With that said, similar appearing white spots can be a sign of more harmful conditions, such as fungal infections, which require medical attention. Most patients are reassured of the benign nature of the condition and no treatment is recommended. WebIdiopathic guttate hypomelanosis (IGH), is a benign skin condition characterized by the presence of many round or oval hypopigmented patches varying in size from a few Read the next section to find out what they are. The patches may take some months to return to their former color, and sun cream should be used to protect the skin from the sun. The white patches may start small and sometimes remain this way, but they can also slowly increase until the patch covers a large part of the body. B. Ginger juice, especially the roots of ginger are effective in treating hypopigmentation. WebNatural Cures Protecting the skin from the sun is the most important form of treatment and prevention. It is important to keep the skin clean. WebIdiopathic guttate hypomelanosis is a common acquired leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed areas, Idiopathic guttate hypomelanosis isnt a harmful condition. (8) As noted above, in other studies, scarring does not seem to be an important histologic feature of IGH. There are several treatments available that may reduce the appearance of white spots, however fully erasing these spots can be difficult, particularly when using at-home treatments alone. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. Hypomelanosis, , . J Am Acad Dermatol 2018; 78: 212-5. Lesions cover 10% or more of your Please tell me if there is any link between leukaemia and idiopathic guttate hypomelanosis? If it turns out to be IGH, your derm will definitely advise you to get better about sun protection. Vitiligo It's essential that you exercise caution with any at-home remedies, including topical application of fresh ginger, cabbage juice, or lime juice and eating antioxidant-rich figs and walnuts. These spots can occur on the face, arms, upper back, and the shins. The growth of these white spots or patches is fairly slow and they are often found in a cluster. What to do: Avoid scratching the bumps and steer clear of skin products with harsh chemicals which can dry out your skin. (6) Arbache et al utilized a microneedling technique to deliver 5-fluorouracil (5-FU) in eight patients with IGH. Method: Dab a little apple cider vinegar in a cotton ball and apply directly to the affected part of your skin. Moderate. Most conditions that cause white spots on the face are also harmless. The name is descriptive, referring to the cause and appearance of these spots: idiopathic means the cause is unknown, guttate refers to their teardrop shape and hypomelanosis, the lighter-colored skin. Hill, J. P., & Batchelor, J. M. (2017). Wash it off with lukewarm water. People can use this on their face but not around their eyes. Read on for more about them, what causes them, and treatment options. Our studies have shown that significantly fewer dopa-positive melanocytes are in the white macules of idiopathic guttate hypomelanosis than in normal skin. Apart from the above-mentioned readily available products, there are numerous ingredients from your kitchen that can be used to treat white sunspots or skin discoloration. These red and inflamed patches eventually heal and leave behind pale white spots. Pityriasis alba is thought to be a type of eczema. Access resources to help you promote the specialty in your community and beyond. Effectiveness was graded by the blinded observer scale through photographic comparisons at the end of the study. In fact, they can be easily treated in simple ways with easily available ingredients in our house. The dermoscopic features of idiopathic guttate hypomelanosis are characterised by white structureless areas in which the pigment network is absent. AU - Eun, S. H. AU - Kwon, H. S. 7. Am J Clin Dermatol. Idiopathic guttate hypomelanosis [IGH] - The predominant involvement of sun-exposed areas in IGH raises suspicion of UV light as a primary factor affecting melanin synthesis. These spots are not dangerous or harmful. WebRisk Factors and Treatment: Sun exposure seems to be a factor in the condition, since it tends only to appear on exposed skin. You can learn more about how we ensure our content is accurate and current by reading our. While white spots are not typically cause for alarm, there are times when a professional opinion may be required. Available: om/articles/324228 70. J Am Acad Dermatol 1987; 16:35. WebMacular hypomelanosis and idiopathic guttate hypomelanosis are probably related disorders along a spectrum of depigmentation. There are both over-the-counter and prescription retinol products that you can try depending on the severity of your white spots. Thus, the face, neck, hands and arms are most often affected. All these below-mentioned home remedies