Medanta Mediclinic Defence Colony

While the social stigma pertaining to women's sexuality is being gradually (albeit heavily) dismantled, questions addressing the sexual concerns and problems of women are also more widely and openly discussed now. The debate of whether to completely forgo sexual activity during menstruation is one that continues to share explicitly divided opinions despite everything even till this day.

The idea of intercourse during 'the time of the month' is one that seldom receives an approving nod. Inhibitions relating to the 'mess' and the notion that menstrual blood, sanitary pads, and tampons can lower your arousal rates may underplay the many benefits of engaging in sexual activity during this time.

However, this remains challenged by the many upshots as enlisted below:

-  Helps ease cramps

The release of oxytocin and dopamine along with other endorphins alleviate the cramps and body-ache that one might encounter during periods. Sex promotes better blood flow and relieves stress and can help battle mood swings during periods.

- Shortens the length of periods

Many women who engage in sex during menstruation often claim that their periods last for a comparatively shorter span of time than if they hadn't had any intercourse. This is because every time you have an orgasm, the uterus contracts. The muscle spasms of orgasm allow expulsion of blood and uterine lining faster than it is usually subjected to happen.

-  No need for lubes

Your flow acts as an active and better lubrication during sex and this also enhances pleasure. This might act as a natural way to deal with dryness during sex and one may avoid store-bought lubrications during the time of the month.

- Chances are that you might actually like it

Changes in hormonal balances during the first few days of periods can make women more desirous of sexual activity and the partners may enjoy a greater level of pleasure. Sex during periods also ushers in a feeling of deeper intimacy between the partners. An intensified sense of libido that one may feel during this time is extremely beneficial to sexual activity. The pleasure is therefore greater and you might actually like it more than sex on normal days!

How to minimize the mess?

If your primary concern is the 'mess' that you're afraid to create, a menstrual cap or female condom may be the solution to your problem. They help reduce the blood flow during sexual intercourse. In fact, even a regular condom can make it less messy, at least for you partner. Sex in the shower also elevates cleanliness while retaining (often increasing) the excitement in your sexual act.  

 

Carpal tunnel syndrome is a condition that affects around 3%-5% of the population and generally affects women more than men. This syndrome affects the fingers therefore drastically impairing your ability to perform routine tasks.

Causes of Carpal Tunnel Syndrome
Anything that bothers or stresses the median nerve in the carpal tunnel area can lead to carpal tunnel. However, there are lot of other reasons which may contribute towards causing a condition like carpal tunnel syndrome. They are:

1. Obesity- Being overweight is considered to be one of the major causes of carpal tunnel since all that extra fat puts a lot of pressure on your bones, which puts pressure on the nerve.
2. Gender- Carpal tunnel is generally more common in women because the size of women’s carpal tunnels are smaller than men. 
3. Anatomical reasons- Arthritis or bone dislocation and fracture can lead to modification of the space in the carpal tunnel area. This puts intense pressure on the median nerve and also leads to deformation of the wrist bone.
4. Nerve conditions- Conditions such as multiple sclerosis and diabetes can lead to carpal tunnel syndrome because they mainly affect and damage the nerves, which means it also affects the median nerve where the carpal tunnel is located.
5. Medical conditions- Several medical conditions such as kidney damage or kidney failure, hypothyroid or hyperthyroid and menopause can also cause carpal tunnel syndrome.
6. Inflammation- Inflammation is one of the biggest reasons of carpal tunnel. Rheumatoid arthritis, which is directly caused by inflammation can damage the tendons in your wrist and put a lot of pressure on your median nerve leading to carpal tunnel
7. Body fluids imbalance- As it is commonly known, menopause and pregnancy can cause a lot of fluid retention in the body which tends to aggravate the median nerve in which the carpal tunnel is located.

