Scabies is a skin disease. It causes very itchy skin, and mites can go deeper into the skin. During the night, the intensity of itchiness increases and spreads throughout the skin.It is a transmissible disease in which family and close friends are also affected. The WHO in 2009 has declared scabies an important skin disease. Many individuals from places that are not hygienic can suffer from scabies. It is important to early diagnose this disease. Scabies need to control in the early stage to avoid the complications and to lowerthe incidence rate along with the treatment costs. Diagnosis of scabies can be challenging sometimes because of its infection symptoms in individuals. Â
Epidemiology
Scabies is a skin disease occured by Sarcoptes scabiei mites. It affects 300 million individuals from globally every year. There is a high incidence rate in underdeveloped countries, unhygienic areas, and crowed places. The population generally affected are young people and adults. The places include school. Nursing homes, clinics, and jails where scabies can spread. It is considered as a disregarded skin disease by WHO. Â
Anatomy
Pathophysiology
The pathophysiology of scabies begins with adult female mites, which burrow in the deeper layer of the skin and lay 2 to 3 eggs every day. This laying pattern of eggs takes shape in the form of tunnels, which are 1 to 10 mm long. The hatching of eggs occurs in 2 to 3 weeks. In about 1 or 2 months, the mites die. Some treatments cannot reach the deeper layer of the skin where the eggs are found. After infestation, the symptom may appear after 2 to 5 weeks like papules which appear like tunnel shaped bumps or coma which can range from few mm to 1 cm size. The most common areas include skin areas which are thin, navel, areolar, and shaft of the penis in men.Â
Etiology
The skin contains layers which include the dermis and epidermis in both humans and animals. The mites like Sarcoptes scabiei can live in those area. The female sarcoptes burrow the outer layer of the skin of the host, which is a stratum corneum. In this area, it lays the ages and starts infestation. The mites go through the development phases via nymph. Larva, and adult stages. The number of mites per person includes 10 or 15, which gives scabies a typical appearance.
The spread of the disease occurs within 10 minutes of skin contact or via clothes or bedding in which mites live. The clinical symptoms of scabies are hyperkeratoticplaques on palms, soles, and under the fingernails. Individuals who have weak immune system get Norwegian scabies where the density of mites can affect the million. Transmission or spreading of scabiesoccurs via contaminated objects or contact. The mite numbers aredependent on the immune system of the host and the intensity of the infestation.Â
Genetics
Prognostic Factors
Scabies is a skin disease which is occured by tiny mites called sarcoptes scabiei. It is a transmissible disease. It spread via contact between the person to person. When the scabies are treated properly. The recovery occurs within weeks of spread. Without any proper treatment, it continues to spread and many skin issues will occur. The most important factor in the treatment and to control scabies is early diagnosis and correct approach of the treatment and measures to prevent the disease. Â
Clinical History
Individuals who have scabies are having itchiness during the night. It occurs between the fingers and private parts of the adults and on the wrists. The men population is affected on bumps on the scrotum and penis, while female population are affected on breasts. Â
Children appears the spots on their face, head, palms, feet, and neck. Individuals who have weak immune and geriatrics have severe rashes. The itching is developed in about 2 to 3 weeks.Â
Physical Examination
Scabies lead to primary and secondary skin problems. The first symptoms are small bumps. Blisters and burrows due to scratching can lead to secondary causes. The important symptoms are burrows with thin and gray lines on the skin between wrists, fingers, armpits, and on private parts. It also appeared as a pattern of a circle. These patterns in geriatric individuals occur on their backs. Burrows will appear on the feet and palms of babies. Blisters and reb bumped occur on genital area and breast in adults. Children will have rashes on their neck, face, or it look like eczema. Scalp and nails are also affected. Pinkish-brown bumps will appear in children with nodular scabies.Â
Scabies is a skin disease that has symptoms like burrow masks, skin rashes, or lesions. This can help the doctors to identify the disease. Assessment is done by doing some skin biopsies or skin scrapes for any spotting of eggs or mite wastes. Scabies are treated with creams that containpermethrin. This medication kills the mites when it is applied all over but mainly focusing on the affected areas. After the application of cream, leave it for 8 to 14 hours and wash the area. If the cream is not effective, doctors may prescribe oral ivermectin. The person must go for this treatment to avoid the spread.