can successfully be used to treat and soothe the white sunspots naturally. Pagnoni, A., Kligman, A.M., Sadiq, I., & Stoudemayer, T. (1999). Mitali has worked as a beauty & fashion journalist for over 5 years. Idiopathic Guttate Hypomelanosis. WebTranslations in context of "guttae" in English-Russian from Reverso Context: Very often the parents of affected children confuse the guttae form of the disease with an allergy which is why they do not immediately turn to a specialist. This increased amount of UV damage may explain why lighter- skinned people are more likely to develop IGH. Heart failure: Could a low sodium diet sometimes do more harm than good? Sun is an avid source of vitamin D, which is, indeed, a necessity for our bones. When addressing IGH, it is important to keep in mind that while fading the spots is possible, the complete elimination of these spots is an unlikely outcome even when undergoing professional treatment. WebIdiopathic Guttate Hypomelanosis (IGH) is a benign and asymptomatic skin manifestation characterized as diffuse hypopigmented macules, or white spots. Idiopathic guttate hypomelanosis (IGH) is another hypomelanosis disorder characterized by white macules [7]. Can you get rid of IGH? Interestingly, higher core counts do not result in more patient downtime. abdominal striae, acne and surgical scars, and idiopathic guttate hypomelanosis, she added. Treatment is usually not required as the marks are completely harmless. It is not a sign of a cancer or any contagious skin problem. The information on our website is intended for educational purposes only. Idiopathic Guttate Hypomelanosis Or Idiopathic guttate hypomelanosis is a common acquired skin condition characterized by multiple discrete, round, porcelain-white macules on the extensor aspects of the extremities in the elderly population. Don't let that discourage you too much; she adds that "several modalities have been reported with limited success, including cryotherapy, intralesional steroid injections, topical retinoids, chemical peels, and lasers.". These vitiligo white patches further tend to develop on the skin that is exposed to the sun and may eventually spread slowly or quickly. These white sunspots or pesky marks are medically known as Idiopathic Guttate Hypomelanosis (IGH) and is considered to be a skin damage condition. However, there is no standard treatment. WebIdiopathic guttate hypomelanosis, also known as white sun spots, causes flat white spots that can be 1 to 10 millimeters in diameter. This article explains the different forms of white spots you may notice on your skin, their causes, treatment options, and prevention tips. Excimer lasers, which use ultraviolet light to create pigment-producing cells, led to a significant increase in pigmentation in one small study of people with IGH. Some scientists believe that the skin affected by vitiligo develops when the body forms an antibody against melanin and destroys it. WebIdiopathic guttate hypomelanosis is a common skin disorder of unknown cause. "Once spots have formed, there are no universally effective treatments," Diakow says. A treatment that removes the top layer of skin and can be used to remove milia. WebIdiopathic guttate hypomelanosis is a common but underreported condition in elderly patients that usually presents with small, discrete, asymptomatic, hypopigmented macules. We avoid using tertiary references. Read this month's top stories in Dermatology World. Oakley A. Idiopathic guttate hypomelanosis. WebTreatment modalities that may reduce the appearance of IGH include the topical steroids, tretinoin, pimecrolimus and dermabrasion. The white spots are painless and benign. While one study found that daily tretinoin use over a four-month period significantly improved skin pigmentation, the extent of repigmentation will vary from one person to the next; additional research into this treatment is required. December 4, 2019 By Lauren Sharkey (reviewed by Dr. Amy B. Lewis, M.D.). 13 Home Remedies To Reduce Black Spots On Face (And Why They Actually Work), 5 Easy But Effective Home Remedies to Treat Boils. Also Read 6 Multani Mitti Face Packs to Banish Acne, Scars, and Pigmentation Like Magic! Rose D. Top 12 natural remedies for eczema; 2019. Skin cells make a pigment called melanin, which gives the skin its color. However, following treatment, patients have experienced significant skin redness that can last for up to 6 months. They are caused by localized loss of skin pigmentation. WebOne report describes successful treatment with pimecrolimus 1% [ 12] ; however, caution is warranted because the author has anecdotal experience possibly suggesting that topical Humid environments and moist, oily skin can trigger the discoloration of small skin patches. many patients visit medical centers owing to cosmetic concerns and to confirm the natural course of Unlike sun-borne white spots, Vitiligo spots are much different. WebIntroduction. Later, it may spread to other sun-exposed areas, such as the arms and the upper part of the back. Turmeric has an exceptional skin rejuvenating ability and can effectively help in treating white sunspots. 