Symptoms of Carpal Tunnel
Carpal tunnel syndrome doesn’t happen overnight, it is more of a gradual condition. The common symptoms of carpal tunnel are:

1. Loss of strength in arm- This condition can cause a lot of weakness in your arms which may lead to you dropping things. The median nerve in which the carpal tunnel is located regulates and controls the thumbs pinching muscles and when these muscles become weak, it causes you to momentarily lose your motor skills.
2. Numbness and prickling sensation- In carpal tunnel syndrome, except for the little finger all the other fingers are affected i.e. ring finger, middle finger, index finger and the thumb. Carpal tunnel patients generally experience an electric shock-like sensation in their fingers while holding things and this pain travels from the wrist to the hand. This sensation can even cause you to come awake at night.
3. Pain and burning that travels up your arm
4. Wrist pain at night that interferes with sleep

How can physiotherapy help with carpal tunnel syndrome?
Physiotherapy is a very good idea for dealing with a condition like carpal tunnel syndrome because it takes into account the whole problem and tries to solve it without involving getting into medications.
Once your physiotherapist has understood where the pain is and from where it is originating, he will treat you and guide you in such a way that will work towards lessening the strain on your median nerve. Some of the most useful ways of fighting carpal tunnel are:

1. Splints and braces- The use of splints and braces because it keeps your hands in a stable and straight position and prevents too much pressure on them. In case your physiotherapist feels that your work is aggravating your condition, he will ask you to stop putting excessive pressure on your body especially your hands.
2. TENS- TENS is a type of a machine which stands for Transcutaneous Electrical Muscle Stimulation. This machine helps in reducing the pain of carpal tunnel syndrome.
3. Ultrasound- Ultrasound therapy helps in countering the pain of carpal tunnel by applying an instrument on the affected area and releasing sound waves which are then absorbed by the tissues. This helps in the reduction of disability and pain.
4. Laser- Cold laser also known as low level laser therapy is a highly effective and painless form of treatment which helps in decreasing pain and inflammation and also helps in reinstituting healthy tissue. The laser treatment also rehabilitates the body’s normal functioning by repairing the affected tissues and cells and also increases blood circulation and all this in combination helps in getting rid of the pain.

Physiotherapy is a universally acknowledged and safe form of treatment when it comes to bone-related ailments. This type of treatment doesn’t just help you with your condition, but it also saves a lot of your money and time when compared to other modes of treatments. 

A small piece of bone is known as a fragment and it is very common that an avulsion fracture also tends to damage the protrusions of bone to which the tendons attach. This basically means that the tendon or ligament will come away from the bone and it will take a small piece of bone with it. It is sometimes very hard to find out what type of injury you have and this is why knowing the causes and symptoms of an avulsion fracture are very helpful in determining exactly how severe the injury is.

Here are the causes of an avulsion fracture.

Causes:

1. Explosive Landing: Athletes who tend to jump or land with great impact tend to get these most commonly. Therefore, it is crucial for your health that if you participate in such sports, you do follow the correct method of jumping.

2. Explosive Extension: Similar to how an athlete landing ferociously can get an avulsion fracture, someone who is extending the legs very violently and explosively during an exercise can also get an avulsion fracture. This is because the bone getting extended could very well damage the protrusions to which the tendons are attached.

Symptoms:

These are the two main causes of an avulsion fracture. There are not many symptoms of an avulsion fracture. This is because an avulsion fracture can only be determined by an MRI or by an X-ray scan. Therefore it is nearly impossible to diagnose that you have an avulsion fracture without looking at the results of the tests performed on the part of your body. However, the way you got the fracture and especially the details of it are very good indications of whether you have an avulsion fracture or not.

"You are what you eat". Consuming a well-balanced diet is key to a healthy life, but at times we simply ignore it. Keeping our kidneys healthy is vital for our overall health. Fortunately, a healthy diet can help keep the kidneys in good shape. Here’s how:

1. Choose or prepare food with less salt or sodium: Avoid overly processed foods and stick with natural foods. Don’t consume an excessive amount of salty foods. Keeping a check on the sodium intake will keep your blood pressure levels safe and not lead to any complications with the kidney
2. Eat the right amount of proteins: Consuming high amount of proteins can stress the kidneys. However, if you don’t get enough you can become weak. So, it is essential to calculate how much protein your body needs and limit your protein intake accordingly. Be aware of which foods contain high protein including meat, poultry, and seafood and incorporate them into your diet wisely.
3. Fluids: Drinking more water is not always good. The National Kidney Foundation (NKF) recommends drinking just enough fluids to keep your urine either light yellow or colorless. A standard recommendation is 13 cups daily for men and 9 for women. Also, cranberry juice has a positive association with kidney health for a long time, especially urinary tract infections and can be consumed.
4. Watch your Potassium and Phosphorous: A diet high in potassium and phosphorous can thwart the kidney function. A diet with the right amount of Potassium will help your nerves and muscles work the right way. Also, the right phosphorous levels will help protect your bones and blood vessels. It is better to stay away from packaged foods, junk foods and colas that contain high phosphorous and potassium.
5. Restrict the Fructose: As with sodium, your sugar levels are also to be watched. Since a high sugar diet can lead to diabetes and increase your risk for kidney disease, avoid high sugar foods. Sweetened beverages like sodas, fruit juices and energy drinks are not recommended.
6. Kidney-friendly Superfoods: Adding the following foods to your diet can help promote optimal kidney function:
   • Red bell peppers – Low potassium and rich in vitamins, folic acid and fiber
   • Cabbage – Rich in phytochemicals that protect against toxins and low in potassium
   • Ginger, Garlic and Onion – Anti-oxidants and anti-inflammatory agents
   • Kale – Rich in iron which is important for kidney health
   • Fruits – Apples, berries, cherries and red grapes are good to maintain kidney health
   • Watermelon – Has diuretic properties that help to flush out toxins

Keeping your kidney in good health is essential to lead a happy and disease-free life. So, start out by making small changes to your diet by following the above tips.

When blood clot blocks one or more arteries in your lungs the condition is known as pulmonary embolism. It can cause a decrease in the oxygen levels in your blood, damage to your lungs due to sudden restrictions in the flow of blood along with adverse effects on other parts of your body. Life threatening blockage can cause death if left untreated and you should immediately contact your health care provider to get proper diagnosis. Pulmonary embolism requires various lab tests and generally requires short time to resolve.

Symptoms: The symptoms of pulmonary embolism mainly depend upon many factors pertaining to your previous medical history. Pulmonary embolism varies with the size of your lungs, the size of the clots formed in your blood, and any other underlying history of the heart or lungs. That said, pulmonary embolism has symptoms which are not similar to any two persons and will vary accordingly.

The common symptoms however may include the following and you are advised to opt for a health checkup if these are persistent in your body:

1. Cough along with bloody sputum is a common symptom.
2. Shortness of breath, which will become worse as the days passes by. They will appear suddenly and cause huge discomfort in breathing.
3. Chest pain which may give you the feeling of a heart attack. The pain will intensify when you sit to eat or cough. Deep breath will cause problems too and will not go away easily with exertion.
4. Some other symptoms include fever, excess sweat, irregular heartbeat and dizziness.

Pulmonary embolism can be diagnosed by the following methods:

1. Electrocardiography (also known popularly as ECG) to measure your heart's electrical activity and functioning.
2. CT plumonary angiography is gold standard for diagnosing pulmonary embolism.
3. Chest x ray, which is a common and non invasive test to check your heart and lungs as well as the problems with any bones surrounding them.
4. ECHO can detect secondary changes in heart due to pulmonary embolism.

Treatment of pulmonary embolism can be done with medicines if it is detected at an early stage or also if the clot is small. However, if the size of your clot is problematic and blocks the blood flow to your lungs or heart then surgery may be necessary. Open surgery and clot removal surgery are common in the treatment of pulmonary embolism and will require good regular follow up check ups. Regular leg exercises will also reduce the chances of any underlying disease and you should hence consult your doctor.

What you eat has a direct effect on your skin; eat healthy and your skin looks healthy, eat unhealthy food and your skin looks dull. Eating right can even fight signs of aging thus, negating the need for procedures like Botox. Not only does it cost less, but healthy food boosts your overall health as well.

Here are 6 such foods that can help you fight signs of aging and give you a flawless complexion.

1. Turmeric: Turmeric is well known for its yellow colour and anti-inflammatory properties. Many home remedies suggest the use of turmeric for a number of health ailments including skin conditions. Turmeric can fight signs of aging by reducing inflammation and oxidation. This, in turn, helps the skin heal faster. This spice can be added to your food or mixed with warm milk to benefit from it.

