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Sunday, December 16, 2012

Benigne Tumors Of The Skin Polyps in the skin

Benigne Tumors Of The Skin
Polyps in the skinTumor meaning: that a group of cells in a single tissue in the body begin to divide and multiply abnormally so increase and increase, either benign their meaning: that tumors or to transfer block these cells do not spread to the rest of the body but remain in place therefore be a new block in place were not exist The pressure on the surrounding tissue, but not transmitted through blood or lymph to other places in the body.To make sure it's benign doctor sends mass that Astisalha (or any part thereof to Althalib in vitro)Therefore, the treatment be Bastisalha just does not need to give medications or other.It is important that the doctor tries to distinguish whether the tumor is benign or malignant tumor because if was benign Vnsttia to NJP patient treatments and unnecessary surgical interventions plus anxiety zu mental stateAnd do not forget that the patient is a human being has a family and they are important to them and his condition affect themImagine if we place, how we want to be a doctor
Polyps in the skin get in a lot of people are in fact part of the aging process, but some is made at an early age or some of them in old age
Tumors consisting of the epidermis (top layer of the skin):Offices:verruca seborroica, epidermal cyst, virus warts, kerato-acanthoom, swollen sebacious or sweatglands or hair follicles, chondrodermatitis helices.
Malicious or that have the potential to become malignant:actinic keratosis, basal cell carcinoma, sequamous cell carcinoma, Bowen's disease, Paget's disease, carcinoma of the sweat glands or sebacious glands.
Dermis dermis:Polyps:dermatofibroma, keloid, lipoma, neurofibroma, hemangioma, granuloma telangectesia, lyphangiomaThat have the potential to become malignant Awalkhbayth:dermatofibrosarcoma, neurofibrosarcoma, lymohangiosarcoma, hemangiosarcoma, kaposi sarcoma
Cells Almilanosaats (pigment-producing skin) melanocytes:Polyps: melanocyte naevusMalicious: dysplastic naevus, lentigo maligne
Lymphatic vascular tissue: lymphoreticulair tissue:psudolymphomacutanouse T-cell lymphoma, cutanous B-cell lymphoma, histeocyte malignancy
**** Stases cancer is coming from somewhere else:lung cancer, breast cancer, renal cancer., leukemia

Form polyps possible to have a grain or ulcer or many other formats
Some types of polyps in the gel:Fat mass LIPOMA:
 


Consists of subcutaneous adipose tissue and therefore Thsha coherent and not rigid and can move the skin above and driven over the tissue underneath the surface is usually Pitfalls
And possible to find anywhere in the body, especially the neck and torso
And possible to be small and grow gradually
And possible to be one or a combination
Color from the outside skin color
Treatment: If complained rights can be eradicated





Benign tumor consisting of fatty tissue XANTHOMA:



Tumor is yellow in color because it consists of a pool of fat in the cells that are located in the dermis which may indicate high blood fats and possible to be of several types
The most common is happening in the eyelid eye XANTHELASMA PALPEBRUM where appear yellow high places on the surface of the skin borders and clear from the rest of the skin and flat surface
The rest of the examination must be done types of fat in the blood
Treatment: possible eradicated or possible to put a special article
Of course the treatment of high blood fat must not forget

KELOID:



It turns scar wound to a large scar exaggerated and be of much divided connective tissue and skin colored or yellow or pink or light red and shiny and solid texture
It consists of wound and scar sometimes consists of his own
It consists above where it was wound and expands to more of that region
Sometimes composed over the place he had been burning
And be in a rare light skin getting dark but in the skin occurs more
And rights of form scar as well as itching
Problem if Astisalha doctor, he would work a new wound tissue will appear Gedi
Treatment (itching also) is of second class in terms of power either over the place or glaucoma under the affected area and sometimes useful silicone gel or silicone plaster


NAEVUS NAEVOCELLULARIS

It kind of mole Hamid sometimes be colored or sometimes skin color
Sometimes called NAEVUS PIGMENTOSA
Usually consists in age Alemrahth or thereafter
Be elevated from the skin and flat as possible be felt
It is rare that become malignant
If changed suddenly became bigger or change color or become itchy Valahassan eradicated
And sent for laboratory examination




HAEMANGIOMA :

Is Hamid cancer consists of cells lining
Wild child is in it, but most likely is that he composed after birth
 
neurfibroma:

Are tumors of the same color skin color as possible tumor consists of one or part of the disease neurofibromatosis
Is caused by increased Schwann cells surrounding nerves and vary valuable grain size and half circle smooth texture and possible if large Ahdl skin
Rarely turn into malignant
Treatment: if it is a single can be eradicated
But if part of the disease neurofibromatosis can eradicate places that cause a nuisance or doubt that it turned out to be malignant
 .




sebaceous Hyperplasia:
Appears in the elderly appears yellow كحبة several millimeters in diameter and in the middle and more often than not click on the forehead and sometimes difficult is indistinguishable from the basal skin cancer which generally do not need to treat

dermatofibroma = HISTIOCYTOMA:
Pill strong small-or large-sized single or multiple mostly on the leg, sometimes scattered body afflict women more than men for the color yellow to red to brown to black depending on the amount of the dye and the cells HISTIOCYTES
Do not complain rights of itching and pain
Treatment: If the color may not be distinguishable from colored skin cancer (melanoma) or because the man finds the ugly Venstasalha
But the prospect of leaving a scar visible in place eradication




ANGIOMA SENILE:

Are frequent in elderly
Be a flat place a little high roundish or red network of dilated blood vessels
Sometimes-
Treatment: no need to eradicate

Granuloma Pyogenicum:

Is a benign tumor in a small skin or tissue mucosa consists of Tksmat vascular It consists after inflammation in the area or a blow to the place or some unknown reason is rare in general, and have formed a tumor Rounded Kalkrh diameter 1 centimeter surface shiny and sometimes his leg is bleed easily and occurs more thing in the hands and face and mucous tissue in the mouth, a die on its own to change their minds color from red to black and smaller size
Treatment: Bastisalh advised and sent to histological examination: Why:
1 - because it looks like a malignant tumor (melanoma)
2 - because he bleeds easily.





Angiokeratoma :
Is divided in the blood vessels in the skin clear boundaries of place, possible that the nature of the cells in the (ACANTHOSIS HYPERKERATOSIS) which is similar to melanoma
Eradication and treatment, freezing or laser







Chondrodermatitis Nodularis Helicis :
Is an inflammation of the Foreign Near cartilage (flint), especially in the elderly be rounded bead color skin color to bright red and sometimes its the crust and be very painful and treatment Bastisalha surgery, freezing or injection Kortcosteroyd
.






angiofibroma :

Consists of connective tissue and blood vessels and be single e, for example, in the face or multiple, for example, in the face or edge of the fingernail and be skin colored bead with divisions of capillary vessels or be multiple red.






keratoacanthoma :
Is a benign tumor dome (hemisphere) is growing rapidly and arises from the hair bulb does not grow more than 1 centimeter never. See lonely in place has been subjected to the sun such as the face, for example.
In the middle consists hole and fill with keratinous plug ..
Within months any 4 - 5 fading of the same ..
Tafrgueth malignant tumor is difficult, but here: grow up quickly

If the diagnosis is confirmed, it can be anticipated that fades on its own
In case of doubt: Eradication


verruca seborrhoica:
Is Mkanmstah coarse Mrtqa greasy surface and a diameter smaller than 1 centimeter usually
Appear in the elderly usually so sometimes called verruca senilis.
Sometimes be found in large numbers Bjeet give the whole trunk ..
Color yellow brown or yellow black sometimes be difficult to distinguish from naevus naevocellularis or melanoma.
Treatable: Easy Akectha guessed skimming sharp edge and you see superficial and leave place small blood.
Possible also address freeze
 .





Kaposi sarcoma :
This was a rare tumor in the past, but now has become more especially in AIDS patients
Caused by the herpes virus type 8.
Is a large grain Aosgarh half cm to 2 cm.
Treatment: If the patient receives drugs against AIDS has smaller itself or disappear ... or address radiation therapy which is sensitive to this treatment
 .

