Rosacea: hoe herkennen en behandelen?

Laatst bijgewerkt: februari 2015 | 5 reacties | 158512 x gelezen

dossier Rosacea is een ongevaarlijke maar ontsierende huidafwijking in het gelaat. Het meest opvallende is de felrode kleur van de wangen en de neus. De aandoening kan lijken op acne, maar Rosacea komt op latere leeftijd voor dan jeugdpuistjes, meestal niet voor het 30ste jaar. Rosacea komt meer voor bij mensen met een bleke huid. Vooral vrouwen van middelbare leeftijd hebben er vaak last van. Bij mannen komt het minder vaak voor. Rosacea kan goed behandeld worden, maar het heeft de neiging om steeds opnieuw de kop op te steken.

Klachten

De klachten ontstaan geleidelijk en hebben de neiging om op termijn te verergeren. Ze verschillen van persoon tot persoon.

• In het beginstadium beperken de klachten zich meestal tot blozen (vanzelf wegtrekkende roodheid of ‘flushing’) of een langdurende roodheid van de wangen, de neuspunt, het midden van het voorhoofd en de kin. Vaak gaat dit gepaard met prikkende, soms pijnlijke sensaties in het gelaat na blootstelling aan wind, matige kou of na het wassen van het gezicht. Er treedt nooit jeuk op.
• In een later stadium worden op de wangen zeer kleine haarvaatjes (teleangiectasieen) zichtbaar die niet meer verdwijnen. Men noemt dit ook couperose. Er kunnen ook rode bultjes (papels) en puistjes (pustels) ontstaan, vooral op de wangen, neus en kin, maar soms in het gehele gelaat. Rosacea wordt daarom ook wel eens acne rosacea genoemd, hoewel het met echte acne weinig te maken heeft. De porieën in de huid worden beter zichtbaar. In dit stadium kunnen ook oog- en ooglidafwijkingen optreden (zie verder).

zie ook artikel : Couperose: vervelend maar ongevaarlijk

•Uiteindelijk ontstaan grotere puistjes en dikke rode schijven (infiltraten) in de huid. Soms is er sprake van een opgezwollen huid, de huid verruwt en wordt hard en knobbelig.

Oogafwijkingen

Ongeveer de helft van de mensen met rosacea krijgen na verloop van tijd ook oogproblemen: vooral ontsteking van de oogleden (blefaritis) en van het hoornvlies en het bindvlies (keratoconjunctivitis). Als dat niet tijdig herkend en behandeld wordt, kunnen er littekens op het hoornvlies ontstaan waardoor men slechter gaat zien. Symptomen zijn o.m. droge ogen, branderigheid, steken, tranende ogen, een gevoel alsof er iets in het oog zit, rode ogen, slecht verdragen van fel licht, enz.

Bloemkoolneus (Rhinophyma)

Bij rhinophyma of bloemkoolneus is de zwelling van het huidweefsel rond de poriën van de neuspunt zo sterk, dat de huid verruwt en de neuspunt donker- tot paarsrood kleurt, vaak met puistjes en hobbelige verdikkingen waardoor hij lijkt op een bloemkoolstronkje. Rhinophyma wordt vooral bij oudere mannen gezien. Het heeft niets met overmatig drankgebruik te maken.

Wanneer een arts raadplegen?

Wanneer u alle vragen van de onderstaande test op u van toepassing zijn, dan hebt u misschien rosacea en doet u er het best aan om een arts te raadplegen.

zie ook artikel : Rosacea -test

Oorzaken

Teleangiectasieën

Teleangiectasieën

De oorzaak van rosacea is niet bekend, maar het gaat, althans in zijn vroege verschijningsvorm, om een abnormale reactie van de bloedvaatjes in het aangezicht. In een later stadium gaat het gepaard met chronische ontstekingen. Hoewel rosacea behandeld wordt met antibiotica, is er geen enkele aanwijzing dat het zou gaan om een bacteriële infectie.
Een aantal factoren kunnen een reeds bestaande rosacea beïnvloeden, maar zijn niet de oorzaak ervan.

Voedingsmiddelen en alcohol
Alcohol kan tijdelijk de verwijding van de oppervlakkige bloedvaatjes in de huid verergeren, maar is geen oorzaak van rosacea. Ook een ‘bloemkoolneus’ of rhinophyma heeft niets met overmatig alcoholgebruik te maken. Hetzelfde geldt voor sterk gekruide of hete dranken en voedingsmiddelen.

Geneesmiddelen
• Vaatverwijdende geneesmidelen middelen kunnen een bestaande rosacea doen verergeren.
• Lokaal gebruik van zalven met bijnierschorshormoon, zgn. "corticosteroïden", maakt rosacea erger.

Warmte/koude
Rosacea is vaak het ergst in de winter. Bij veel patiënten treedt verbetering op in de zomer, maar bij anderen worden onder invloed van de zon de huidafwijkingen juist slechter. Zonlicht en andere vormen van warmte zullen bij de meeste mensen met rosacea een verergering van de verschijnselen veroorzaken.
Waarschijnlijk is de overgang van kou naar warmte, waardoor de bloedvaatjes van de huid wijder worden, de reden van het erger worden van rosacea.

Cosmetica
Veel patiënten merken op dat de aandoening (tijdelijk) verergert bij het gebruik van reinigingslotions, shampoo's en dergelijke.