The hot water must be used to wash the sheets and clothes. Vacuuming and sealing the items can be helpful in removing the leftover mites. The symptoms of itching and rashes can be treated with steroidal creams and antihistamines. Regular check ups and follow ups is needed to make sure the effectiveness of treatment. Practicing personal hygiene and not sharing any personal things will help prevent the spread of scabies and future infestations.Â
Hygiene practices are very necessary to control and manage scabies. Taking the bath with soap and hot water is good to remove mites and eggs from the skin. The clean and short nail, which makes the mites not burrow, is necessary. Changing the sheets and clothes regularly also helps.
Wash them with hot water, which will kill the mites. High heating and drying can help kill the mite eggs. Living space must be vaccinated thoroughly. Seal the items to prevent the mite survival. Avoid close contact with people who have scabies and not share any personal tings like razors or towels will help yo keep away from the skin disease.
These practices will help to stop the spread of the disease and manage scabies infestations, which will reduce the contamination in living areas. Â
Role of Antiparasitic agents in the treatment of scabies
Permethrin: Permethrin is used as a first choice of treatment. It comes in cream form. It is applied on the affected areas and rubbed on the very part. This cream will kill the nervous system of mites and kill them This cream should be leave on the skin for 8 to 14 hours after application.Â
Ivermectin (Oral): If Permethrin does not work, then doctors may prescribe oral ivermectin. It is a deworming medication. This will also kill the nervous system of mites and kill them. The dosage duration of this medication is 1 week.Â
Benzyl Benzoate: It is another treatment for scabies.It comes in lotion form. It is applied on the affected areas of the skin. It attacks the nervous system of mites and kills them.Â
Sulfur Preparations: These medications are work differently. They disrupt the energy absorption from the food of mites. Â
Lindane: Lindane is an old medication. It is not used regularly because it can damage the human nerves. Â
Role of Topical Antibiotics in the treatment of scabies
Mupirocin: Mupirocin works against bacteria like staphylococcus and streptococcus, which are infected in the open sores by scratching scabies. Â
Neomycin/Polymyxin B/Bacitracin: This combination is used to treat a bacterial skin infections to heal the infected scabies sores. This will halt the growth of bacteria and allow them to heal.Â
Role of Topical Corticosteroids in the treatment of scabies
Hydrocortisone: Hydrocortisone is a corticosteroidcream. It only reduces redness and itchiness from scabies. It gives soothing effects and decrease the inflammation, redness, swelling and itchiness. It comes in the form of lotion, cream, and ointment.Â
Skin biopsies and skin scrapes are necessary to identify scabies if they are not certain. Doctors sent the samples for microscopic examination to check for the presence of eggs, mites, or waste. There are drainage methods for impetigo or cellulitis from the damage caused because of scratching. Scabies heals when the infected waste is removes.
Complications like dermatitis or eczema from scabies need emollients, corticosteroids, or barrier creams. Practicing hygiene, environment, and cleanliness will help to treat the scabies. Education and counselling about the hygiene practises will help the person to avoid any contact to the affected person. Â
use-of-phases-in-managing-scabies
Scabies is diagnosed and identify by symptoms like burrows, rash, or small bumps on the skin which are linked to itching. The clinical assessment includes the detection of symptoms like burrows or lesions. The treatment of scabies includes medications like permethrin, oral ivermectin, crotamiton, or benzyl benzoate to remove mites.
Corticosteroids andantihistamines are also used to soothing effects from inflammation and itching. Daily hygiene practice and regularcheck-up is needed to make sure the effectiveness of the treatment. Â
Topical-It instructs the patient to thoroughly wash and clean the affected area, remove any loose scales or debris, and then dry the skin. Then, the patient is instructed to apply a thin layer of the medication to the entire body, from the neck to the toes, massaging it into the skin. The patient is instructed to repeat this process 24 hours later and then take a bath 48 hours after the final application to cleanse the body. Additionally, if live mites are still present, the patient may repeat the treatment after 7-10 days
Apply a thin lotion coating and massage it into the skin all over your body, avoiding the face. After 8–12 hours, take a bath and remove the medication
Apply a thin lotion coating and massage it into the skin all over your body, avoiding the face. After 8–12 hours, take a bath and remove the medication
For three days, apply 6% ointment before bedtime each night.
Using soap and water, thoroughly wash and dry the whole body.