9. Idiopathic guttate hypomelanosis does not appear to be due to trauma or viral infection. By using our website, you consent to our use of cookies. The magical and wondrous apple cider vinegar is considered one of the most effective So, anytime something out of the ordinary pops up that we don't automatically know how to deal with, things can reach panic mode pretty quickly. Kim SK, et al. Sun damage can lead to age spots, or dark spots, on our skin, as well as white spots known as idiopathic guttate hypomelanosis (IGH). Pityriasis versicolor is a common condition, due to a yeast infection, that causes lighter or darker patches on the skin. Then the answer would be no. Accessed 12 th February 2021. "Light areas of skin on the face, back, or abdomen, and in a younger patient would be less likely to be IGH," she says. Effectiveness of the 308-nm excimer laser on hypopigmentation after lichen striatus: A retrospective study of 12 patients. Method: Apply honey on the infected skin or the white sunspots and let it sit for at least 20 minutes or till it dries off. A good skincare routine, including dead skin removal with exfoliants and wearing sun protection cream, is also advisable for adults. The doctor may also recommend anti-inflammatory creams, such as a higher strength corticosteroid, to help restore missing pigment. "guttate" refers to "raindrops", the pattern. Most people notice these white spots only when they have a suntan or if they dwell in any hot, humid, or warm environment. Leave it on for 25 to 30 minutes and wash it off with plain water. For these, please consult a doctor (virtually or in person). Artificial ultraviolet (UV) light treatment or phototherapy may be used, often over a period of several months. This might take upto a year to show any visible results. in size) on the shins, arms, upper back, and face. Learn about different causes of white spots on the nipples, including those linked with breast-feeding. Scroll down to read more. Few studies also suggest that IGH has a positive association with HLA DQ3, repeated microtrauma, and autoimmunity. IGH typically occurs in people with lighter skin tones over the age of 40, and becomes increasingly common with age. Milia can occur at all ages in both men and women. It contains antiseptic properties that promote and boost quick healing and skin-restoring (12). Although there are various other skin conditions like Milia, Vitiligo, Tinea Versicolor, or Pityriasis Alba that are very similar looking to white sunspots, it is always recommended to consult a dermatologist if the patches get itchy or painful. They will be able to offer reassurance and treatment advice if necessary. Idiopathic guttate hypomelanosis appears to occur in relation to prolonged exposure to the sun over time. When used to treat IGH, dermabrasion causes white spots to crust over and triggers the bodys melanin production process. At-home treatments are limited to topicals which require months of regular application to achieve even minor results. White spots can be reduced by consuming vitamins such as B12, D, and E, as well as Arch Dermatol 1966; 93:184. 8. 4 Best Ones and Alternatives, Probiotics for Acne: Do They Work, How to Use Them and More, Wear a broad-spectrum, water-resistant sunscreen with a minimum. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. However, if they have any associated symptoms, such as itching or pain, if they are growing or spreading, or if they are raised and flaky, then Diakow recommends making an appointment with a dermatologist. Why Do I Get White Sunspots When I Get Tan? Pityriasis Alba (PA) is somewhat a common non-cancerous skin condition that causes redness, scaly and itchy patches on the skin (4). She finds her solace and magic in the power that can be created by weaving words together. Betaine HCl to increase your stomach acid to protect from increases in further fungus exposure 2. Idiopathic guttate hypomelanosis is a common acquired leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed areas, especially on the extensor surface of forearms and pretibial areas. Journal of the American Academy of Dermatology, Volume 75, Issue 3, 2016, Pages 637-639, ISSN 0190-9622. Procedural treatments chemical peel, excimer laser, skin grafting. 