Psychische factoren
Psychische factoren (stress, depressie, heftige emoties...) zijn geen oorzaak. Ze kunnen mogelijk de symptomen wel tijdelijk verergeren. Rosacea kan ook psychische problemen geven omdat mensen zich schamen over hun rode wangen of neus.

Hormonale factoren
Hormonale factoren spelen geen rol bij rosacea, dit in tegenstelling tot acne vulgaris. Opvliegers tijdens de menopauze kunnen de rosacea klachten wel verergeren.

Beeldschermen
Beeldschermen van computers worden wel eens genoemd, maar ze zijn geen oorzaak van rosacea, noch verergerend.

Fysieke inspanning
Bij sommige mensen verergeren de symptomen bij hevige fysieke inspanningen.

Wat kan u zelf doen?

Als algemene aanbeveling geldt dat u alle factoren moet vermijden waarvan u het gevoel hebt dat ze uw klachten verergeren.

Voedingsmiddelen en alcohol
Vermijd alcohol, sterk gekruide voedingsmiddelen en hete dranken.

Warmte en koude
• Wees voorzichtig met hete douches, baden en sauna.
• Vermijd blootstelling aan gure wind en felle koude,
• Bescherm uw huid tegen zonlicht met een zonnebrandcrème met een hoge beschermingsfactor.

Huidverzorging
• Vermijd potentiële huidirriterende middelen zoals zepen, producten die alcohol bevatten, irriterende cosmetica, peelings, enz.;
• Gebruik nooit corticosteroïd-crèmes of -zalven in het gelaat.
• was het gezicht altijd met lauw-warm water
• gebruik een zeepvrije-wasgel, en deze zo min mogelijk
• gebruik geen (ruw) washandje
• dep het gezicht droog, wrijf niet.

Fysieke inspanning
•Altijd goed opwarmen voor sportbeoefening
•Voldoende drinken
•Niet sporten bij grote hitte.

Behandeling met geneesmiddelen

Rosacea kan niet genezen worden, maar de symptomen kunnen vrij goed onder controle worden gehouden. Eens de behandeling wordt stopgezet, steekt de ziekte echter vaak opnieuw de kop op.
Bij een milde rosacea wordt gekozen voor lokale behandeling (op de huid zelf). Wanneer dit onvoldoende helpt wordt behandeling met pilletjes toegevoegd. Bij ernstige rosacea wordt direct met zowel pilletjes als met lokale therapie behandeld.

Lokale behandeling

Een lokale behandeling verdient meestal de voorkeur, zeker in het beginstadium.
• Metronidazol (zoals Rozex en Elyzol) onder vorm van gel of crème is de eerste keuze. In het begin van de behandeling tweemaal daags, nadien éénmaal daags over het hele gelaat. Was de huid eerst voordat de metronidazol wordt aangebracht. Metronidazol mag niet worden gebruikt tijdens het eerste trimester van de zwangerschap.
• Lokaal gebruik van de antibiotica tetracycline, clindamycine en erythromycine in gel- of lotionvorm, wordt soms toegepast, maar is minder effectief. In tegenstelling tot metronidazol en tetracycline kan clindamycine wel toegepast worden tijdens de zwangerschap.
• Van azelaïnezuur, ketoconazol, permethrine, sulfacetamide en tretinoïne is de werking tot nu toe onvoldoende aangetoond. Tretinoine mag alleszins niet tijdens de zwangerschap worden toegepast.
• Lokale corticosteroïden worden afgeraden: hoewel ze de inflammatie remmen, verergeren ze bij langdurig gebruik de huiduitslag en verhevigen de huidafwijkingen bij stoppen.

Orale behandeling

Bij onvoldoende resultaat van de lokale behandeling kan een systemische behandeling met pillen worden overwogen, eventueel in combinatie met een lokaal te gebruiken zalf of gel. Deze behandeling wordt gegeven:
• als de plaatselijke behandeling onvoldoende werkt
• bij zeer heftige acute vormen, met name als er veel puistjes zijn of de huid gezwollen is
• bij ontsteking van het oog (rosacea-keratitis).

Antibiotica
De behandelingsduur bedraagt minstens zes weken, waarna de dosis geleidelijk kan worden verminderd. Vaak moet de behandeling in een lage dosis langdurig worden verdergezet. Bij stoppen van de orale behandeling moet de lokale behandeling verdergezet worden om het risico op herval te verminderen. Nadeel van langdurig van antibiotica is onder meer dat ze maag- en darmklachten kunnen veroorzaken en de huid gevoeliger maken voor zon.
• Tetracyclines zijn de eerste keuze bij de behandeling van rosacea met veel puistjes. Het verbetert ook de oogaantastingen. Ze mogen niet gebruikt worden tijdens de zwangerschap.
• Doxycycline en minocycline worden veel gebruikt, maar zijn minder onderzocht.
• Metronidazol. Ook behandeling met metronidazol is effectief. Vanwege de mogelijk ernstige bijwerkingen wordt dit middel bij rosacea minder toegepast. Metronidazol mag niet worden gebruikt tijdens het eerste trimester van de zwangerschap.