2. Tomatoes: Tomatoes are rich sources of vitamin C and lycopene. Vitamin C helps stimulate the production of collagen and hence keeps the skin firm while lycopene protects the skin against harmful UV radiation. As a general rule of thumb, the deeper red the tomato is, the better it is.

3. Berries: Berries such as blueberries and raspberries are excellent sources of Vitamin E and antioxidants that fight against the effects of pollution and rids the body of free radicals and other toxins that cause premature aging. These berries also have anthocyanins that boost the effects of vitamin C

4. Honey: Honey can be eaten or applied topically on the skin to benefit from it. Honey helps keep the body hydrated by absorbing moisture and preventing the skin from drying out. It also has antibacterial properties that prevent acne and other breakouts. Ideally, honey should be used and consumed in its raw, unprocessed form.

5. Nuts: Nuts are a great snack that keeps your skin looking young and fresh. Almonds are excellent sources of vitamin E that help fight acne, psoriasis and eczema among other skin ailments. Walnuts are rich in Omega-3 fatty acids that keep the skin soft and supple. Brazil nuts are also rich sources of vitamin E. However, keep in mind the high calorific value of these nuts and do not overindulge in them.

Avocados: Avocados are filled with essential fatty acids that moisturize and nourish skin. They are also rich in Vitamin B, C and E. While vitamin C boosts collagen production, vitamin E maintains the elasticity of skin and prevents sagging.

Complications in the heart valve occur when the functioning of the heart valve is impaired. Valves of the heart allow the blood to flow in one direction and prevent the blood from flowing back into the ventricles of the heart.

Heart valve diseases can be classified as follows:

1. Valvular stenosis: This condition occurs when the valves of the heart does not open completely due to stiffness. As the opening is narrow, the heart has to work hard to pump blood. This condition may lead to heart failure.
2. Valvular insufficiency: This is a condition where the valve does not close tightly. This causes some of the blood to flow back to the valve. As this condition deteriorates, the heart has to work harder to pump blood. 

Types and Causes of valve diseases:

1. Acquired valve disease: The structure of the valve changes due to various infections or rheumatic fever. Rheumatic fever is caused by bacterial infectionthat had not been treated. It tends to occur in children and cause inflammation of the valve.
2. Congenital valve disease: This condition usually affects the pulmonary valve where the size of the valve is abnormal.
3. Bicuspid aortic valve disease: It is a type of valve disease that impairs the aortic valve. Instead of the regular three cusps, the bicuspid valve only has two. This may cause the valve to be stiff or cause it to leak.
4. Mitral valve prolapse: This condition causes the valve to flop back when the heart contracts. This condition also causes the leaflets of the valve to turn irregularly and cause it to stretch. This condition causes the valve to leak.

Symptoms: The symptoms of valve diseases are as follows:

1. Weakness: This condition may cause weakness and cause severe discomfort while performing daily activities.
2. Palpitations: Symptoms such as irregular heartbeats, skipped beats and rapid heart rhythm occurs in this condition.
3. Rapid weight gain: This condition can cause you to gain weight very rapidly.
4. It may cause swelling in your ankles, abdomen and feet.
5. This condition causes shortness of breath. 

The clothes we wear are often dictated by fashion and with our desire to conform with the latest cultural trends around the world. However, from a health perspective, the most important consideration of how you dress should be based primarily on local weather conditions. So it is perfectly ok to pull out your parkas, mittens, scarfs, stockings and jeans if you are located in a chilly and snowy location. In hot and humid India, it makes much more sense to wear light, breezy, thin clothes like dhotis, salwars, skirts, shorts or lungis. You can land up with painful and dangerous medical conditions with clothes unsuitable to your climate.