Hemorrhoids

Hemorrhoids:
Sometimes comes to the treatment of hemorrhoids in the jurisdiction dermatologist
The most important place to control offload waste from the bowel is flexor which is located in a slot and is director rounded muscle Klhalqh as well as mucosal tissue located
Hemorrhoids are parts of the mucosal tissue may Asttalt and filled with blood
Patient feels itchy and pain and see blood to go out and be a form of pure blood and new
And sometimes feels piles like small blocks out of the anus
Sometimes causes hemorrhoids is unknown and may be related to the arrest warrant because the man does not eat a lot of fiber, such as vegetables and fruits, as well as the lack of drinking water and lack of movement
And other reasons
Advice for those who have hemorrhoids:
Eating a diet rich in fiber
Drink enough water
Body Movement
Go to the bathroom when you feel the need to
Sit up straight when defecation
Washing director twice to three times a day with cold water a little
Beware of using strong soaps on the place
Place fat in fat doctor who prescribed
Can treatment that puts the doctor cut from small rubber bands around the neck of hemorrhoids Vttibs and drop a treat does not need to Tdkhir
And there are other types of processes for the treatment of hemorrhoids

Skin color

Skin color:
That skin color comes from the amount of melanin pigment in it. Well as from Alheiemogloban and layer of the cornea and other things.
Cases where changing color of the skin and nails (which is not the result of aneurysm) name dyschromia. Whether increased melanin, the pigment that named hypermelanosis.

hyperpigmentation is discoloration of the skin color is darker than normal color due to increased melanin pigment which

Hypopigmentation is the lack of pigment in the skinReasons: pityriasis albavitiligoleprosyalbinismidiopathic guttate hypomelanosis
Color by human genetics and the environment and the color of the skin is a way to keep the skin itself from harmful rays of the sun that is, they Kalmazlh that protect cells from the sunIf there has been a change in skin pigment may be the reason:Sun exposure, infection, changes in hormones, drugs, materials on the skin, a hereditary disease, unknown reasons.
MELASMA: becoming mostly in women at the time of conception due to changing hormones (estrogen) and exposure to the sun or during menopause or during the use of the pill and have darker skin color to brown and places exposed to the sun such as the face, neck and arms
Some medications cause an increase in skin discoloration, such as the treatment of malaria and treatment of epilepsy as well as address some metals such as mercury, lead or silver or gold as possible be the reason
Freckles:


Is discoloration of the skin in places exposed to the sun, the color yellow to brown, especially at young ages, then disappear gradually, and in winter equally bright, and the number of cells that make pigment no more than the normal number, but the dye or device maker dye in cells grow in size as it is the case in people with dark skin color. Treatment is not easy to avoid the sun does not prevent spots from appearing. Her inheritance relationship and do not turn into a malignant disease.
Spot (coffee with milk):


Appear at birth or months after birth, I do not know the cause exactly but it comes in a lot of people any 2% in people with dark skin are more than any 25% and boys and girls is no difference between them in that. Number of cells that make pigment melanin is like normal skin but the dye increases, and possible to be a small or large spot and their edges are clear from the rest of the skin, light brown.




Dermatologist with less pigment: to get to know the following words:
leukoderma: is the generic name for the disease or cases where gets Ngerlon skin color to open.hypomelanosis: is the lack of melanin pigmentamelanosis: is a complete lack of melanin pigmenthypopigmentation: loss of some character that was already present in the skinmacula: a spot in the skin either be lighter or darker than the rest of the skin.

albinism: congenitalpityriasis versicolor, secondary syphilis, leprosy: infectiousmelanoleukodermia from the sun, Xrays: physicalhydrochinonderivatives: Iatrogenicvitiligo and pityriasis alba: unknown
VITILIGO:Is a lack of melanin pigment occurs in 2% of the people, and often members of the same family. Places in the skin become non-existent character Faisarlunha Kpaad milk and their edges sharp distinction than the surrounding skin color original, and grow gradually, and even the hairs in place becomes a white, and the most happening places this is the face and hands and armpit

pityriasis alba: is a place in the skin is formed rounded to oval its borders are not clear, it Takecrat light (so named pityriasis any scaling light of places in the skin) and the word alba namely that a white but in fact that color these places is not completely white as suggested Name. Cause is unknown may be inflammation of the skin healed leaves the place open, which was originally idiopathic hypopigmentary condition, or use a lot of الكورتزون to treat eczema. Reason for the lack of pigment is due to lack of work the pigment-producing cells and the quality of the dye. And see the situation in children between 3 -16 years in the Fatihi skin more than the skin Gamqa but in the skin Gamqa and more clear. And mostly get in the face.Treatment: Not recommended type of treatment. Because these spots do not exceed in Ghamq when sun exposure Valahassan protect the skin around the sun so as not to show the difference between them. Sometimes the other tattooed to hide the spot if they are small. May remain part of the month-to-ten years and on the face mostly lasting for a year or more.Using KOH examination to distinguish them from fungal infection tinea versicolor, which gives similar spots.






postinflammatory hypogimentation

Is that less skin pigment in one skin some places that have happened inflammation of the skin, for example, in the case of eczema or psoriasis. I do not know the cause exactly but it seems that the work of the pigment producing cells influenced by interactions.