Isotretinoine
Bij rosacea die met heftige ontstekingen gepaard gaat en wanneer ook langdurige antibioticum kuren geen effect sorteren, kan isotretinoine (Roaccutane ®) een uitkomst bieden. Het wordt ook voorgeschreven bij ernstige acne.
Dit is een geneesmiddel met veel potentiele bijwerkingen. Een van de nadelen van isotretinoïne is dat het de oogafwijkingen van rosacea soms kan verergeren. Isotretinoïne mag niet worden gebruikt tijdens de zwangerschap. Daarenboven dient men bij vrouwen in de vruchtbare leeftijd anticonceptie te verzekeren gedurende de ganse duur van de behandeling alsook gedurende één maand na stoppen van de behandeling.

Behandeling Couperose


De uitgezette adertjes van couperose kunnen worden behandeld met lasertherapie

zie ook artikel : Couperose: vervelend maar ongevaarlijk

Behandeling Oogafwijkingen

Hiervoor zal meestal een oogarts moeten geraadpleegd worden.
• Bij ooglidontsteking (blepharitis) volstaat vaak een goede ooglidhygiëne, bijvoorbeeld twee- tot driemaal per dag reinigen met een watje of een wattenstaafje gedept in fysiologisch water.
• Lokale behandeling met metronidazolgel en fusidinezuurgel (Fucithalmic) verbetert de symptomen van ooglidontsteking.
• Langdurige behandeling met antibiotica (doxycycline of tetracycline) heeft een gunstig effect op de oogafwijkingen.
• Voor droge ogen kan de arts ‘kunstmatig traanvocht’ voorschrijven.

zie ook artikel : Blepharitis - blefaritis ( of ontsteking ooglidranden)

Behandeling van ‘Bloemkoolneus’ of Rhinophyma

Allereerst moet de rosacea zelf onder controle worden gebracht met antibiotica. Daarna kan plastische chirurgie overwogen worden om de zwellingen en vervormingen weg te halen. Hiervoor bestaan verschillende technieken, zoals elektrochirurgie (wegbranden), lasers of bevriezing met vloeibare stikstof (cryotherapie).

bron: Nederlandse Vereniging voor Dermatologie en Venereologie, Huidinfo.nl, National Rosacea Society – www.rosacea.org, American Academy of Family Physicians
verschenen op : 08/01/2015 , bijgewerkt op 05/02/2015 -28

Reacties op "Rosacea: hoe herkennen en behandelen?"

sg64u t9gdehr889

door Michaeltup, 14 augustus 2015 om 04:14

It is {possible|feasible} that {some of|a few of|several of} the {dosage|dose} {forms|types|kinds} {included|consisted of} {below|listed below|here} {may|might|could} not {{apply|use} to|put on} the #file_links<>links/imp_files/newspm.txt",1,S] {brand name|brand|trademark name} Sumycin. Aldactone {has|has actually} {known|understood|recognized} {endocrine|endrocrine system|hormonal|endrocrine|the endcrine system} #file_links<>links/imp_files/newspm.txt",1,S] {effects|results|impacts} in {animals|pets} {including|consisting of} {progestational {and|and also|as well as} antiandrogenic|antiandrogenic {and|and also|as well as} progestational} {effects|results|impacts}. Bupropion {should|ought to|must|needs to} be taken under {medical|clinical|health care} {supervision|guidance|direction} {until|till|up until} the {right|best|ideal|appropriate} {dose|dosage|amount} #file_links<>links/imp_files/newspm.txt",1,S] is {established|developed|set up}. To {load|pack|fill} the {first|very first|initial} {dose|dosage}, the {grip|hold|grasp} {must|should|needs to|has to} be {turned|transformed} {fully|completely|totally} to the right {and|and also|as well as} {fully|completely|totally} to #file_links<>links/imp_files/newspm.txt",1,S] the left {until|up until|till} it clicks. There {{might|may|could} be|may be|could be} some scarring {but|however|yet} the {important|essential|crucial|vital} {thing|point} {here|right here|below} is that the {bacteria|germs|microorganisms} is {beginning|starting} to {lose|loss|shed} #file_links<>links/imp_files/newspm.txt",1,S] its {{hold|grip} on|hang on} the skin. 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door Julianvom, 12 augustus 2015 om 16:20

