppress the cholinergic stimulation of the eccrine sweat glands by the sympathetic nerve trunks to eliminate or reduce excessive sweating. However, they can cause significant adverse effects, limiting their usefulness.

Iontopheresis

Iontopheresis is an alternative treatment which utilizes an electrical stimulation to the hands. Patients are instructed to bathe thier hands in an electrolyte containing solution through which an electrical current is passed. This "stuns" the sweat glands of the hand, in effect decreasing the "sweat reflex" for periods of hours to weeks. Most patients find this mode of treatment as ineffective and not of durable benefit.

How About Botox?

Is Botox only for the rich and famous? Injection of botulinum toxin (Botox) into the area of excessive sweating has been shown to cause temporary benefit in hyperhidrosis. Botix affects nerve endings and decreases the transmission of nerve impulses to sweat glands, effectively reducing the production of sweat.

Multiple injections in the palms of the hand or armpit have been described as "painful" by most patients and quite costly as most health insurance companies do not pay for these treatments. Repeated injections are nearly always required to maintain an adequate level of dryness.

In general, surgery is contemplated only when the less invasive medical treatments have failed to provide adequate treatment. This is an important point, as most insurers want documented failure of conservative therapy before endoscopic thoracic sympathectomy is approved.

What's Best for Me?

Talking to your physician should help point you in the right direction. After a thorough discussion, surgery may be the definitive solution.

Botulinum Toxin A for Axillary Hyperhidrosis (Excessive Sweating)

ABSTRACT

Background Treatment of primary focal hyperhidrosis is often unsatisfactory. Botulinum toxin A can stop excessive sweating by blocking the release of acetylcholine, which mediates sympathetic neurotransmission in the sweat glands.

Methods We conducted a multicenter trial of botulinum toxin A in 145 patients with axillary hyperhidrosis. The patients had rates of sweat production greater than 50 mg per minute and had had primary axillary hyperhidrosis that was unresponsive to topical therapy with aluminum chloride for more than one year. In each patient, botulinum toxin A (200 U) was injected into one axilla, and placebo was injected into the other in a randomized, double-blind manner. (The units of the botulinum toxin A preparation used in this study are not identical to those of other preparations.) Two weeks later, after the treatments were revealed, the axilla that had received placebo was injected with 100 U of botulinum toxin A. Changes in the rates of sweat production were measured by gravimetry.

Results At base line, the mean (±SD) rate of sweat production was 192±136 mg per minute. Two weeks after the first injections the mean rate of sweat production in the axilla that received botulinum toxin A was 24±27 mg per minute, as compared with 144±113 mg per minute in the axilla that received placebo (P<0.001).>

Conclusions Intradermal injection of botulinum toxin A is an effective and safe therapy for severe axillary hyperhidrosis.

Source Information

From the Department of Dermatology, Ludwig-Maximilians-Universität (M.H., G.P.), and the Department of Neurology, Technische Universität München (A.O.C.-B.) - both in Munich, Germany.

An intramedullary tumor presenting with hyperhidrosis

Abstract

A case of a cervical intramedullary tumor is reported whose presentation was with disabling hyperhidrosis. The symptom resolved after surgical debulking of the tumor. Hyperhidrosis as a presenting manifestation of an intramedullary tumor has not been reported earlier.

Introduction

We report an unusual case of hyperhidrosis in a middle-aged woman, as a presenting feature of an intramedullary cervical tumor. We could not locate any similar case in the literature.

Case Report

A 56-year-old lady presented with difficulty in using her hands as the initial complaint for a period of 6 months. This was followed by excessive sweating involving her head and neck area, so much so that she had to use 10-12 handkerchiefs daily to wipe herself. By the time she was seen at the Clinic, she had also started experiencing difficulty in walking "with a tendency to fall forwards" and had also developed urgency of micturition. However her main disabling symptom was hyperhidrosis.
On examination, she had a mild spastic quadriparesis. She was also observed to have wasting and weakness of the small muscles of her hands. There was excessive sweating in her face and head and neck area, without significantly increased sweating in her trunk or limbs. MR scan of her cervical spine showed a large intramedullary space-occupying lesion extending from the level of the foramen magnum down to the D2 level. A syrinx was identified both above and below the level of the lesion. She declined surgery initially only to return after 2 months with advanced neurological deficits. At this time she had marked spastic quadriparesis, disabling hyperhidrosis, urge incontinence, decreased sensation to pinprick below her sternal angle, and diminished posterior column sensations in her lower limbs. She could barely stand unaided, was dyspnoeic and had abdominal respiration without much excursion of her chest wall. The tumor was debulked after performing a C2 to D2 laminectomy.
Postoperatively the patient had dramatic and complete cessation of her hyperhidrosis. Her spastic quadriparesis gradually improved, and at the time of discharge she was able to walk unaided and was able to pass urine normally. She had no respiratory problem. A follow-up MR scan was done after 6 months and the T1 weighted Gadolinium enhanced image [Figure - 1] showed a small residual tumor. The histopathological examination confirmed that the tumor was an astrocytoma.