If I knew why he tried to avoided as much as you can

Skin changes resulting from the use of drugs

Skin changes resulting from the use of drugs:
Possible to show all kinds of changes in the skin due to a drug used to cure or for the diagnosis or preventionFor example: penicillin, ACE inhibitors, NSAID's, sulpherpreparations, thiazides.Or preservatives or coloring with medication.Attention to these important changes in the skin show us what we can not see what is happening inside the body therefore if we see changes, it must hurry to stop the medication so as not to further damage occurs. But it's important to know what skin changes that may take place in this medicine or to know whether the rash of drug or is it the disease who seek treatment from the patient. Each diffuse rash all over the body must make us form a sensitivity of drug in a patient who used the drug and one or more, but sometimes difficult is that the patient uses more than one medicine ..Diagnosis depends on: the form changes, the story, the particular test.Story: What is the relationship between the rash and how you can use the medicine and the time-of-use?Do you use the medicine before?Are you using other drugs with this medicine?Is the patient allergic to medications?Are there other symptoms may indicate if the rash of drug or disease?
Examination:In the acute phase of the sensitivity of the drug: the first type of an allergic reaction: increase the number of white blood cells Almjbbh kind of eosinophils in the blood. In the second type of sensitivity: Sometimes anemia and lack of Kriya T. and white blood platelets. Sometimes the presence of immune compounds in the blood.Rast test to see the amount of IgE in the blood (after 6 weeks of interaction can be considered reliable)Other tests:IN VIVO TEST: three steps:Drug arrest leads to stop symptomsTo return the use of the drug leads to the appearance of new symptoms (careful not to get the case sensitivity hazardous to life)Skin examination put a drop on the skin and see the interaction
IN VITRO TEST: other laboratory tests to detect allergies
Treatment:Discontinue doubtful and replace it with another medication from another group of medicinesContinue medication as possible to be a danger to life or to increase the changes in the skin, which sometimes does not go away after the cessation of the drug.Local fat: Menthol or KortizonOral or injection: antihistamines and in dangerous situations only.
Prevention: The patient is given a paper written by drugs that has the sensitivity of itIt reminds each doctor prescribe medicationKnows that there are medications may work his sensitivity also if he had the sensitivity of a particular drug cross reactionAvoid drugs that are unnecessary and not be prescribed ointments that trigger allergiesGet rid of allergies by a particular treatment is possible only in a limited number of medications, and here are a difficult way and must enter the patient to the hospital and under heavy surveillance.
Important word: Make sure that the rash caused by medication, medicine Description row rash and make sure because some people are denied drugs they need it because of their belief that line are allergic to them.

Skin changes at conception

Skin changes at conception:Three types of changes:Natural changes with pregnancyChanges are dermatologist with pregnancy appears onlySkin changes already exist and are affected by pregnancy
Changes that appear when pregnancy:Increase the dye: hyperpigmentationIncreases the concentration of the hormone as a catalyst for Milansaat MSH that causes (with increased hormone estrogen and progesterone) increase in pigment in the skin, especially in the middle of the abdomen and line the bottom of the abdomen and these are all less after birth.Melasma is a discoloration increase in the face be symmetrical on both sides of the face and be light brown to Gamqouhavath sharp, especially on the forehead, cheeks, temples and around the eyes and above the upper lip. Exposure to the sun has an important role in the survival of variegated get after birth.Treatment: prevention or protection from the sun.
Hair change: hair during pregnancy passes the situation becomes more calm intensity, then compensated after birth Cuomo lot of hair after birth month to 15 monthTreatment: patience
Lines in the abdomen:All pregnant women show they have pink lines in the abdomen and sometimes in other parts of the body. And be dark in pregnancy and opens the color after birth. It may be due to the expansion with increased abdominal circumference adrenal cortex college.Treatment: There is no effective treatment if they have reached the light colorBut if it was still dark one can give vitamin A products but the problem is that if a woman is pregnant, it causes distortion in the fetus, in addition to other problems.
Other changes:spider naevi, hemorroids, varicose veins, palmer erythema
Dermatologists occur only during pregnancy:Itching, especially in the last trimester of pregnancy: perhaps because of cholestasis and disappears after birth

