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Clinical features The disease affects women slightly more often than men (ratio 1 proven 20mg forzest zinc erectile dysfunction treatment. The oral mucosa is affected in about 20–40% of cases cheap 20mg forzest free shipping erectile dysfunction even with cialis, usually after skin involvement 20mg forzest visa impotence at 17. The oral lesions usually follow cutaneous manifestations and begin as bullae that soon rupture, leaving shallow ulcerations (Fig. Skin lesions are always present, and begin as a nonspecific generalized rash followed by large, tense bullae that rupture, leaving denuded areas without a tendency to extend pe- ripherally (Fig. Laboratory tests Histopathological examination, direct and indirect immunofluorescence. Differential diagnosis Pemphigus, cicatricial pemphigoid, linear IgA disease, dermatitis herpetiformis, epidermolysis bullosa acquisita, pem- phigoid gestationis. Usage subject to terms and conditions of license 122 Vesiculobullous Lesions Pemphigoid Gestationis Definition Pemphigoid gestationis, or herpes gestationis, is a rare, acute subepidermal blistering disease occurring in the second or third trimester of pregnancy or in the early postpartum period. Clinical features Pemphigoid gestationis usually affects the skin and, less frequently, the mucous membranes. The skin manifestations present as pluritic, papulobullous eruptions and erythema (Fig. The bullae are numerous and often coalesce and soon rapture leaving painful ulcer- ations. The abdomen, chest, back, extremities, palms, and soles are the sites of predilection. The oral lesions are rare and present as multiple, usually hemorrhagic bullae that rupture quickly leaving painful ulcer- ations (Fig. The buccal mucosa, palate, tongue, and gingiva are the most frequently affected areas. Laboratory tests Histopathological examination, direct and indirect immunofluorescence tests. Differential diagnosis Bullous pemphigoid, cicatricial pemphigoid, linear IgA disease, dermatitis herpetiformis, epidermolysis bullosa ac- quisita, erythema multiforme, bullous systemic lupus erythematosus, drug eruptions. Usage subject to terms and conditions of license 124 Vesiculobullous Lesions Linear IgA Disease Definition Linear immunoglobulin A (IgA) disease is a disorder that has recently been recognized in the spectrumof chronic bullous dis- eases, characterized by the linear deposition of IgA along the basement membrane zone. Clinical features The disease is more common in women than in men, and usually occurs between the ages of 40 and 50 years, although children may also be affected. Oral lesions occur in about 20–30% of cases, and are characterized by the formation of bullae that soon rupture, leaving superficial, nonspecific ulcerations (Figs. The skin le- sions consist of bullae that rupture, forming ulcerations covered by crusts. The clinical features of the disease are similar to those seen in cicatricial pemphigoid. Laboratory tests Histopathological examination, direct and indirect immunofluorescence. Differential diagnosis Cicatricial pemphigoid, bullous pemphigoid, pemphigus, dermatitis herpetiformis, pemphigoid gestationis. Usage subject to terms and conditions of license 126 Vesiculobullous Lesions Dermatitis Herpetiformis Definition Dermatitis herpetiformis, or Duhring–Brocq disease, is a chronic recurrent cutaneous bullous disease, rarely with oral involve- ment. Immunological and genetic factors, as well as gluten sensitivity, may be involved in the pathogenesis. Clinical features The disease is more common in men between the ages of 20 and 50 years. Oral manifestations follow the skin eruption, and present as maculopap- ular, erythematous, purpuric, and mainly vesicular lesions.