Discussion

Intramedullary spinal cord tumors can present with a variety of symptoms.[1] Neck or back pain is often the earliest symptom.[2] Sensory symptoms frequently antedate the motor symptoms and are consistent with the central location of the lesion within the spinal cord. Involvement of the descending autonomic pathways, which are located between the corticospinal and spinothalamic tracts may cause both sympathetic and parasympathetic disturbances below the level of the lesion.
Hyperhidrosis has been described in spinal cord injured patients,[3],[4] and also in post-traumatic syringomyelia.[5] A syndrome of autonomic dysreflexia has been described[6] which occurs in patients with lesions of the spinal cord above the D6 spinal level. This is characterized by exaggerated autonomic responses to stimuli which may be innocuous in normal individuals. In our patient it is likely that there was involvement of the sympathetic fibers in the upper cervical cord or in the ciliospinal center of Budge at the C8-D2 segmental level.
Hyperhidrosis in this instance may be postulated to have occurred as a result of overactivity of the sympathetic fibers due to irritation by the tumor. It may be hypothesized that had no treatment been done, the hyperhidrosis may have gradually progressed to anhydrosis.

Thoracoscopic Sympathectomy for Palmar Hyperhidrosis

Hyperhidrosis is excessive sweating beyond the physiological need. It usually affects the palms, axillae, and soles and may affect the face, groin, and legs. Symptoms usually appear at puberty and may cause psychological and social problems, as well as occupational and educational difficulties. Between 0.6% and 1% of the general population are affected by hyperhidrosis.(1)

People with palmar hyperhidrosis may be embarrassed to hold hands or be hesitant to shake hands because of having excessively wet palms, often feeling as if they must wipe their palms on their clothing first. People with palmar hyperhidrosis may have difficulty holding onto objects or tools or may have difficulty using computer keyboards, typewriters, or pens. Papers they handle may become wet, and metal objects that they use repeatedly may become rusty. Individuals with palmar hyperhidrosis may find it difficult to play a musical instrument or perform a job requiring the wearing of gloves (eg, food handler, perioperative nurse).

Patients with palmar hyperhidrosis may find that it aggravates eczematous dermatitis, and they may have a predisposition to bacterial and fungal infections. As a result, these people may become withdrawn socially and suffer from low self-esteem. They even may develop psychiatric problems, such as social anxiety disorders.

Sweating is a physiological response to body overheating. It is controlled by the heat regulatory center in the hypothalamus. As the temperature of the environment rises, the body is cooled by vasodilatation of the cutaneous blood vessels and the production of sweat. The sweat then evaporates from the surface of the skin and cools the body.(2)

Sweat glands are tubular structures consisting of a coiled portion deep within the dermis that secretes sweat and a duct through which the sweat travels to the skin. Cholinergic sympathetic nerve fibers on or near the glandular cells elicit the secretion of sweat.

The secretory portion of the gland secretes a fluid called precursor secretion. Concentrations of the constituents of this fluid are modified as the fluid travels through the duct to the pore. When sweat glands are stimulated normally, the precursor secretion passes slowly through the duct where most of the sodium and chloride content is reabsorbed. The concentration of sodium and chloride can fall as low as 5 mEq per liter. This reduces the fluid's osmotic pressure, and most of the water is reabsorbed, thus concentrating other ions in the fluid.