2011 Jul;50(7):798-805. Box 1 Disorders of Hypermelanosis Genetic Caf-au-lait macules Albright's syndrome The affected areas may just be on the face, or they may appear on the chest or arms as well. Journal of Pigmentary Disorders. How Long Does It Take For White Sunspots To Heal Naturally? The Academy has developed quality measures to help your dermatology practice. Contents Can you get rid of IGH? These sunspots take around 10 to 21 days to completely heal by themselves and do not need any precise medical treatment. Pityriasis alba. While not all forms of psoriasis cause white spots, the condition can cause spots that resemble IGH. People with different skin types develop idiopathic guttate hypomelanosis. In particular, patients should avoid putting many of these, especially lime juice, on any sun-exposed areas of the skin to prevent worsening of pigmentation and irritation of the skin. If a person wants, they can use colored skin creams to hide areas of vitiligo, and a doctor will be able to recommend the best creams available. On the pathogenesis of idiopathic guttate hypomelanosis. Idiopathic guttate hypomelanosis (IGH) is the medical term for white spots on the skin. Dermabrasion is also not suitable for people with acne or a history of keloid scarring as these conditions increase the risk of side effects associated with the procedure. "The use of broad-spectrum sunscreens and photo-protective clothing are recommended for prevention [of IGH]," Diakow says. This is thought to improve the production of melanocytes, however additional research into this process is still needed to confirm the exact cause of repigmentation. Despite the benign course of progression, many patients visit medical centers owing to cosmetic concerns and to confirm the natural course of idiopathic guttate hypomelanosis. Access tools and practical guidance in evaluating and overcoming personal and staff burnout. Lesions that received the excimer treatment had significantly higher repigmentation compared with baseline and untreated lesions. Yes, indeed. If a dermatologist does conclude that the spots aren't dangerous (but they still bother you), you can have them filled in by a tattoo artist that specializes in skin pigment matching. WebIdiopathic Guttate Hypomelanosis . Many people experience white spots on their face at some point during their lives. Milia usually get better without treatment within a few weeks. I once asked a terribly pruritic patient why he kept scheduling appointments when I did not help him at all. 3 4. Comprehensive understanding of idiopathic guttate hypomelanosis: clinical and histopathological correlation.Int J Dermatol. We Asked Experts to Give Us the Facts, How to Even Out Discoloration on Darker Skin Tones. What is the effectiveness of ayurveda in treatment of neurodegenerative disease? Although not in the movie, I recalled his quote: Success consists of going from failure to failure without loss of enthusiasm. As only affected areas of skin are treated with UV radiation, the risk of side effects is relatively low. Falabella R, et al. Also, when used on sunspots, Aloe Vera catalyzes the new cell generation production and helps effectively in restoring the skins natural color. Arbache S, et al. Although the exact number of people with IGH is unknown, one study found that more than 85% of people over the age of 40 had some level of white sunspots. I went to numerous doctors but no one knew what it was. Idiopathic guttate hypomelanosis. 4. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. Although they are most often develop in people with fair skin, people with dark skin can develop them as well. All rights reserved. It affects around 1 percent of people worldwide. Wearing sunscreen daily and limiting sun exposure whenever possible can also serve to minimize UV damage and may prevent sunspots from forming. Although topical corticosteroid creams are prescribed to those with white sunspots, there is no conclusive evidence to support their ability to fade these spots. Shin MK, Jeong KH, Oh IH, Choe BK, Lee MH. WebRemove Pesky White Sunspots With These 8 Simple Remedies. Treatment is aimed at improving the cosmesis of lesions. Get help to evaluate what practice model fits your needs, as well as guidance on selling a practice. While both these creams may help to reduce the appearance of white spots, their effectiveness is questionable and neither can be considered a reliable treatment method. Learn more about these, Age spots, or liver spots, are common and harmless. Surgical treatments are being developed but are not yet common practice. (2007, October). Many of us take great pains to make sure our skin is clear and pristine. WebTED'S ADVICE ON IDIOPATHIC GUTTATE HYPOMELANOSIS 1. A study of people with IGH found that dermabrasion achieved significant repigmentation in roughly 80% of cases, by helping to increase the formation of new melanocytes. WebIdiopathic guttate hypomelanosis is a condition where white spots appear mainly on the shins and forearms. Berry J. This link to sun exposure is partially based on the fact that the spots most often appear on areas exposed to the sun such as the arms, legs, face and back. Most commonly in middle-aged, light-skinned women, but increasingly Igh is a benign skin condition