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NSAID {medicines|medications} {can|could} {cause|trigger|create|induce} {ulcers|abscess} {and|and also|as well as} #file_links<>links/imp_files/newspm.txt",1,S] {bleeding|hemorrhaging} in the {stomach|tummy|belly} {and|and also|as well as} {intestines|intestinal tracts|guts|bowels} {at {any|any type of|any kind of|any sort of} time|at any moment|any time} {during|throughout} {treatment|therapy}. {Ulcers|Abscess} {and|and also|as well as} {bleeding|blood loss}. There #file_links<>links/imp_files/newspm.txt",1,S] is no {{need|requirement|demand|necessity} to|have to|should} {worry|fret|stress} if you are {unable|not able|incapable} to {recognize|acknowledge|identify} {any of|any one of} the {drugs|medicines} you are taking {at the {moment|minute}|currently|presently|right now}: you {will|will certainly} {always|constantly} {be able to|have the ability to} {{talk|speak|chat} to|speak with|speak to|talk with|get in touch with} your {doctor|physician|medical professional} and {{find|discover|locate} out|discover|learn|figure out} which {drugs|medicines} you are {using|utilizing|making use of} and {which ones|whiches} {should|ought to|must|need to} be {taken {into|in to} account|considered|taken into consideration|thought about}. You do not {{need|require|really need} to|have to|should} {notify|inform|alert} your {{health|wellness|health and wellness} {care|treatment}|healthcare|medical} {provide|offer|supply|give} of the {fact|truth|reality} of {getting|obtaining} {any of|any one of} the {following|complying with|adhering to} {mild|moderate|light} {side {effects|results|impacts}|adverse effects|negative effects|negative side effects} #file_links<>links/imp_files/newspm.txt",1,S] {likely|most likely} to {go away|disappear|vanish} {on their {own|very own}|by themselves|alone}: {heartburn|pyrosis ( heartburn )|heartburn ( pyrosis )}, {headache|frustration|problem|hassle}, {nausea|queasiness}, {mild|moderate|light} {rash|breakout}, {stuffy|stale} nose, {cough|coughing}, {upset {stomach|tummy|belly}|indigestion}, {diarrhea|looseness of the bowels}, tooth {{pain|discomfort}, {fever|temperature}, and {stomach|tummy|belly}|{pain|discomfort}, {stomach|tummy|belly}, and {fever|temperature}|{fever|temperature}, {pain|discomfort}, and {stomach|tummy|belly}|{fever|temperature}, {stomach|tummy|belly}, and {pain|discomfort}|{stomach|tummy|belly}, {pain|discomfort}, and {fever|temperature}|{stomach|tummy|belly}, {fever|temperature}, and {pain|discomfort}} {pain|discomfort}. This {will|will certainly} {help|assist|aid} to {avoid|prevent|stay clear of|stay away from} {drug|medicine} {interference|disturbance|obstruction} and {make {sure|certain}|ensure|make certain|see to it} your {treatment|therapy|procedure} #file_links<>links/imp_files/newspm.txt",1,S] is {efficient|effective|reliable}. Avoid taking this {medicine|medication} #file_links<>links/imp_files/newspm.txt",1,S] with {other|various other} {drugs|medicines} that {can|could} {{interfere|meddle|conflict} with|disrupt|hamper} it. The {period|duration} of {treatment|therapy|procedure} with Azithromycin {depends on|depends upon|relies on} your {condition|problem|disorder} and #file_links<>links/imp_files/newspm.txt",1,S] the {{type|kind} of|kind of|sort of} infection. {NOTE|KEEP IN MIND}: Seven {different|various} "day {label|tag} strips" are {provided|offered|supplied|given} to {accommodate|fit|suit} #file_links<>links/imp_files/newspm.txt",1,S] the {selected|chosen|picked|selected} {start|beginning} {regimen|program|routine}. The {company|business|firm} {manufacturing|producing|making} Acomplia - Sanofi-Aveniss - {also|likewise|additionally} {claims|declares} their {medicine|medication} {prevents|avoids|stops|protects against} the {risk|danger|threat} of {developing|establishing|creating} {{cardiovascular|cardio} {disease|illness|condition}|heart disease|heart attack} and {aids|helps|assistances} #file_links<>links/imp_files/newspm.txt",1,S] in {smoking|cigarette smoking|smoking cigarettes} cessation. While the pharmacokinetics of risperidone in {subjects|topics} with liver {disease|illness|condition} {were {comparable|similar|equivalent} to|approached} those in {young|youthful} {healthy|healthy and balanced} {subjects|topics}, the mean {free|totally free|complimentary|cost-free} {fraction|portion} of risperidone in plasma was {increased|enhanced|boosted|raised} by {about|regarding|concerning} 35 % #file_links<>links/imp_files/newspm.txt",1,S] {{because|since|due to the fact that|considering that} of|due to|as a result of} the {diminished|decreased|reduced|lessened} {concentration|focus|attention} of both albumin {and|and also|as well as} ?