In normal sweating, urea, lactic acid, and potassium ions are very concentrated. When the sweat glands are stimulated strongly by the sympathetic nervous system, large amounts of precursor secretion are formed. Sweat flows so rapidly through the duct that little of the water and slightly more than one-half of the sodium and chloride are reabsorbed, leaving sodium and chloride concentrations as high as 50 to 60 mEq per liter. In these situations, a large loss of sodium chloride and water can occur.(3)

The human body contains two types of sweat glands--apocrine and eccrine. Their location and characteristics differ slightly.

Apocrine sweat glands. The apocrine sweat glands are confined to the axillae, areolas of the nipples, the anogenital area, and the external auditory meatus. They are simple, coiled tubes and are 10 times larger than eccrine glands. The sweat from these glands is milky, contains fat and cholesterol, and can have a strong odor. The apocrine glands begin to function at puberty.

Eccrine sweat glands. The eccrine glands are present on the entire surface of the body but are most numerous on the palms, soles of the feet, face, axillae, and, to a lesser degree, the back and chest. They are coiled tubular glands that open onto the skin through pores. These sweat glands have a rich blood supply and are innervated by the sympathetic nervous system (Figure 1). Nerves stimulate the glands to secrete a plasma-like fluid that is hypotonic (ie, 0.3% to 0.5% sodium chloride) and contains small amounts of potassium, lactic acid, glucose, and urea. Myoepithelial cells, through their contraction, aid in the expulsion of sweat. Acetylcholine and other cholinergic agents increase sweating. Atropine and anticholinergic agents inhibit sweating.(4)


CAUSES OF HYPERHIDROSIS

There are many causes of hyperhidrosis. It can be caused by

* emotional factors,

* a warm environment,

* exercise,

* spinal cord injuries, and

* familial dysautonomia (eg, Riley-Day syndrome--an inherited congenital disease occurring mainly in children of Ashkenazic Jewish decent and characterized by a decrease in the number of small unmyelinated autonomic and peripheral fibers that carry pain, temperature, and taste sensations; Nail-patella syndrome--an inherited multisystem disorder characterized by dystrophic nails, hypoplastic or absent patellae, and renal disease).

Hyperhidrosis can be cold-induced, gustatory (ie, stimulated by eating), olfactory (ie, stimulated by strong smells), compensatory (ie, areas of the body become affected by hyperhidrosis after the areas originally affected by hyperhidrosis have been disrupted by surgery or other means), or idiopathic.(5) This article discusses treatment for idiopathic or primary palmar hyperhidrosis.

TREATMENT

Treatment should be directed at the underlying cause whenever possible. Affected individuals should wear light clothing, keep the environment cool, and replenish water and sodium chloride lost through sweating. Topical applications of aluminum chloride or aluminum chlorhydroxide may be used to block the openings of the sweat ducts. They must be reapplied frequently (ie, three to four times per day) because excessive sweating unblocks the ducts.

A 20% alcohol solution of aluminum chloride hexahydrate is the most effective topical solution. It blocks the openings to the sweat ducts and should be applied at night, covered with plastic wrap, and washed off in the morning. The skin needs to be dried thoroughly before application. The solution is used daily, weekly, or whenever needed. Skin rashes may result from this treatment; therefore, it should not be applied to freshly shaved skin.(6) Glutaraldehyde and tannic acid also may be used topically, but they can cause skin irritation and brownish skin discoloration.


Iontophoresis can create a temporary blockage of the sweat duct. This is accomplished by directing a mild electric current through the skin in a shallow tap water bath. The electric current shocks the sweat glands, and they stop producing sweat temporarily. The iontophoresis machine is used for 20 minutes a few times per week and may cause sweating to stop for weeks. It can be used at home but is only useful for palms, feet, and axillae.(7) Surgical excision of axillary apocrine sweat glands rarely is performed and may result in infection, hidradenitis, and scarring.(8) Locally applied astringents (eg, potassium permanganate) may provide temporary local relief. Antiperspirant with aluminum salts also may be used to block the ducts.

Anticholinergic medications, such as atropine, oxyphencyclimine, glycopyrrolate, and propantheline bromide, inhibit parasympathetic effects, but these often cause dry mouth, blurred vision, or constipation. These medications usually are taken several times per day. Patients can use them regularly to try to control sweating or only when in situations that cause excessive sweating, such as public speaking or business meetings. Multiple medications and schedules are tried to determine a treatment schedule that works best for the individual patient, depending on the severity of his or her hyperhidrosis.