Apply from the neck down to the whole body and rub it in gently, allow it to stay for 24 hours.
Wash the body thoroughly using water and soap within 24 hours after your previous treatment
Indicated for Scabies
Cream: From head to the toe area, apply the 5% cream, leave it for 8-14 hours, and wash it; if live mites are reappeared, reapply in 7 days
One-time application is generally sufficient for a curative effect
Head Lice and Nits (Eggs)
Cream/ liquid or lotion: Apply to rinsed hair, and leave it for nearly 10 minutes; wash and comb it to remove nits and eggs; if live mites are reappeared, reapply in 7 days
One-time application is generally sufficient for a curative effect
Dilute and apply topically on the affected areas
Indications: this is indicated for use in the treatment of joint pains, gum pain, skin infections, headache, colds, and congestion
Topical-It instructs the patient to thoroughly wash and clean the affected area, remove any loose scales or debris, and then dry the skin. Then, the patient is instructed to apply a thin layer of the medication to the entire body, from the neck to the toes, massaging it into the skin. The patient is instructed to repeat this process 24 hours later and then take a bath 48 hours after the final application to cleanse the body. Additionally, if live mites are still present, the patient may repeat the treatment after 7-10 days
Apply a thin lotion coating and massage it into the skin all over your body, avoiding the face. After 8–12 hours, take a bath and remove the medication
For three days, apply 6% ointment before bedtime each night.
Using soap and water, thoroughly wash and dry the whole body.
Apply from the neck down to the whole body and rub it in gently, allow it to stay for 24 hours.
Wash the body thoroughly using water and soap within 24 hours after your previous treatment.
Indicated for Scabies
Age >2 months
Cream: From head to the toe area, apply the 5% cream, leave it for 8-14 hours, and wash it; if live mites are reappeared, reapply in 7 days
One-time application is generally sufficient for a curative effect
Age <2 months
Safety and efficacy not established
Head Lice and Nits (Eggs)
Age >2 months
Cream/ liquid or lotion: Apply to rinsed hair, and leave it for nearly 10 minutes; wash and comb it to remove nits and eggs; if live mites are reappeared, reapply in 7 days
One-time application is generally sufficient for a curative effect
Age <2 months
Safety and efficacy not established
Scabies is a skin disease. It causes very itchy skin, and mites can go deeper into the skin. During the night, the intensity of itchiness increases and spreads throughout the skin.It is a transmissible disease in which family and close friends are also affected. The WHO in 2009 has declared scabies an important skin disease. Many individuals from places that are not hygienic can suffer from scabies. It is important to early diagnose this disease. Scabies need to control in the early stage to avoid the complications and to lowerthe incidence rate along with the treatment costs. Diagnosis of scabies can be challenging sometimes because of its infection symptoms in individuals. Â
Scabies is a skin disease occured by Sarcoptes scabiei mites. It affects 300 million individuals from globally every year. There is a high incidence rate in underdeveloped countries, unhygienic areas, and crowed places. The population generally affected are young people and adults. The places include school. Nursing homes, clinics, and jails where scabies can spread. It is considered as a disregarded skin disease by WHO. Â
The pathophysiology of scabies begins with adult female mites, which burrow in the deeper layer of the skin and lay 2 to 3 eggs every day. This laying pattern of eggs takes shape in the form of tunnels, which are 1 to 10 mm long. The hatching of eggs occurs in 2 to 3 weeks. In about 1 or 2 months, the mites die. Some treatments cannot reach the deeper layer of the skin where the eggs are found. After infestation, the symptom may appear after 2 to 5 weeks like papules which appear like tunnel shaped bumps or coma which can range from few mm to 1 cm size. The most common areas include skin areas which are thin, navel, areolar, and shaft of the penis in men.Â
The skin contains layers which include the dermis and epidermis in both humans and animals. The mites like Sarcoptes scabiei can live in those area. The female sarcoptes burrow the outer layer of the skin of the host, which is a stratum corneum. In this area, it lays the ages and starts infestation. The mites go through the development phases via nymph. Larva, and adult stages. The number of mites per person includes 10 or 15, which gives scabies a typical appearance.