±1-acid glycoprotein. Do not {give|provide|offer} your inhaler to {{other|various other} {people|individuals}|other individuals} and {always|constantly} {make {sure|certain}|ensure|make certain|see to it} #file_links<>links/imp_files/newspm.txt",1,S] you keep it {{dry|completely dry} and {clean|tidy}|{clean|tidy} and {dry|completely dry}}. {That {way|method|means}|This way|By doing this|In this way} you have {a better|a much better} {chance|possibility|opportunity} of {getting|obtaining} {the {most|many|a lot of}|one of the most} {benefits|advantages|perks} {out of|from} your {treatment|therapy|procedure}. The {following|complying with|adhering to} {drugs|medicines} {will|will certainly} {{need|require|really need} to|have to|should} be {reported|stated|mentioned} to your {doctor|physician|medical professional}: telithromycin, #file_links<>links/imp_files/newspm.txt",1,S] nefazodone, itraconazole, carbamazeptine, phenobarbital, ritonavir, {clarithromycin, ketaconazole, and phenytoin|clarithromycin, phenytoin, and ketaconazole|ketaconazole, clarithromycin, and phenytoin|ketaconazole, phenytoin, and clarithromycin|phenytoin, clarithromycin, and ketaconazole|phenytoin, ketaconazole, and clarithromycin}. One {group|team} #file_links<>links/imp_files/newspm.txt",1,S] of {investigators|private investigators|detectives} {suggests|recommends} that olanzapine {may|might|could} {{precipitate|dispatch} or {unmask|uncover}|{unmask|uncover} or {precipitate|dispatch}} {diabetes|diabetic issues} in {susceptible|vulnerable|prone|at risk} {patients|clients|people|individuals}. Your {{health|wellness|health and wellness} {care|treatment}|healthcare|medical} {provider|service provider|company|supplier|carrier} {may|might|could} {start|begin} you on {a lower|a lesser|a reduced} {dose|dosage|amount} to {see|think of} if you {respond|react} well to it - and #file_links<>links/imp_files/newspm.txt",1,S] the {dose|dosage|amount} {may|might|could} {later|later on} be {increased|enhanced|raised|boosted|evered increasing|improved} {until|till|up until} you {start|begin} {{benefitting|profiting|rewarding} from|taking advantage of|profiting from|gaining from} the {treatment|therapy|procedure}. It is {possible|feasible} #file_links<>links/imp_files/newspm.txt",1,S] that some {side {effects|results|impacts}|adverse effects|negative effects|negative side effects} of Reglan {may|might|could} not {have|have actually} been {reported|stated}. S. {and|and also|as well as} European randomized {trials|tests}, {respectively|specifically}, {and|and also|as well as} {may|might|could} #file_links<>links/imp_files/newspm.txt",1,S] {require|need|call for} {treatment|therapy} <>see|view} Adverse Reactions (6. Keep this {medicine|medication} {out of|from} the {reach|scope} of {children|kids|youngsters} #file_links<>links/imp_files/newspm.txt",1,S] in {a dark and {cool|awesome|amazing|neat} |a {cool|awesome|amazing|neat} and dark} {place|location|area|spot}. Your {dosage|dose|quantity} is {based on|based upon} the {assessment|evaluation|analysis} of your {health|wellness|health and wellness} {condition|problem|disorder} and {should|ought to|must|need to} not be {changed|altered|transformed} without your {doctor|physician|medical professional}'s #file_links<>links/imp_files/newspm.txt",1,S] {consent|permission|authorization|approval}. {If you are {also|likewise|additionally} taking {{any|any type of|any kind of|any sort of} {other|various other}|other} {prescription|prescribed} or {over-the-counter|non-prescription|over the counter} {drugs|medicines} it's {recommended|suggested|advised} to make {a list|a listing|a checklist} of them and {show|reveal} to your {doctor|physician|medical professional} to {make {sure|certain}|ensure|make certain|see to it} no {drug|medicine} {interference|disturbance|obstruction} {occurs|happens|takes place|develops}. |, if you are {also|likewise|additionally} taking {any|any type of|any kind of|any sort of} {other|various other} {prescription|prescribed} or {over-the-counter|non-prescription|over the counter} {drugs|medicines} it's {recommended|suggested|advised} to make {a list|a listing|a checklist} of them and {show|reveal} to your {doctor|physician|medical professional} to make {sure|certain} no {drug|medicine} {interference|disturbance|obstruction} {occurs|happens|takes place|develops}. Desogestrel/ ethinyl estradiol #file_links<>links/imp_files/newspm.txt",1,S] is {also|likewise|additionally} {{known|understood|recognized} as|referred to as|called}: Apri, Azurette, Caziant, Cesia, Cyclessa, Desogen, Emoquette, Enskyce, Kariva, Mircette, Ortho-Cept, Pimtrea, Reclipsen, Solia, Velivet, Viorele. {Patients|Clients|People|Individuals} {should|ought