Here's how your clothing could be harming you: 

1. Increased heat rashes or miliaria. Your vest could be the culprit!: A very common skin condition seen in hot and humid weather conditions is called “miliaria” and is caused by blocked sweat ducts. Thick, tight clothes hamper normal evaporation of sweat into the atmosphere and cause this kind of irritable heat rash. Simple physics dictates that any extra or double layer of cloth, like a vest, would further hamper evaporation and aggravate these rashes. While vests may save your overlying shirt from getting damp, they are certainly bad news for your underlying skin which has to carry the unevaporated sweat on its surface. 
2. Increased chances of fungal and bacterial infections. Ditch the Denim!: The hot and humid environment within slim-fitting, thick clothes creates ideal conditions for fungi and bacteria to proliferate. Itchy, red rashes like ringworm appear in the groins, underarms and other parts of the skin. Painful boils and itchy, pus-filled folliculitis are common and often require surgery. This kind of dangerous environment is easily created within the skin-hugging denims you see so many people wearing all around you. 
3. Bacterial and fungal resistance to antimicrobials: Your dermatologist will treat your infections with appropriate antibiotics or antifungals. Unfortunately, in this era of global warming, many patients fail to respond and are tortured by recurrent, severe infections in spite of adequate dosing of medicines. One major reason is clothing and fashion which does not match the environment, creating ideal conditions for resistant, harmful bugs to multiply. You should choose lighter, airier, non-synthetic clothes that let your skin ‘breathe’ and does not allow sweat, dirt and deadly bugs to stick to your skin. 
4. Increased chances of urinary and genital infections: Tight, synthetic undergarments are thought to increase chances of genital and urinary infections. Tight and ill-fitting underwear can also cause discomfort, soreness and chafing by repeated friction. 
5. Body Odor: Body odor can be embarrassing and is aggravated by full-sleeved shirts, long undergarments, tight leggings, stockings and skinny jeans. 
6. Allergic dermatitis: Many individuals develop allergic rashes with certain common items like jewellery, footwear, earrings, cloth dyes, wristwatches and metallic buttons. A combination of heat, sweat and dissolved allergens precipitates these rashes in predisposed individuals. 
7. Environmental damage! Use minimum clothes: You definitely need to cover your skin, but are you cluttering your wardrobe with clothes that you keep on purchasing and hardly ever use? The apparel industry exploits huge amounts of natural resources like water, plant products, petroleum products, chemicals and electricity. You yourself require quite a bit of water, laundry detergents, and electricity just to maintain your clothes. Is it worth the environmental cost to purchase and maintain clothes that you will hardly ever use?

Colon polyps are growths that are typically found in the large intestine. Although the causes behind the occurrence of colon polyps are not known, this condition is usually seen to affect adults.

These colon polyps might turn into colon cancer over a period of time; the development of cancer can happen over a number of years.

Colon polyps are usually symptomless; hence it becomes difficult to diagnose the condition. They are commonly found as additional results of screening tests for colon cancers. Screening tests are conducted when there is a suspicion of a disease but it displays no significant symptoms. The symptoms can only be visible if the polyps are enlarged.

Typical symptoms include:

1. Rectal bleeding.

2. Changes in bowel conditions such as diarrhoea and constipation.

3. Change in appearance of stool.

As the presence of most polyps becomes evident only during colon cancer tests, it is recommended that regular tests for colon cancer be conducted for adults over the age of 50.

Some of these tests include:

1. Colonoscopy: This is highly recommended for detecting colon polyps. A small tube used for viewing is inserted into the colon by the doctor.

2. Flexible Sigmoidoscopy: This test is similar to colonoscopy but only a part of colon i.e sigmoid colon is screened.

3. Computed Tomographic Colonography (CTC): Also known as virtual colonoscopy, various computer systems and X-rays are used to create a detailed picture of the colon so that the doctor can search for polyps.

The size of the colon polyps helps to identify if the polyp is cancerous or not. Chances of the polyp being cancerous are high if the size of the polyp is higher than 1 cm or 0.4 inches. Hyperplastic polyps (smaller polyps) do not become cancerous and hence, do not need to undergo a colonoscopy. Another form of polyp is the sessile polyp which is usually a flat growth without a stalk and grows on the inner wall of the colon. Similar to other polyps, these polyps can be found and removed using a colonoscopy or a sigmoidoscopy.

Hives, also known as urticaria, is a kind of skin rash with red, raised, itchy bumps. They may also burn or sting. Often the patches of rash move around. Typically they last a few days and do not leave any long-lasting skin changes. Fewer than 5% of cases last for more than six weeks. the condition frequently recurs.