Psychological impact on the skin disease case

Psychological impact on the skin disease case:

psychodermatology:

Possible situation that lead psychological (tension, for example) to increase dermatologist or return appearance, or that the dermatologist lead to deteriorating mental state, especially since a lot of skin diseases of a chronic nature.
The skin is made and nerves of origin and any one of a single layer when the fetus is a layer Alambroderm ectoderm .. Therefore, the skin and nervous system are linked closely ..
They are linked to the immune system in the body ..
psycho-neuro-immunological model explains a lot of diseases

Dermatologists affect mental state:
Such as: eczema (allergies), psoriasis, excessive sweating in the hands or feet or armpit g

Dermatologists affect mental state less:
Partial or total baldness, acne, herpes, Alvalol

There is a state called dermatitis artefacta where the injured or infected hurting himself, but he denies that he may do so and did not know a reason for that. In other cases not deny the infected person, such as trichotillomania, or itchiness.

Trichomycosis: Hair injury fungal

Trichomycosis: Hair injury fungal
Call injury if the injury was superficial include hair and skin surface without causing inflammation in the hair bulb.
We see injuries rounded red scaly in the hair or beard area
And because the hairs break in place slot hair bulb remains bald scaly area to see where the roots of the hairs black dots and called areas patchy alopecia.
Infection can be of another child (eg school) or an animal in the house like a bunny.

Treatment: must address the mouth because the fat on the hair to to sufficient depth in the hair bulbs. Possible to choose griseofulvine or other possible to start using fat over the injury in the first weeks of treatment with oral treatment to avoid infecting others.







Deep wounding hair:
It is rare, and mostly originating from an animal. And become a private in the beard area and possible that Antchro becomes the pus.
And drug treatment against local fungi and mouth

tinea corporis and Tinea intertriginosum

tinea corporis:

Here shows one place or several places in the trunk (or the face or limbs) rounded to oval shape and their edges sharp and high and sometimes small blisters pus. Then cured place in the middle, while the remaining edges becomes a form of place Klhalqh and so-called 'ringworm'



Tinea intertriginosum: fungal infection in the skin folds
Affects, in a few cases, skin fold between the leg and abdomen tinea inguinalis red we see the place its borders sharp scaly and sometimes called eczema marginatum is possible to expand the area to top leg is called tinea cruris

Treatment: This surface fungi can be addressed well in fat containing substances kill. If there is liquid comes out of them is preferable put 10% of sulfur in zinc. If light is not wet, it acid الساليسليك with antifungal such as miconazole or other.

Tinea manuum

Tinea manuum

Is an inflammation of the hands or in the hands caused by fungi and have a variety of forms:
If the place was red and scaly, it must try that we distinguish from, for example, psoriasis
Or when bubbles Vnmesh pompholyx
Tinea usually begins in one hand, and be sharp edges and clear for the rest of the skin and heal from the center.



Eczema especially the type known B Pompholyx is a type of eczema affects the hands and sometimes the feet as well, and be quick acute phase where tiny bubbles deep in the palm of your hands and fingers and toes and can be bubbles severe itching or pain. Possible that the case may be simple flake or so strong that few where large bubbles and cracks and prevents the patient from work. At a later stage be chronic skin Viakecr more then heals cracks or bubbles begin to re-emerge.
 

Tinea

Tinea

 
Read "Tinea" which is not the girl's name but is the name of any fungal tissue injury podded Infection of keratinized tissues such as skin, hair and nails and cause inflammation is a group of fungi call dermatophytes. After word Tenja comes word show anywhere in the body to be an injury.
Identify the fungal infection from taking a sample of the place and the addition of KOH  skin cells we see fungus KOH preparation, or planting fungal action.