Botulinum toxin injections sometimes are used for focal hyperhidrosis of the axillae, palms, and feet. Botulinum toxin is a potent neurotoxin that blocks the cholinergic nerve terminals. It is effective only at the site of injection and may be painful and expensive. The injections usually are effective for three to 12 months.(9) In 1998, German neurologists and dermatologists used intracutaneous injections of botulinum toxin on 11 patients with focal hyperhidrosis. Sweating was abolished completely in all patients in three to seven days, but some reactivation of sweat gland function was observed four months after treatment.(10) Biofeedback, hypnosis, and psychotherapy have been tried with variable results. Early in the twentieth century, irradiation of the skin was used to atrophy the sweat glands; however, this treatment has been abandoned.

As sweating is mediated through the sympathetic nervous system, selective sympathectomy appears to be the most effective method to permanently rid patients of palmar hyperhidrosis.(12) Sympathectomy abolishes eccrine sweating in areas supplied by post-ganglionic fibers. In the past, an open surgical technique was used. This generally was performed via transthoracic, supraclavicular, transcervical, transaxillary, or dorsal thoracic surgery. These surgeries involved long hospital stays, large scars, increased morbidity, and long recuperative periods for patients.

THORACOSCOPIC SYMPATHECTOMY

The advent of thoracoscopic surgery has made surgical treatment for palmar hyperhidrosis much more attractive. The procedure generally is performed on an outpatient basis, with the patient going home a few hours after the surgery. After the procedure, patients have two one-inch scars hidden in the axillae. At present, patients undergoing this procedure at New York Presbyterian Hospital, New York, have gained relief from hyperhidrosis. Patients are referred by dermatologists or they refer themselves to this program. Many patients have learned about this procedure on the Internet or from other patients who have benefited from the surgery.

The surgeon sees and evaluates the patient while performing a physical examination and taking a clinical history. He or she explains the surgical procedure, potential complications, and side effects to the patient and obtains written informed consent for the surgery and a consent for the administration of blood products if necessary. Patients who typically undergo this procedure are in their twenties and thirties. They find this condition to be embarrassing and believe that their lives have been affected negatively by the condition. The surgeon schedules the patient for elective surgery and sends him or her to the preadmission testing area of the hospital for blood tests (eg, complete blood count; prothrombin time; partial thromboplastin time; eosinophil sedimentation rate; sodium, potassium, chloride, glucose, and carbon dioxide levels; blood urea nitrogen; creatinine; calcium; thyroid profile). The thyroid profile is drawn to rule out thyroid disease as a cause of the hyperhidrosis. A chest x-ray and electrocardiogram also are performed. The anesthesia care provider interviews the patient, explains his or her plans for anesthesia, and obtains informed consent. The anesthesia care provider instructs the patient not to eat or drink after midnight the night before surgery; however, no other special preparations are needed.

On the day of surgery, the patient arrives at the ambulatory surgery unit (ASU) one and one-half hours before surgery is scheduled. In the ASU, the patient changes into a hospital gown, and the admitting nurse takes vital signs and checks the chart for a history and physical examination, blood work, and signed consent forms. The nurse performs a systems assessment of the patient that includes

* the patient's general health,

* any previous surgeries,

* existing medical conditions or disabilities,

* routine medications, and

* pregnancy status, if applicable.

He or she questions the patient about allergies, including those to medications, food, and latex. The nurse verifies that the surgery will be bilateral and that the patient will accept a blood transfusion, if necessary. The nurse asks the patient to remove all jewelry, dentures, hearing aides, contact lenses, and any other prostheses. Hearing or sight impaired patients are allowed to retain their heating aids or glasses until induction. The nurse verifies that the patient has an escort to take him or her home after recovery from anesthesia. Table 1 provides a nursing care plan.


The perioperative circulating nurse greets the patient, explains the anticipated procedures, and transports the patient to the OR where the anesthesia care provider inserts an IV line and an arterial line to continuously monitor vital signs during the surgical procedure. The anesthesia care provider administers a general anesthetic and intubates the patient with a double-lumen endotracheal tube. The double-lumen tube allows the anesthesia care provider to selectively ventilate one lung while the other lung is deflated. This allows the surgeon to better see the surgical field.