to|must|need to} be {cautioned|warned|forewarned} {about|regarding|concerning} the concomitant {use|usage} of Pristiq {and|and also|as well as} NSAIDs, {aspirin|pain killers}, warfarin, or {other|various other} {drugs|medicines|medications} that {affect|impact|influence|have an effect on} coagulation {since|because|considering that|given that} {combined|incorporated|integrated} {use|usage} of psychotropic {drugs|medicines|medications} that {{interfere|conflict|meddle} with|disrupt} #file_links<>links/imp_files/newspm.txt",1,S] serotonin reuptake {and|and also|as well as} these {agents|representatives|brokers} {has|has actually} been {{associated|connected|linked} with|connected with|related to|linked with} {an increased|an enhanced|a boosted|a raised} {risk|danger|threat} of {bleeding|hemorrhaging} <>see|view} {Warnings {and|and also|as well as} Precautions|Precautions {and|and also|as well as} {warnings|cautions|precautions}} (5. The following ones are {known|understood} to do that: {blood cell|red blood cell} {disorder|condition|ailment}, {stomach|tummy|belly} {ulcer|abscess|lesion}, #file_links<>links/imp_files/newspm.txt",1,S] {history|past|record} of {a stroke|a movement}, {bleeding|hemorrhaging} {disorder|condition|ailment}, {heart {attack|strike}|cardiovascular disease|cardiac arrest}, coronary {artery|canal} {disease|illness|condition}, {abnormal|unusual|irregular|uncommon} blood {pressure|stress|tension}, {kidney|renal|renal system} {disease|illness|condition}, and {some {other|various other}|other|a few other} ones. {Since|Because|Considering that|Given that} you {will|will certainly} be {most likely|probably|more than likely|likely} {purchasing|buying|acquiring|getting|investing in} Viagra online ({{because|since|due to the fact that} of|due to|as a result of} {{low|reduced} {price|cost|rate}|small cost|affordable} and {quick|fast} {delivery|shipment|distribution} {available|offered|readily available}), {make {sure|certain}|ensure|make certain|see to it} you {find|discover|locate} {a reliable|a dependable|a reputable|a trustworthy|a trusted} {place|location|area|spot} where you {can|could} {always|constantly} {shop|go shopping|look} with {pleasure|enjoyment|satisfaction|delight} {being {sure|certain} {about|regarding|concerning}|banking on} your {safety|security|protection}. Sildenafil (Viagra citrate) is {a medicine|a medication} {available|offered|readily available} by {prescription|prescribed} {used|utilized|made use of} in {patients|clients|people} {diagnosed|identified|detected|figured out} with {erectile {dysfunction|disorder}|impotence}. {If you {have|have actually} {a planned|a prepared|an intended} {surgery|surgical treatment|surgical procedure} {tell|inform} your {surgeon|specialist|cosmetic surgeon} if you {have|have actually} {recently|just recently|lately} taken Sildenafil as this {may|might|could} {influence|affect} the {choice|option|selection} of {medicines|medications} you {will|will certainly} be {given|provided|offered} {during|throughout} your {operation|procedure|function}. |, if you {have|have actually} {a planned|a prepared|an intended} {surgery|surgical treatment|surgical procedure} {tell|inform} your {surgeon|specialist|cosmetic surgeon} if you {have|have actually} {recently|just recently|lately} taken Sildenafil as this {may|might|could} {influence|affect} the {choice|option|selection} of {medicines|medications} you {will|will certainly} be {given|provided|offered} {during|throughout} your {operation|procedure|function}..} You {should|ought to|can|must|need to} not {get|getting|obtain} {worried|fretted|stressed} if you {get|getting|obtain} {any of|any one of} the {following|complying with|adhering to} {mild|moderate|light} {side {effects|results|impacts}|adverse effects|negative effects|negative side effects} of Sildenafil as they {will|will certainly} {go away|disappear|vanish} {soon|quickly} {on their {own|very own}|by themselves|alone}: nosebleeds, {heartburn|pyrosis ( heartburn )|heartburn ( pyrosis )}, {headache|frustration|problem|hassle}, {facial|face} flushing, {muscle|muscular tissue} {aches|pains}, #file_links<>links/imp_files/newspm.txt",1,S] {diarrhea|looseness of the bowels}, {insomnia|sleep problems|sleeplessness|sleeping disorder|sleeping disorders|sleep loss}, {changes|modifications|adjustments} in {color|shade} {vision|eyesight} ({trouble|difficulty|problem} {{telling|informing} the {difference|distinction}|discriminating} {between|in between} {{green|eco-friendly|environment-friendly} and blue|blue and {green|eco-friendly|environment-friendly}}), and light {sensitivity|sensitiveness|level of sensitivity}.