Tinea pedis: fungal foot injury: athlete's foot
It mostly starts in the young boy (broken antibiotic) from swimming or sports, or, for example, from military service, and inflammation between the fingers and is sometimes called the foreign tongue eczema swimming. Light symptoms are redness, scaling scaling of the skin, then influenced by skin maceration becomes white and a little swollen and a little wet and sometimes painfully choppy fissures.
If expansion inflammation is also subject to reach the soles of the feet and sometimes the back of the foot. Possible be the beginning of inflammation in the soles of the feet, recognizing place red scaly well-defined edges rounded shape and see the edges effectiveness vesicles or bubbles sometimes pus








fungus Epidermophyton floccosum

Definition : mycosis or dermatomycosis

Definition:
mycosis or dermatomycosis:An inflammatory condition caused by a fungus.Any injury type of inflammation in the skin due to infection by a fungus.
dermatophyte:A vegetable parasite, infesting the skin.Any parasite that causes the disease.
Any parasitic fungus disease-causing his name dermatophyte infection dermatomycosis
The fungi live in the top layer of the skin any stratum corneum epidermomycosis or onychomycosis or nail hair trichomycosis. In very few cases up to the deeper tissues.On the skin causing itching little or a lot.In some professions for humans to catch fungal more than others, such as working with livestock or hairdressers, nurses and workers in the laundry and cleaned.Factors that help to stabilize the fungi to humans are:Rapid growth of foreign Tabbakh of the skin, moisture and warmth, use a lot of soap, arent hormones such as diabetes, a change in the immune system.Research shows that the immune type IV resist returning rights to fungal infection. But if immunity evolved from the first type (sensitivity that we talked about earlier), the immunity of the type IV will not work.Divide injury to the skin into three types:By place of injury:(Tinea pedis, tinea capitis, tinea unguinum (onchomycosistinea cruris, tinea inguinalis, tinea corporis, tinea barbae, and other
Depending on the type and characteristics of fungi:trichophye from trichophton species -1: these تاقلموا well on live humans. They live and grow up most often on the scalp where there hair and beard area and between the toes and the soles of the feet and nails. In poetry are spores "spores - spore collection" any such seeds: Inside the hair matrix and hair so-called endotrix. They generally cause superficial inflammation so that the hair cut off or broken at the mouth of the hair follicle.
microspory from microsporum species -2:Living on the skin of the head where the hair on the trunk but rarely on skin and nails. They are spores on the hair from home and abroad and for this so-called ectotrix. The cause often deeper infections (folliculitis) and where broken hairs with the highest level of the scalp.
epidermophyte from epidermophyton floccosum - 3 and the latter becomes the armpit and the area between the leg and abdomen and does not affect hair.

Definition fungus disease and its causes Halajh

Definition fungus disease and its causes Halajh
 
dermatophyte: is a fungus that affects the skin in humans or animals. A Greek word meaning skin plants.
Fungal infection called:
mycosis and collected mycoses
Fungi live on human skin and hair and nails because they can take the food from the stratum corneum of these places. Vtcesp inflammation due to the reaction of the host _ human or animal _ the remnants of metabolic processes.

MOULD rot: is a type of fungus is a simple type of organisms which can not carry out photosynthesis can not be able to have its own food himself Vieih parasite on others to take them food. It is a type of fungi that grow hyphae and yarn colony shape lumbar velvety.
And there are a lot of species and are very important to dismantle the dead objects in nature. Some of which are useful to us, such as Penicillium, which it manufactures antibiotics, and some possible cause health problems such as asthma and allergic rhinitis and other
 .








Yeasts Yeast: is a type of fungus consists of a single cell which multiplies a budding Vtkon way colonies such as soft dough. Example: Candida species.
 
 

Bacterial vaginosis

Bacterial vaginosis :

Here are the symptoms of itching and unpleasant odor but the cause is the bacteria that normally live in the place. Means that sometimes these bacteria that are innocent and living in each ordinary people but have been active in some people and cause them to itch and secretions. That is, they: an increase in the growth of normal bacteria are not obsessed disease or something like that.
Secretions are homogeneous and light textures and sometimes like soap bubbles.
Acidic secretions to be more than 4.5 and a private scan paper.
Smells like fish called ammonia odor if added a drop of KOH.
Cells evidence exists clue cells which cells of the mucous membrane epithelial cells are covered with bacteria Gardnerella vaginalis.

Treatment: metronidazole 500 mg twice daily by mouth for seven days
Grameen or mouth once.


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