Hives frequently occur following an infection or as a result of an allergic reaction such as to medication, insect bites, or food. Psychological stress, cold temperature, or vibration may also be a trigger. In half of cases the cause remains unknown. risk factors include having conditions such as hay fever or asthma.diagnosis is typically based on the appearance. Patch testing may be useful to determine the allergy

Prevention is by avoiding whatever it is that causes the condition. treatment is typically with antihistamines such as diphenhydramine and ranitidine. in severe cases, corticosteroids or leukotriene inhibitors may also be used. keeping the environmental temperature cool is also useful. for cases that last more than six weeks immunosuppressants such as ciclosporin may be used.

About 20% of people are affected. cases of short duration occur equally in males and females while cases of long duration are more common in females. cases of short duration are more common among children while cases of long duration are more common among those who are middle aged. hives have been described at least since the time of hippocrates. the term urticaria is from the latin urtica meaning" nettle. 

Sign n symptoms

Welts (raised areas surrounded by a red base) from hives can appear anywhere on the surface of the skin. Whether the trigger is allergic or not, a complex release of inflammatory mediators, including histamine from cutaneous mast cells, results in fluid leakage from superficial blood vessels. Welts may be pinpoint in size, or several inches in diameter.

Angioedema is a related condition (also from allergic and nonallergic causes), though fluid leakage is from much deeper blood vessels in the subcutaneous or submucosal layers. Individual hives that are painful, last more than 24 hours, or leave a bruise as they heal are more likely to be a more serious condition called urticarial vasculitis. Hives caused by stroking the skin (often linear in appearance) are due to a benign condition called dermatographic urticaria.

Cause-

Hives can also be classified by the purported causative agent. Many different substances in the environment may cause hives, including medications, food and physical agents. In perhaps more than 50% of people with chronic hives of unknown cause, it is due to an autoimmune reaction.

Medications- Drugs that have caused allergic reactions evidenced as hives include codeine, sulphate of morphia, dextroamphetamine, aspirin, ibuprofen, penicillin, clotrimazole, trichazole, sulfonamides, anticonvulsants, cefaclor, piracetam, vaccines, and antidiabetic drugs. The antidiabetic sulphonylurea glimepiride, in particular, has been documented to induce allergic reactions manifesting as hives. Drug-induced hives has been known to have an effect on severe cardiorespiratory failure.[medical citation needed]

Food- The most common food allergies in adults are shellfish and nuts. The most common food allergies in children are shellfish, nuts, eggs, wheat, and soy. One study showed balsam of peru, which is in many processed foods, to be the most common cause of immediate contact urticaria. A less common cause is exposure to certain bacteria, such as streptococcus species or possibly helicobacter pylori. Infection or environmental agent 

Hives including chronic spontaneous hives can be a complication and symptom of a parasitic infection, such as blastocystosis and strongyloidiasis among others.The rash that develops from poison ivy, poison oak, and poison sumac contact is commonly mistaken for urticaria. This rash is caused by contact with urushiol and results in a form of contact dermatitis called urushiol-induced contact dermatitis. Urushiol is spread by contact, but can be washed off with a strong grease- or oil-dissolving detergent and cool water and rubbing ointments.

Dermatographic urticaria 

Dermatographic urticaria (also known as dermatographism or" skin writing") is marked by the appearance of weals or welts on the skin as a result of scratching or firm stroking of the skin. Seen in 4–5% of the population, it is one of the most common types of urticaria, in which the skin becomes raised and inflamed when stroked, scratched, rubbed, and sometimes even slapped.

The skin reaction usually becomes evident soon after the scratching, and disappears within 30 minutes. Dermatographism is the most common form of a subset of chronic hives, acknowledged as" physical hives.

It stands in contrast to the linear reddening that does not itch seen in healthy people who are scratched. In most cases, the cause is unknown, although it may be preceded by a viral infection, antibiotic therapy, or emotional upset. Dermographism is diagnosed by taking a tongue blade and drawing it over the skin of the arm or back. The hives should develop within a few minutes. Unless the skin is highly sensitive and reacts continually, treatment is not needed. Taking antihistamines can reduce the response in cases that are annoying to the patient.