The spread of the disease occurs within 10 minutes of skin contact or via clothes or bedding in which mites live. The clinical symptoms of scabies are hyperkeratoticplaques on palms, soles, and under the fingernails. Individuals who have weak immune system get Norwegian scabies where the density of mites can affect the million. Transmission or spreading of scabiesoccurs via contaminated objects or contact. The mite numbers aredependent on the immune system of the host and the intensity of the infestation.Â
Scabies is a skin disease which is occured by tiny mites called sarcoptes scabiei. It is a transmissible disease. It spread via contact between the person to person. When the scabies are treated properly. The recovery occurs within weeks of spread. Without any proper treatment, it continues to spread and many skin issues will occur. The most important factor in the treatment and to control scabies is early diagnosis and correct approach of the treatment and measures to prevent the disease. Â
Individuals who have scabies are having itchiness during the night. It occurs between the fingers and private parts of the adults and on the wrists. The men population is affected on bumps on the scrotum and penis, while female population are affected on breasts. Â
Children appears the spots on their face, head, palms, feet, and neck. Individuals who have weak immune and geriatrics have severe rashes. The itching is developed in about 2 to 3 weeks.Â
Scabies lead to primary and secondary skin problems. The first symptoms are small bumps. Blisters and burrows due to scratching can lead to secondary causes. The important symptoms are burrows with thin and gray lines on the skin between wrists, fingers, armpits, and on private parts. It also appeared as a pattern of a circle. These patterns in geriatric individuals occur on their backs. Burrows will appear on the feet and palms of babies. Blisters and reb bumped occur on genital area and breast in adults. Children will have rashes on their neck, face, or it look like eczema. Scalp and nails are also affected. Pinkish-brown bumps will appear in children with nodular scabies.Â
Scabies is a skin disease that has symptoms like burrow masks, skin rashes, or lesions. This can help the doctors to identify the disease. Assessment is done by doing some skin biopsies or skin scrapes for any spotting of eggs or mite wastes. Scabies are treated with creams that containpermethrin. This medication kills the mites when it is applied all over but mainly focusing on the affected areas. After the application of cream, leave it for 8 to 14 hours and wash the area. If the cream is not effective, doctors may prescribe oral ivermectin. The person must go for this treatment to avoid the spread.
The hot water must be used to wash the sheets and clothes. Vacuuming and sealing the items can be helpful in removing the leftover mites. The symptoms of itching and rashes can be treated with steroidal creams and antihistamines. Regular check ups and follow ups is needed to make sure the effectiveness of treatment. Practicing personal hygiene and not sharing any personal things will help prevent the spread of scabies and future infestations.Â
Hygiene practices are very necessary to control and manage scabies. Taking the bath with soap and hot water is good to remove mites and eggs from the skin. The clean and short nail, which makes the mites not burrow, is necessary. Changing the sheets and clothes regularly also helps.
Wash them with hot water, which will kill the mites. High heating and drying can help kill the mite eggs. Living space must be vaccinated thoroughly. Seal the items to prevent the mite survival. Avoid close contact with people who have scabies and not share any personal tings like razors or towels will help yo keep away from the skin disease.
These practices will help to stop the spread of the disease and manage scabies infestations, which will reduce the contamination in living areas. Â
Permethrin: Permethrin is used as a first choice of treatment. It comes in cream form. It is applied on the affected areas and rubbed on the very part. This cream will kill the nervous system of mites and kill them This cream should be leave on the skin for 8 to 14 hours after application.Â
Ivermectin (Oral): If Permethrin does not work, then doctors may prescribe oral ivermectin. It is a deworming medication. This will also kill the nervous system of mites and kill them. The dosage duration of this medication is 1 week.Â
Benzyl Benzoate: It is another treatment for scabies.It comes in lotion form. It is applied on the affected areas of the skin. It attacks the nervous system of mites and kills them.Â
Sulfur Preparations: These medications are work differently. They disrupt the energy absorption from the food of mites. Â
Lindane: Lindane is an old medication. It is not used regularly because it can damage the human nerves. Â
Mupirocin: Mupirocin works against bacteria like staphylococcus and streptococcus, which are infected in the open sores by scratching scabies. Â
Neomycin/Polymyxin B/Bacitracin: This combination is used to treat a bacterial skin infections to heal the infected scabies sores. This will halt the growth of bacteria and allow them to heal.Â
Hydrocortisone: Hydrocortisone is a corticosteroidcream. It only reduces redness and itchiness from scabies. It gives soothing effects and decrease the inflammation, redness, swelling and itchiness. It comes in the form of lotion, cream, and ointment.Â
Skin biopsies and skin scrapes are necessary to identify scabies if they are not certain. Doctors sent the samples for microscopic examination to check for the presence of eggs, mites, or waste. There are drainage methods for impetigo or cellulitis from the damage caused because of scratching. Scabies heals when the infected waste is removes.