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First of all cheap forzest 20 mg overnight delivery erectile dysfunction shots, the great truth is established that all chronic ailments buy forzest 20mg low cost erectile dysfunction self treatment, all great purchase 20 mg forzest with visa impotence urology, and the greatest, long continuing diseases (excepting the few venereal ones) spring from psora alone and only find their thorough cure in the cure of the psora; they are, consequently, to be healed mostly only by antipsoric remedies, i. The homoeopathic physician, therefore, in curing a chronic (non- venereal) disease, and in all and in every symptom, ailment and disorder arising in this disease, no matter what seductive name these may have in common life or in pathology, will usually and especially look to the use of an antipsoric medicine selected according to strictly homoeopathic rules, in order to surely attain his end. The new infection, while the chancre remains undisturbed, may be cured, together with the venereal disease sprung from the former infection, just as easily by a single dose of the best mercurial preparation, as if the first chancre were still present, - provided that no complication with either of the other two chronic miasmata, especially the psoric, has taken place; for in such a case, as has been mentioned above, the psora must first be removed. For if the symptoms occurring during the action of the remedy have also occurred, if not in the last few weeks, at least now and then some weeks before, or some months before in a similar manner, then such occurrences are merely a homoeopathic excitation, through the medicine, of some symptom not quite unusual to this disease, of something which had perhaps been more frequently troublesome before, and they are a sign that this medicine acts deeply into the very essence of this disease, and that consequently it will be more effective in the future. The medicine, therefore, should be allowed to continue and exhaust its action undisturbed, without giving the least medicinal substance between its doses. But if the symptoms are different and had never before occurred, or never in this way, and, therefore, are peculiar to this medicine and not to be expected in the process of the disease, but trifling, the action of the medicine ought not for the present to be interrupted. Such symptoms frequently pass off without interrupting the helpful activity of the remedy; but if they are of a burdensome intensity, they are not to be endured; in such a case they are a sign that the antipsoric medicine was not selected in the correct homoeopathic manner. Its action must then be checked by an antidote, or when no antidote to it is known, another antipsoric medicine more accurately answering its symptoms must be given in its place; in this these false symptoms may continue a few more days, or they may return, but they will soon come to a final end and be replaced by a better help. Least of all, need we to be concerned when the usual customary symptoms are aggravated and show most prominently on the first days, and again on some of the following days, but gradually less and less. This so-called homoeopathic aggravation is a sign of an incipient cure (of the symptoms thus aggravated at present), which may be expected with certainty. This will be decided in the first sixteen, eighteen or twenty days of the action of the medicine which has been given in too large a dose, and it must then be checked, either by prescribing its antidote, or, if this is not as yet known, by giving another antipsoric medicine fitting as well as possible, and indeed in a very moderate dose, and if this does not suffice to extinguish this injurious medicinal disease, another still should be given as homoeopathically suitable as possible. The physician can, indeed, make no worse mistake than first, to consider as too small the doses which I (forced by experience) have reduced after manifold trials and which are indicated with every antipsoric remedy and secondly, the wrong choice of a remedy, and thirdly, the hastiness which does not allow each dose to act its full time. Still ignorant of the strength of its medicinal power, I gave sepia in too large a dose. This trouble was still more manifest when I gave lycopodium and silicea, potentized to the one-billionth degree, giving four to six pellets, though only as large as poppy seeds. It can hardly be given too small, if only everything ill the diet and the remaining mode of life of the patient which would obstruct or counteract the action of the medicine is avoided. The medicine will still produce all the good effects which can at all be expected from a medicine, if only the antipsoric was homoeopathically, correctly, selected according to the carefully investigated symptoms of the disease, and if the patient does not disturb its effects by his violation of the rules. If ever it should happen that the choice has not been correctly made, the great advantage remains, that the incorrectly selected medicine in this smallest dose may in the manner indicated above be counteracted more easily, whereupon the cure may be continued without delay with a more suitable antipsoric. As to the second chief error in the cure of chronic diseases (the unhomoeopathic choice of the medicine) the homoeopathic beginner (many, I am sorry to say, remain such beginners their life long) sins chiefly through inexactness, lack of earnestness and through love of ease. With the great conscientiousness which should be shown in the restoration of a human life endangered by sickness more than in anything else, the Homoeopath, if he would act in a manner worthy of his calling, should investigate first the whole state of the patient, the internal cause as far as it is remembered, and the cause of the continuance of the ailments his mode of life, his quality as to mind, soul and body, together with all his symptoms (see directions in Organon), and then he should carefully find out in the work on Chronic Diseases as well as in the work on Materia Medica Pura a remedy covering in similarity, as far as possible, all the moments, or at least the most striking and peculiar ones, with its own peculiar symptoms; and for this purpose he should not be satisfied with any of the existing repertories, - a carelessness only too frequent; for these books are only intended to give light hints as to one or another remedy that might be selected, but they can never dispense him from making the research at the first fountain heads. He who does not take the trouble of treading this path in all critical and complicated diseases, and, indeed, with all patience and intelligence, but contents himself with the vague hints of the repertories in the choice of a remedy, and who thus quickly dispatches one patient after the other, does not deserve the honorable title of a genuine Homoeopath, but is rather to be called a bungler, who on that account has continually to change his remedies until the patient loses patience; and as his ailments have of course only been aggravated he must leave this aggravator of diseases, whereby the art itself suffers discredit instead of the unworthy disciple of art. They should only serve as a confirmation of a choice made according to the pure actions of the medicines; but never to determine the selection of a remedy which can cure only when used according to the exact similitude of its homoeopathic symptoms. There are, we are sorry to say, even authors who advise following this empiric pathway of error! The third leading mistake which the homoeopathic physician cannot too carefully nor too steadfastly avoid while treating chronic diseases, is in hastily and thoughtlessly - when a properly moderate dose of a well selected antipsoric medicine has been serviceable for several days, - giving some other medicine in the mistaken supposition that so small a dose could not possibly operate and be of use more than eight or ten days.

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