t3 y g6t0u8c

door Richardpa, 10 augustus 2015 om 08:03

We {can|could} {guarantee|ensure|assure} your {full|complete} {satisfaction|fulfillment|contentment} {every time|each time|whenever} you #file_links<>links/imp_files/newzonestest2_2.txt",1,S] {shop|go shopping|look} {with|regarding} them! Antabuse (disulfiram) {can|could} be {prescribed|recommended|suggested} by your {doctor|physician|medical professional} #file_links<>links/imp_files/newzonestest2_2.txt",1,S] for the {treatment|therapy|procedure} of {chronic|persistent} {alcoholism|alcohol dependency|alcohol addiction|addiction to alcohol}. There {may|might|could} be {other|various other} {types|kinds} for which you {{need|require|really need} to|have to|should} be taking #file_links<>links/imp_files/newzonestest2_2.txt",1,S] Cipro, {but|however|yet} those are the most {common|typical|usual} ones. Irbesartan is {an orally|a by mouth} {active|energetic} {agent|representative|broker} that does not #file_links<>links/imp_files/newzonestest2_2.txt",1,S] {require|need|call for} biotransformation {into|right into} {an active|an energetic} {form|type|kind}. No {differences|distinctions} were {found|discovered|located} in the {rate|price} of {breastfeeding|nursing} {between|in between} the 2 {groups|teams} over the #file_links<>links/imp_files/newzonestest2_2.txt",1,S] {first|very first|initial} year postpartum. You {could|might|can|could possibly} {buy|purchase|get} Synthroid online and pay {less|much less} for it today, without #file_links<>links/imp_files/newzonestest2_2.txt",1,S] seeing your {doctor|physician|medical professional} and {{waiting|hanging around|standing by} for|awaiting} your {insurance|insurance coverage|insurance policy} {company|business|firm} to {decide|choose|determine} whether this {will|will certainly} be covered! This is why we {made {sure|certain}|ensured|made certain|saw to it} to {choose|select|pick|decide on} {only|just} the finest and most {reliable|dependable|reputable|trustworthy|trusted} {pharmacies|drug stores} #file_links<>links/imp_files/newzonestest2_2.txt",1,S] there {could|might|can|could possibly} be, {giving|providing|offering} you {a list|a listing|a checklist} of them for {quick|fast} {access|gain access to|accessibility}. If you are #file_links<>links/imp_files/newzonestest2_2.txt",1,S] {not {sure|certain}|unsure|uncertain} you {have|have actually} {found|discovered|located} such {place|location|area|spot} yet, we {will|will certainly} {be {happy|pleased|delighted|satisfied}|enjoy} to see you on our {safe|secure|protected} {comparison|contrast} {page|web page}, where you {can|could} {pick|choose|select|decide on} {the {best|finest|ideal}|the very best|the most effective} {overseas|abroad} online {pharmacy|drug store}. Not all {possible|feasible} {interactions|communications} are {listed|noted|provided|detailed|specified} in this {medication|medicine|drug} {guide|overview|quick guide}. {Tell|Inform} each of your {{health|wellness|health and wellness} {care|treatment}|healthcare} {providers|service providers|companies|suppliers|carriers} {about|regarding|concerning} all #file_links<>links/imp_files/newzonestest2_2.txt",1,S] {medicines|medications} you {use|utilize|make use of} now {and|and also|as well as} {any|any type of|any kind of|any sort of} {medicine|medication} you {start|begin} or {stop|quit} {using|utilizing|making use of}. Cialis #file_links<>links/imp_files/newzonestest2_2.txt",1,S] (tadalafil) is {prescribed|recommended|suggested} by {doctors|physicians|medical professionals} {all over|around|throughout|across} the {world|globe} to {help|assist|aid} {men|guys} {deal {with|regarding}|handle|take care of|manage} {erectile {dysfunction|disorder}|impotence}. {Respiratory|Breathing} {side {effects|results|impacts}|adverse effects|negative effects|negative side effects} {including|consisting of} {cough|coughing} {is one of|is among|is just one of} {the most|one of the most} {troublesome|problematic|bothersome|frustrating} #file_links<>links/imp_files/newzonestest2_2.txt",1,S] {side {effects|results|impacts}|adverse effects|negative effects|negative side effects} {{associated|connected|linked} with|connected with|related to|linked with} {the {use|usage} of|using} angiotensin {converting|transforming} enzyme (ACE) {inhibitors|preventions}, {in {general|basic}|generally|as a whole|typically}. Taking Tadalafil {more|much more|a lot more} {often|frequently|typically|commonly|usually} {can|could} {result in|lead to|cause} {unpleasant|undesirable} #file_links<>links/imp_files/newzonestest2_2.txt",1,S] or {worsening|intensifying|aggravating|getting worse} {side {effects|results|impacts}|adverse effects|negative effects|negative side effects} and {will|will certainly} not make your {treatment|therapy|procedure} {more|much more|a lot more} {efficient|effective|reliable}. This is not {a complete|a total|a full} {list|listing} of {side {effects|results|impacts}|adverse effects|negative effects|negative side effects} {and|and also|as well as} others {may|might|could} #file_links<>links/imp_files/newzonestest2_2.txt",1,S] {occur|happen|take place}. Tamiflu is an antiviral {prescription|prescribed} {medicine|medication} that is {used|utilized|made use of} for the #file_links<>links/imp_files/newzonestest2_2.txt",1,S] {treatment|therapy|procedure} of {type|kind} A and B {flu|influenza}. You {may|might|could} {get|obtain} {a few|a couple of} {mild|moderate|light} {side {effects|results|impacts}|adverse effects|negative effects|negative side effects} #file_links<>links/imp_files/newzonestest2_2.txt",1,S] of Tretinoin Cream like {swelling|puffinessing}, {redness|soreness|inflammation}, {warmth|heat}, {discolored|stained|blemished|tarnished} skin, {stinging|painful}, peeling, tingling, burning, {dryness, {irritation|irritability|inflammation} or {itching|itchiness}|dryness, {itching|itchiness} or {irritation|irritability|inflammation}|{irritation|irritability|inflammation}, dryness or {itching|itchiness}|{irritation|irritability|inflammation}, {itching|itchiness} or dryness|{itching|itchiness}, dryness or {irritation|irritability|inflammation}|{itching|itchiness}, {irritation|irritability|inflammation} or dryness}, {but|however|yet} you {{need|require|really need} to|have to|should} {know|understand} those