Complications like dermatitis or eczema from scabies need emollients, corticosteroids, or barrier creams. Practicing hygiene, environment, and cleanliness will help to treat the scabies. Education and counselling about the hygiene practises will help the person to avoid any contact to the affected person. Â
Scabies is diagnosed and identify by symptoms like burrows, rash, or small bumps on the skin which are linked to itching. The clinical assessment includes the detection of symptoms like burrows or lesions. The treatment of scabies includes medications like permethrin, oral ivermectin, crotamiton, or benzyl benzoate to remove mites.
Corticosteroids andantihistamines are also used to soothing effects from inflammation and itching. Daily hygiene practice and regularcheck-up is needed to make sure the effectiveness of the treatment. Â
Scabies is a skin disease. It causes very itchy skin, and mites can go deeper into the skin. During the night, the intensity of itchiness increases and spreads throughout the skin.It is a transmissible disease in which family and close friends are also affected. The WHO in 2009 has declared scabies an important skin disease. Many individuals from places that are not hygienic can suffer from scabies. It is important to early diagnose this disease. Scabies need to control in the early stage to avoid the complications and to lowerthe incidence rate along with the treatment costs. Diagnosis of scabies can be challenging sometimes because of its infection symptoms in individuals. Â
Scabies is a skin disease occured by Sarcoptes scabiei mites. It affects 300 million individuals from globally every year. There is a high incidence rate in underdeveloped countries, unhygienic areas, and crowed places. The population generally affected are young people and adults. The places include school. Nursing homes, clinics, and jails where scabies can spread. It is considered as a disregarded skin disease by WHO. Â
The pathophysiology of scabies begins with adult female mites, which burrow in the deeper layer of the skin and lay 2 to 3 eggs every day. This laying pattern of eggs takes shape in the form of tunnels, which are 1 to 10 mm long. The hatching of eggs occurs in 2 to 3 weeks. In about 1 or 2 months, the mites die. Some treatments cannot reach the deeper layer of the skin where the eggs are found. After infestation, the symptom may appear after 2 to 5 weeks like papules which appear like tunnel shaped bumps or coma which can range from few mm to 1 cm size. The most common areas include skin areas which are thin, navel, areolar, and shaft of the penis in men.Â
The skin contains layers which include the dermis and epidermis in both humans and animals. The mites like Sarcoptes scabiei can live in those area. The female sarcoptes burrow the outer layer of the skin of the host, which is a stratum corneum. In this area, it lays the ages and starts infestation. The mites go through the development phases via nymph. Larva, and adult stages. The number of mites per person includes 10 or 15, which gives scabies a typical appearance.
The spread of the disease occurs within 10 minutes of skin contact or via clothes or bedding in which mites live. The clinical symptoms of scabies are hyperkeratoticplaques on palms, soles, and under the fingernails. Individuals who have weak immune system get Norwegian scabies where the density of mites can affect the million. Transmission or spreading of scabiesoccurs via contaminated objects or contact. The mite numbers aredependent on the immune system of the host and the intensity of the infestation.Â
Scabies is a skin disease which is occured by tiny mites called sarcoptes scabiei. It is a transmissible disease. It spread via contact between the person to person. When the scabies are treated properly. The recovery occurs within weeks of spread. Without any proper treatment, it continues to spread and many skin issues will occur. The most important factor in the treatment and to control scabies is early diagnosis and correct approach of the treatment and measures to prevent the disease. Â
Individuals who have scabies are having itchiness during the night. It occurs between the fingers and private parts of the adults and on the wrists. The men population is affected on bumps on the scrotum and penis, while female population are affected on breasts. Â
Children appears the spots on their face, head, palms, feet, and neck. Individuals who have weak immune and geriatrics have severe rashes. The itching is developed in about 2 to 3 weeks.Â
Scabies lead to primary and secondary skin problems. The first symptoms are small bumps. Blisters and burrows due to scratching can lead to secondary causes. The important symptoms are burrows with thin and gray lines on the skin between wrists, fingers, armpits, and on private parts. It also appeared as a pattern of a circle. These patterns in geriatric individuals occur on their backs. Burrows will appear on the feet and palms of babies. Blisters and reb bumped occur on genital area and breast in adults. Children will have rashes on their neck, face, or it look like eczema. Scalp and nails are also affected. Pinkish-brown bumps will appear in children with nodular scabies.Â
Scabies is a skin disease that has symptoms like burrow masks, skin rashes, or lesions. This can help the doctors to identify the disease. Assessment is done by doing some skin biopsies or skin scrapes for any spotting of eggs or mite wastes. Scabies are treated with creams that containpermethrin. This medication kills the mites when it is applied all over but mainly focusing on the affected areas. After the application of cream, leave it for 8 to 14 hours and wash the area. If the cream is not effective, doctors may prescribe oral ivermectin. The person must go for this treatment to avoid the spread.