Surgical team members place the patient in the supine position with his or her arms extended at right angles on padded arm boards to allow a transaxillary incision (Figure 2). Care is taken to not extend the patient's arms past 90 degrees, which could cause nerve damage. The nurse ensures that the safety belt is in place, pads any bony prominences, inspects the patient's skin for problems, and applies an electrosurgical dispersive pad. He or she shaves the patient's axillae and preps the chest and axillae with an antimicrobial solution. The surgeon and scrub person drape the patient using sterile split sheets and an iodophor-impregnated adhesive drape.

The surgeon, assistant, and scrub person all stand on one side of the patient to perform the surgery on the initial side. The circulating nurse positions a monitor on each side of the patient to allow the surgeon to view the surgical field from either side. The scrub person and circulating nurse attach the camera and light source to the thoracoscope and the unipolar and bipolar cords to the electrosurgical unit. The surgeon asks the anesthesia care provider to deflate one of the patient's lungs, makes a one-inch transverse incision in the axillae between the patient's second and third ribs, and inserts a disposable. 11.5-mm thoracic port into the incision (Figure 3). The 11.5-mm port accommodates the 0-degree, 5-mm thoracoscope, as well as any instruments used, through a single incision.


The surgeon then identifies the sympathetic nerve chain at the T-2 level (Figure 4). He or she opens the pleura in the posterior thoracic cavity using an endoscopic scissor (Figures 5 and 6), grasps the nerve between the T-2 and the T-3 levels with an endoscopic bipolar forcep (Figure 7), and cauterizes it (Figure 8).

The surgeon removes the disposable thoracic port, inserts a 20-Fr thoracic catheter into the thoracic cavity, closes the soft tissues, and submerges the other end of the chest tube in a bowl of saline (Figure 9). He or she then asks the anesthesia care provider to reinflate the patient's lung and sustain lung expansion at 30 mm Hg of pressure. As the patient's lung reexpands, air is forced out of the thoracic cavity, causing bubbling in the bowl of saline. When the bubbling stops, the surgeon quickly removes the catheter, and closes the remainder of the incision. A sterile adhesive bandage strip is placed on the incision. The surgeon, assistant, and scrub person then move to the patient's opposite side and repeat the procedure.

The anesthesia care provider awakens and extubates the patient in the OR and helps surgical team members transport him or her to the postanesthesia care unit (PACU) for recovery. In the PACU, nurses observe the patient for any sign of pneumothorax (eg, pain on one side, difficulty breathing, uneven breath sounds in the chest). A chest x-ray is taken in the PACU to ascertain that no pneumothorax has occurred. The surgeon gives the patient a prescription for acetaminophen with codeine to be taken every four hours if needed for pain and instructs the patient to keep the incision dry. The patient's activities are limited only by discomfort, but he or she is advised to take a few days off from work. The nurse discharges the patient with instructions to return to the surgeon's office for a postoperative check in one week.

COMPLICATIONS

The patient is warned preoperatively of possible complications, including

* infection;

* bleeding, which would require the surgeon to perform a small thoracotomy incision and necessitate a possible overnight stay;

* compensatory sweating, usually in the feet, axillae, or trunk; and

* Homer's syndrome, which occurs because of damage to the sympathetic nerve fibers of the face and results in an ipsilateral small pupil, dry face, and slight ptosis (ie, drooping) of the eyelid.(13)

CASE STUDY

Mr R is a 34-year-old man with palmar hyperhidrosis. His occupation entails installing specialized components in computers. Computer components may not be exposed to moisture, which can damage them. He feels uncomfortable shaking hands at business meetings because of his sweaty palms. He feels uncomfortable in his sexual life, although his wife says she does not mind. His nine-year-old daughter often says to him, "Ugh, Daddy, your hands are always wet."

Mr R tried an aluminum chlorhydroxide product but found he could not handle computer components with particles of aluminum chlorhydroxide on his hands. He also tried iontophoresis, but he says with a full-time job, a nine-year-old daughter, and a three-month-old son, he could not find the time to soak his hands in a bath for 30 to 60 minutes every day for seven days. He found an Internet site from a Swedish facility that introduced him to thoracoscopic sympathectomy, and he was referred to a physician by his father-in-law, who is a dermatologist. Mr R decided to have the elective bilateral thoracoscopic sympathectomy because he felt hampered in his professional life and embarrassed in his personal life. He is a healthy male with no previous surgical history. He has no cardiac disease, respiratory symptoms, endocrine symptoms, genitourinary problems, musculoskeletal problems, or other neurological problems. His surgeon tested him for abnormal thyroid function, which can cause hyperhidrosis, and all tests were within normal limits. Mr R denied tobacco and alcohol use.