Pressure or delayed pressure 

This type of hives can occur right away, precisely after a pressure stimulus or as a deferred response to sustained pressure being enforced to the skin. In the deferred form, the hives only appear after about six hours from the initial application of pressure to the skin. Under normal circumstances, these hives are not the same as those witnessed with most urticariae. Instead, the protrusion in the affected areas is typically more spread out. The hives may last from eight hours to three days. The source of the pressure on the skin can happen from tight fitted clothing, belts, clothing with tough straps, walking, leaning against an object, standing, sitting on a hard surface, etc. The areas of the body most commonly affected are the hands, feet, trunk, abdomen, buttocks, legs and face. Although this appears to be very similar to dermatographism, the cardinal difference is that the swelled skin areas do not become visible quickly and tend to last much longer. This form of the skin disease is, however, rare.

Cholinergic or stress 

Main article: cholinergic urticaria
Cholinergic urticaria (cu) is one of the physical urticaria which is provoked during sweating events such as exercise, bathing, staying in a heated environment, or emotional stress. The hives produced are typically smaller than classic hives and are generally shorter-lasting.[13][14]

Multiple subtypes have been elucidated, each of which require distinct treatment.[15][16]

Cold-induced 

Further information: chronic cold urticaria
The cold type of urticaria is caused by exposure of the skin to extreme cold, damp and windy conditions; it occurs in two forms. The rare form is hereditary and becomes evident as hives all over the body 9 to 18 hours after cold exposure. The common form of cold urticaria demonstrates itself with the rapid onset of hives on the face, neck, or hands after exposure to cold. Cold urticaria is common and lasts for an average of five to six years. The population most affected is young adults, between 18 and 25 years old. Many people with the condition also suffer from dermographism and cholinergic hives.

Severe reactions can be seen with exposure to cold water; swimming in cold water is the most common cause of a severe reaction. This can cause a massive discharge of histamine, resulting in low blood pressure, fainting, shock and even loss of life. Cold urticaria is diagnosed by dabbing an ice cube against the skin of the forearm for 1 to 5 minutes. A distinct hive should develop if a patient suffers cold urticaria. This is different from the normal redness that can be seen in people without cold urticaria. Patients with cold urticaria need to learn to protect themselves from a hasty drop in body temperature. Regular antihistamines are not generally efficacious. One particular antihistamine, cyproheptadine (periactin), has been found to be useful. The tricyclic antidepressant doxepin has also been found to be an effective blocking agent of histamine discharge. Finally, a medication named ketotifen, which keeps mast cells from discharging histamine, has also been employed with widespread success.Solar urticaria 

Solar urticaria-
This form of the disease occurs on areas of the skin exposed to the sun; the condition becomes evident within minutes of exposure.

Water-induced 

Water urticaria- 
This type of urticaria is also termed rare, and occurs upon contact with water. The response is not temperature-dependent and the skin appears similar to cholinergic form of the disease. The appearance of hives is within one to 15 minutes of contact with the water, and can last from 10 minutes to two hours. This kind of hives do not seem to be stimulated by histamine discharge like the other physical hives. Most researchers believe this condition is actually skin sensitivity to additives in the water, such as chlorine. Water urticaria is diagnosed by dabbing tap water and distilled water to the skin and observing the gradual response. Aquagenic urticaria is treated with capsaicin (zostrix) administered to the chafed skin. This is the same treatment used for shingles. Antihistamines are of questionable benefit in this instance, since histamine is not the causative factor.

Chizzola maculae is a very specific skin lesion due to fluoride exposure. The size of a coin, these lesions may resemble small blue bruises or be wholly pink. Doctors george waldbott and v. A. Cecilioni named the lesions after a town in italy, where they were common in young women and children. According to waldbott, chizzola maculae are early symptoms of fluoride intoxication.

Exercise 

The condition was first distinguished in 1980. People with exercise urticaria (eu) experience hives, itchiness, shortness of breath and low blood pressure five to 30 minutes after beginning exercise. These symptoms can progress to shock and even sudden death. Jogging is the most common exercise to cause eu, but it is not induced by a hot shower, fever, or with fretfulness. This differentiates eu from cholinergic urticaria.