The hot water must be used to wash the sheets and clothes. Vacuuming and sealing the items can be helpful in removing the leftover mites. The symptoms of itching and rashes can be treated with steroidal creams and antihistamines. Regular check ups and follow ups is needed to make sure the effectiveness of treatment. Practicing personal hygiene and not sharing any personal things will help prevent the spread of scabies and future infestations.Â
Hygiene practices are very necessary to control and manage scabies. Taking the bath with soap and hot water is good to remove mites and eggs from the skin. The clean and short nail, which makes the mites not burrow, is necessary. Changing the sheets and clothes regularly also helps.
Wash them with hot water, which will kill the mites. High heating and drying can help kill the mite eggs. Living space must be vaccinated thoroughly. Seal the items to prevent the mite survival. Avoid close contact with people who have scabies and not share any personal tings like razors or towels will help yo keep away from the skin disease.
These practices will help to stop the spread of the disease and manage scabies infestations, which will reduce the contamination in living areas. Â
Permethrin: Permethrin is used as a first choice of treatment. It comes in cream form. It is applied on the affected areas and rubbed on the very part. This cream will kill the nervous system of mites and kill them This cream should be leave on the skin for 8 to 14 hours after application.Â
Ivermectin (Oral): If Permethrin does not work, then doctors may prescribe oral ivermectin. It is a deworming medication. This will also kill the nervous system of mites and kill them. The dosage duration of this medication is 1 week.Â
Benzyl Benzoate: It is another treatment for scabies.It comes in lotion form. It is applied on the affected areas of the skin. It attacks the nervous system of mites and kills them.Â
Sulfur Preparations: These medications are work differently. They disrupt the energy absorption from the food of mites. Â
Lindane: Lindane is an old medication. It is not used regularly because it can damage the human nerves. Â
Mupirocin: Mupirocin works against bacteria like staphylococcus and streptococcus, which are infected in the open sores by scratching scabies. Â
Neomycin/Polymyxin B/Bacitracin: This combination is used to treat a bacterial skin infections to heal the infected scabies sores. This will halt the growth of bacteria and allow them to heal.Â
Hydrocortisone: Hydrocortisone is a corticosteroidcream. It only reduces redness and itchiness from scabies. It gives soothing effects and decrease the inflammation, redness, swelling and itchiness. It comes in the form of lotion, cream, and ointment.Â
Skin biopsies and skin scrapes are necessary to identify scabies if they are not certain. Doctors sent the samples for microscopic examination to check for the presence of eggs, mites, or waste. There are drainage methods for impetigo or cellulitis from the damage caused because of scratching. Scabies heals when the infected waste is removes.
Complications like dermatitis or eczema from scabies need emollients, corticosteroids, or barrier creams. Practicing hygiene, environment, and cleanliness will help to treat the scabies. Education and counselling about the hygiene practises will help the person to avoid any contact to the affected person. Â
Scabies is diagnosed and identify by symptoms like burrows, rash, or small bumps on the skin which are linked to itching. The clinical assessment includes the detection of symptoms like burrows or lesions. The treatment of scabies includes medications like permethrin, oral ivermectin, crotamiton, or benzyl benzoate to remove mites.
Corticosteroids andantihistamines are also used to soothing effects from inflammation and itching. Daily hygiene practice and regularcheck-up is needed to make sure the effectiveness of the treatment. Â
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