probably related to chronic sun exposure. Treatment is usually not required as the marks are completely harmless. Only a few spots cover about 3% of your skin. There is no specific treatment for pityriasis alba, but a doctor may treat any symptoms of itching or discomfort with a steroid or non-steroid cream. Lancing. But apart from tan, if you happen to notice a few tiny white spots that vary in size, then you need to take a closer look. No treatment is needed or available to remove the condition. (3) Histologic features of scars are not observed. Web3 Ways to Treat Idiopathic Guttate Hypomelanosis - wikiHow Personal Care and Style Skin Care How to Treat Idiopathic Guttate Hypomelanosis Download Article methods 1 Applying Prescribed Topical Creams 2 Damaging Skin Therapeutically to Remove IGH 3 Clinically, these lesions are found more commonly in the elderly on sun-exposed surfaces of the skin. Castor Oil is highly popular for its amazing properties in healing and maintaining the skins health. Experts Weigh In, The 10 Best Moisturizers for Oily Skin of 2023, Tested and Reviewed, How to Treat Dermatosis Papulosa Nigra (DPN), Intense Pulsed Light (IPL) Lasers: The Complete Dermatologist's Guide, Fordyce Spots Look Like Milia, but Are Very Different, Here's How to Prevent Hyperpigmentation in the Summer. Keep your skin moisturized. Is the ketogenic diet right for autoimmune conditions? Juntongjin P, Laosakul K. Idiopathic Guttate Hypomelanosis: A Review of its Etiology, Pathogenesis, Findings, and Treatments. Stay in the shade during the hottest parts of the day, usually between 10 a.m. and 2 p.m. Cover as much exposed skin as possible by wearing sunglasses, a hat and long-sleeved shirts and pants. Avoid overly long and hot showers or baths. idiopathic guttate hypomelanosis (IGH) Cryotherapy has been reported as an alternative therapy for years; nevertheless, there is no randomized controlled study to determine its efficacy. And if you have sensitive skin, it is better that you dilute apple cider vinegar with water before applying it. (2016, January). A Plastic Surgeon Breaks Down What You Need To Know About Excel V, Keratosis Pilaris: What It Is and How to Treat It, Is Your Birth Control Causing Dark Spots? Last medically reviewed on October 22, 2017, White spots can appear on the skin when protein and dead cells become trapped under the surface, or when there is a loss of pigmentation. The white spots are due to a decrease in melanin in your skin. But the secondary version of Milia can occur due to the traumatic result of events such as dermabrasion, blistering, tissue damage, or any other kind of skin inflammation, all of which may be caused due to side effects from some medication. This is a procedure which removes the uppermost layers of the affected area. They found that IGH repigmentation was statistically higher for those treated with 5-FU (75.3% repigmentation) versus placebo (33.8% repigmentation). It takes place when the melanocyte cell reduces or stops the production of melanin. If youre unsure of the cause of white spots on your skin, seek the advice of a board-certified dermatologist. A dermatologist can give an accurate assessment of your skin and provide treatment. Pityriasis versicolor is more commonly found in adolescents and younger adults and frequently in the tropics and sub-tropical areas. but there are natural remedies that can help. Sir Winston would not have been proud. The doctor or dermatologist will use a medical-grade fine needle to extract the keratin. The majority of remedies are anecdotal, with no randomized controlled clinical research. If you find sunspots occur after tanning, this might be a sign of pre-existing or underlying vitiligo condition. 3. WebA cream with glycolic acid, like Dr. Lancers Retexturizing Treatment, can help reduce the appearance of discoloration and give your skin a smoother appearance. "There are no large-scale scientific studies showing that any of these ingredients are effective treatments. An approach to hypopigmentation. This is a challenging one. BMJ Case Rep 2017; Apr 22: 2017. Milia are small round, hard, white bumps on the face that are often mistaken for whiteheads. It develops when the melanocyte cells in a certain part of your skin reduce or almost stop producing melanin due to the overexposure to the sun thereby leading to de-pigmented and white sunspots on the skin. Honey not only helps in fading scars, exfoliating but also moisturizes the skin thoroughly. Sometimes, however, the yeast overgrows. Accessed 12 th February 2021. Professional treatments offer quicker and typically more superior results, however, even the best available options will not fully fade spots. If treatment is desired for cosmetic reasons, treatments such as cryotherapy, localized dermabrasion or microabrasion, small skin grafts, tretinoin cream, and topical steroids. WebBecause there is no standard therapy for this condition, numerous medical and surgical treatments including intralesional corticosteroids, topical retinoids, topical calcineurin It not only restores the natural color of the skin but also promotes quick healing of infected skin (10). 