Eu sometimes occurs only when someone exercises within 30 minutes of eating particular foods, such as wheat or shellfish. For these individuals, exercising alone or eating the injuring food without exercising produces no symptoms. Eu can be diagnosed by having the patient exercise and then observing the symptoms. This method must be used with caution and only with the appropriate resuscitative measures at hand. Eu can be differentiated from cholinergic urticaria by the hot water immersion test. In this test, the patient is immersed in water at 43 °c (109.4 °f). Someone with eu will not develop hives, while a person with cholinergic urticaria will develop the characteristic small hives, especially on the neck and chest.

The immediate symptoms of this type are treated with antihistamines, epinephrine and airway support. Taking antihistamines prior to exercise may be effective. Ketotifen is acknowledged to stabilise mast cells and prevent histamine release, and has been effective in treating this hives disorder. Avoiding exercise or foods that cause the mentioned symptoms is very important. In particular circumstances, tolerance can be brought on by regular exercise, but this must be under medical supervision

 Diagnosis-

The cause of chronic hives can rarely be determined. In some cases regular extensive allergy testing over a long period of time is requested in hopes of getting new insight. No evidence shows regular allergy testing results in identification of a problem or relief for people with chronic hives.[29][30] regular allergy testing for people with chronic hives is not recommended.

Acute versus chronic 

Acute urticaria is defined as the presence of evanescent wheals which completely resolve within six weeks. Acute urticaria becomes evident a few minutes after the person has been exposed to an allergen. The outbreak may last several weeks, but usually the hives are gone in six weeks. Typically, the hives are a reaction to food, but in about half the cases, the trigger is unknown. Common foods may be the cause, as well as bee or wasp stings, or skin contact with certain fragrances. Acute viral infection is another common cause of acute urticaria (viral exanthem). Less common causes of hives include friction, pressure, temperature extremes, exercise, and sunlight.
Chronic urticaria (ordinary urticaria) is defined as the presence of evanescent wheals which persist for greater than six weeks. Some of the more severe chronic cases have lasted more than 20 years. A survey indicated chronic urticaria lasted a year or more in more than 50% of sufferers and 20 years or more in 20% of them.
Acute and chronic hives are visually indistinguishable.

Homeopathic remedies- 

• Apis mell: The hives consist of isolated patches that are painful, tender, itch at night, feel like bee stings, become purple. There is burning pain, slight fever, and warmth of the surrounding skin. It is worsened by changing weather and exercise, causing severe itching and burning. The patient may already have asthma.
• Arsenic album: The urticaria is caused by eating shellfish and causes burning and restlessness. The condition gets worse being at the seaside and by getting into sea water. Arsenic is also useful to treat urticarial symptoms during the recession of the lesions. The person also could be down emotionally with depression, despair, indifference and irritability. If the lesions are more severe, the restlessness is also severe. It is worse after midnight, from 1 to 2 a. M.
• Rhus toxicodendron: Prepared from the leaves and bark of the plant poison ivy, rhus works on multiple body systems including skin, joints, eyes, extremities, and overall vitality. In addition to urticaria, it is also used in cellulitis, arthritis, fevers, etc. It is effective if the urticaria has a burning sensation, inflamed reddened rash that is worsened by cold and improved by warmth.
• Urtica urens: Made from a plant called stinging nettle, which itself has a tendency to produce urticaria, it is used when there is urticaria from bee stings or after eating shellfish. The lesions are red with severe burning and itching, recurring every year, could be associated with weather changes.
• Natrum muriaticum: The common salt sodium chloride is potentized, and its inner healing power activated. It is used for chronic urticaria, where the lesions develop after severe irritation
• Dulcamara: The lesions develop followed a general prickly sensation setting in and at night when it is cold and damp. The hives are irregular white patches surrounded by a red area that itch badly. The hives are associated with violent cough, swelling of the lymph nodes, fever, restlessness, sleeplessness, decreased appetite, nausea, vomiting, bitter taste, and intense aching in pit of stomach.