Nurses in the ambulatory surgery department admitted Mr R for a bilateral thoracoscopic sympathectomy without complications. The surgery lasted one and one-half hours. Mr R emerged from general anesthesia without incident and was transferred to the PACU. When interviewed in the PACU, he was very pleased that his palms no longer felt sweaty. He was sure that his daughter and wife would be thrilled. He was delighted that he had only a one and one-half inch incision in each axilla and little discomfort. Mr R left for home later that afternoon with his wife.

When more conservative therapies fail, patients may benefit from undergoing thoracoscopic sympathectomy for primary palmar hyperhidrosis. One study of 400 patients found that those who underwent sympathectomy showed 100% immediate relief from palmar sweating. The posterior surgical approach used on these patients, however, lasted two to three hours and involved a four- to five-day hospital stay.(14) The 45 patients who underwent the procedure at the New York Presbyterian Hospital between 1998 and 2000 received immediate relief of palmar sweating. Their surgeries lasted one and one-half to two hours, and all but one of the patients returned home a few hours after the procedure. This patient experienced bleeding that necessitated a mini-thoracotomy and an overnight hospital stay. Thorocoscopic sympathectomy is safe and effective, and the result is a life-changing experience for patients.

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Abdomen Pain after Child Birth

It is a known fact that your body will take at least six weeks post delivery to regain its natural composure. During pregnancy the abdominal walls are stretched to accommodate the enlarged uterus. After delivery these abdominal muscles becomes loose and soft leading to many complications. In this period a new mother can experience several physical disturbances like afterbirth pains, perineal discomfort , abdominal pain, constipation, difficulty in passing urine, sore breasts, fatigue to name a few.

Among all these the most common occurrence is of abdominal pain. 90 % of the cases of cesarean deliveries have complained about abdomen pain. The pain is usually from the slit, and results in a feeling of discomfort caused by a sensation of pull, sting and hurt.

Gas Pain is another common source of abdominal discomfort after a cesarean birth. Usually this discomfort happens 1 to 2 days after giving birth.

To minimize the pain what s recommended here is that you move around a bit. It is advised that you change your positions frequently. The body needs some movement and the more it gets the better. However, be careful, 5-10 minutes of walk every day twice should do the trick. As the days goes by, you can increase the time frame. The aim should be to oil the mechanism of your body. You should also avoid oily food and all the carbonated drinks that might cause gas problems.

Herbal Remedy Anal Soreness

Anal Soreness or Anal Itching is seen more in men than the women. The reasons might vary from profuse sweating, diabetes to chronic dry skin conditions such as psoriasis and seborrhea. Some foods irritate the anus when they are expelled during a bowel movement. The most common culprits are caffeine, chocolate, beer, nuts, dairy products, and spicy food. Infections such as pinworms, yeast, and genital warts can also cause itching. Hemorrhoids, which cause painful swelling of blood vessels in the anal area, can cause itching.

To avoid anal soreness avoid spicy food. The smallest amount of black pepper, cayenne or cinnamon added to food can produce extreme itching in the anus of sensitive persons. Instead, eat raw, fresh fruits and vegetables, and whole grains for fiber to combat constipation and anal fissures, which can cause itching. Eat plain, unsweetened yogurt, kefir and other lactic acid fermented food to fight a possible candida yeast infection. Unrefined, cold-pressed flax seed oil also softens the stools and lubricates the walls of the rectum, reducing irritation.

Herbal remedies also provide effective relief of itching and irritation. If the itching is due to hemorrhoids, apply cool compresses of witch hazel to shrink blood vessels, camomile to speed healing and peppermint to relieve itching. If the itching is due to worms, take 15 drops of wormwood tincture twice daily. Dandelion root is also a gentle laxative and effective treatment for worms. Mix 2 tsp. of the root with 1 cup boiling water, simmer for ten minutes and drink three times a day. Aloe Vera and tea tree oil mixed with some olive oil rubbed on the skin also helps relieve itching.