6 Multani Mitti Face Packs to Banish Acne, Scars, and Pigmentation Like Magic! WebA: Your condition has a long name with lots of syllables: idiopathic guttate hypomelanosis. If the condition does not improve on its own, a doctor or dermatologist can treat milia in a variety of ways: Milia is not a dangerous condition and causes no discomfort, pain, or stinging. Additionally, those with lighter skin tones are subjected to more UV damage over the course of a lifetime than those with darker skin due to lighter skins lower levels of melanin, a natural defense against UV damage. While full repigmentation is still unlikely, the various tools and procedures utilized in these treatmentsincluding lasers, dermabrasion, chemical peels and cryotherapycan improve the localized lack of melanin that causes white sunspots. Ortonne JP, Perrot H. Idiopathic guttate Repeat this process 2 or 3 times a day for best results. With time, they may change in shape and size, but theyre usually permanent. (4) Other features such as collagen bundle homogenization and inflammatory cell infiltration are unremarkable. Mostly, Pityriasis Alba is found in children and teenagers between the age group of 3 to 16 years and is mainly noticed on the face, neck, shoulders, and arms. In: StatPearls [Internet]. It appears as pale pink or red, scaly areas on the skin, which clear to smooth white (hypopigmented) patches. This activity describes the clinical evaluation of idiopathic guttate hypomelanosis and explains the role of the health professional team in coordinating the care of this condition. However, it is recommended to consult a doctor if you notice any of the following changes: Numerous home remedies can come in handy to lessen the white sunspots and also help in boosting the production of pigments and melanin in the de-pigmented parts of the affected skin. "The incidence of IGH increases with age, and it affects the majority of the population over age 70," Diakow says, adding that other theories indicate trauma or genetic factors may play a role in its development. Method: Take a small piece of freshly cut Aloe Vera leaf and cut it open. Marla Diakow, MD, is a dermatologist specializing in both medical and cosmetic dermatology at Schweiger Dermatology Group in Garden City, New York. Are White Sunspots Dangerous or Harmful? Method: Make a thick paste of turmeric powder with either honey or mustard oil and apply this paste to the white sunspots and infected areas. Or you can apply it for 30 minutes and wash it off. Dr. Michael Tomeo If the spots are psychologically bothersome, the easiest treatment is cosmetic camouflage or applying a dab of foundation or concealer to the area. T2 - a pilot study. Read on to get the full scoop on this condition that causes white spots and how it can be treated. Where is the best place to get ayurveda treatment done? These patches are easy to identify as they are usually seen on skins, upper back, arms, or faces and are around 1 to 3mm in size. A conservative approach involving monitoring and photoprotection may help avoid forming new lesions. The patches usually disappear within a few months but can last up to a few years. It keeps the infected skin area nourished and hydrated, thereby preventing it from drying, itching, and irritating thus also preventing the development of white sunspots. MeSH terms Administration, Cutaneous Adult Aged Diagnosis, Differential Elasticity Female With easily available kitchen and household ingredients like Garlic, Aloe Vera, Apple cider vinegar, Vitamin E capsules, Honey, Turmeric, Lemon and Tomato juice, and much more. [7] IGH spots appear gradually on the skin over time and tend to be small commonly between 26 mm. Unfortunately, treating IGH is particularly difficult. WebNatural Remedies REMEDIES Activated Charcoal Activated Charcoal for BO Acupressure ACV and Baking Soda ACV for Weight Loss ACV Side Effects ACV: Where to Buy Alfalfa Apart from following the preventive measures strictly, you can try the home remedies that work effectively. Idiopathic guttate hypomelanosis. "For fairer skin types with sun damage and freckling [or] brown spots, photo facials or laser treatments to remove the surrounding excess pigmentation can make the white spots look less noticeable, due to less contrast," says Guanche. Method: Dab a cotton ball in Vitamin E oil and apply it directly to the affected area or the white sunspots. As sunspots cause no health threat, removing them isnt medically necessary, however, some may prefer treatment for aesthetic reasons. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.
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