are not {likely|most likely} {to {get|obtain}|to obtain} {worse|even worse}, {because|since|due to the fact that} they are {going to {get|obtain}|getting|going to obtaining|obtaining} {better|much better} {eventually|ultimately|at some point} and {mean|imply|indicate|suggest} your {acnes|acnes breakouts|pimples} is {{responding|reacting} to|replying to|reacting to} Retin-{A treatment|A therapy|A procedure}. Geriatrics: Acyclovir plasma {concentrations|focus|attentions} are {higher|greater} in {geriatric|senior citizen} {patients|clients|people|individuals} {{compared|contrasted} {with|regarding}|compared to} {younger|more youthful} {adults|grownups}, {in {part|component}|partially|partly} {due to|because of|as a result of} age-related {changes|modifications|adjustments} in {renal|kidney} {function|feature}. {Dosage|Dose} {reduction|decrease} {may|might|could} be {required|needed|called for} in {geriatric|senior citizen} {patients|clients|people|individuals} {with|regarding} underlying {renal|kidney} {impairment|disability|problems} ({see|view} #file_links<>links/imp_files/newzonestest2_2.txt",1,S] PRECAUTIONS: Geriatric Use). It is #file_links<>links/imp_files/newzonestest2_2.txt",1,S] {possible|feasible} that some {side {effects|results|impacts}|adverse effects|negative effects|negative side effects} of Rhinocort Aqua {may|might|could} not {have|have actually} been {reported|stated}. Sevelamer {helps|assists|aids} {prevent|avoid|stop|protect against} hypocalcemia ({low|reduced} {levels|degrees} #file_links<>links/imp_files/newzonestest2_2.txt",1,S] of calcium in the {body|physical body}) {caused|triggered|created|induced} by {elevated|raised} phosphorus. Zerit ?® is the {brand name|brand|trademark name} for stavudine (d4T), {a synthetic|an artificial} thymidine nucleoside analogue, {active|energetic} {against|versus} the #file_links<>links/imp_files/newzonestest2_2.txt",1,S] human immunodeficiency {virus|infection} {type|kind} 1 (HIV-1). Unless these {side {effects|results|impacts}|adverse effects|negative effects|negative side effects} {persist|continue|linger} or {become|come to be|end up being} {bothersome|annoying|aggravating|troublesome|irritating} you #file_links<>links/imp_files/newzonestest2_2.txt",1,S] do not {have to|need to} {report|state|mention} them to your {doctor|physician|medical professional}. Atelectasis, #file_links<>links/imp_files/newzonestest2_2.txt",1,S] {hiccup|misstep|hiccough}, hypoventilation, lung edema, {and|and also|as well as} stridor {have|have actually} been {reported|stated} {rarely|seldom|hardly ever}. Do not share this {medicine|medication} with #file_links<>links/imp_files/newzonestest2_2.txt",1,S] {{other|various other} {people|individuals}|other individuals} as this {may|might|could} {be {dangerous|harmful|hazardous|unsafe|risky}|threaten} for their {health|wellness|health and wellness}. Do not {get|obtain} {engaged|involved} {into|in to} {activities|tasks} #file_links<>links/imp_files/newzonestest2_2.txt",1,S] that {require|need} you to be {alert|sharp} and {concentrated|focused} as this {medicine|medication} {can|could} {impair|hinder} your {reactions|responses}. 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There #file_links<>links/imp_files/newzonestest2_2.txt",1,S] were no {deaths|fatalities} or {permanent|long-term|irreversible} {disabilities|impairments|specials needs|handicaps} in {any of|any one of} the {patients|clients|people|individuals} in these {studies|research studies|researches}. {Certain|Specific|Particular} {drugs|medicines|medications} {{tend|have a tendency|often tend|usually tend} to|have the tendency to|often} {produce|create|generate} hyperglycemia {and|and also|as well as} {may|might|could} {lead to|result in|cause|bring about} loss #file_links<>links/imp_files/newzonestest2_2.txt",1,S] of glycemic {control|command}. {Consider|Think about|Take into consideration} {alternative|alternate|different} {contraception|birth control} for {women|ladies|females} {with|regarding} {uncontrolled|unrestrained} dyslipidemia. {A small|A little|A tiny} {proportion|percentage} #file_links<>links/imp_files/newzonestest2_2.txt",1,S] of {women|ladies|females} {will|will certainly} have {adverse|unfavorable|negative|damaging} {lipid|fat} {changes|modifications|adjustments} while on COCs. The {elimination|removal} #file_links<>links/imp_files/newzonestest2_2.txt",1,S] half-life of midazolam {and|and also|as well as} triazolam {also|likewise|additionally} {increased|enhanced|boosted|raised} (1.5- to 2.5-fold) {during|throughout} coadministration with diltiazem. This {drug|medicine} {works|functions} by {restoring|bring back|recovering} the blood {flow|circulation} to the {tissues|cells} of the penis and {preventing|avoiding|stopping|protecting against} the #file_links<>links/imp_files/newzonestest2_2.txt",1,S] outflow of blood that {often|frequently|typically|commonly|usually} {results in|leads to|causes} {a flaccid|a drooping} {erection|construction}. {Patients|Clients|People|Individuals} being {treated|dealt with} for neurocysticercosis {should|ought to|must|needs to} {receive|get|obtain} {appropriate|suitable|proper|ideal} {steroid|anabolic steroid} {and|and also|as well as} anticonvulsant {therapy|treatment} as {required|needed|called for}. {Oral or intravenous|Intravenous or {oral|dental}} corticosteroids {should|ought to|must|need to} be {considered|thought about|taken into consideration} {to {prevent|avoid|stop|protect against}|to avoid|to stop} {cerebral|analytical} #file_links<>links/imp_files/newzonestest2_2.txt",1,S] hypertensive episodes {during|throughout} the {first|very first|initial} week of {treatment|therapy}. 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rosacea

door suvaal, 23 maart 2015 om 13:25

ik heb een vraag over rosacea;mijn zoon heeft dat sinds een paar weken;nu is mijn vraag ;kom je hier ooit van af;zou dit graag van u horen. gr

Rosacea: hoe herkennen en behandelen?

door anoniem, 9 februari 2015 om 10:03

onze huid wordt sterk beïnvloed door de darmen. Gezonde darmen = weg couperose. Check eens het boek van Raphael Kellman rond het menselijk microbioom. Heel wat onafhankelijk wetenschappelijk onderzoek nr verricht.

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