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Ask a Doctor Online Now!Itching skin during pregnancy may be due to a number of causes that were present prior to conception. However, itchy skin in pregnancy may be a result of some underlying condition or cause that has been exacerbated due to the pregnant state. Of these type of conditions, allergic conditions resulting in itchy skin are the most common.
The use of antihistamines to treat the itch are often of concern due to the debate surrounding the teratogenic properties of these drugs. Ask a Doctor Online Now!Itching within the first trimester of pregnancy is common and is usually not a cause for concern if there is no visible skin rash or concomitant signs and symptoms. There are certain causes of pruritus in pregnancy that may only occur or are more likely to occur in the pregnant state.
Also known as polymorphic eruption of pregnancy (PEP) or previously as toxemic rash of pregnancy.
More commonly affects a woman in her first pregnancy but may recur in subsequent pregnancies. Usually occurs in the areas where stretch marks (striae distensae) is most prominent – abdomen, thighs and buttocks.
Previously known as herpes gestationis due to its appearance but it is not caused by the herpes virus.
Tends to occur in the third trimester of pregnancy but may initially appear in the latter part of the second trimester. Progresses into large blisters (bullae) surrounded by rough, cracking skin (excoriated papules). Poses a varying degree of risk to the fetus and an early delivery may have to be considered. Occurs when bile (bile salts) enter the bloodstream due to the diminished flow of bile out of the liver.
Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis.
Please, complete the form with your suscription data.If you are a member of the Spanish Society of Cardiology, you can use the same login and password that you use to access the Society's website. Hives that are accompanied by other symptoms such as a swollen tongue or throat should be addressed by a doctor immediately.
If a bald eagle loses a feather on one wing, it will drop a matching feather on the other side to maintain balance. Taking antihistamine medications and steroids and avoiding tight clothing and certain foods are tried and true methods of treatments for hives.
One of the most common treatments for hives is the administration of antihistamine medications, which is a typical treatment for many other symptoms of allergies as well. When a person has hives that are not responding to typical antihistamine treatments, doctors will often administer a steroid medication, such as cortisone, to get rid of the hives.
In many situations, the best treatments for hives are simple home remedies, changes in behavior, or avoidance of environmental causes. Sometimes avoiding certain foods can prove to be an effective treatment for hives, as many food allergies can result in hives.
Contrary to popular belief, at least 60% of children with ADHD continue to exhibit features of the disorder during adulthood.
Poor adjustment and performance can have an erosive effect on self-esteem, leading to clinically significant anxiety or depression, or both, which are often the presenting features of adult ADHD in the primary care setting. There was a high rate of psychiatric comorbidity in ADHD adults: 38% had a mood disorder, 47% had an anxiety disorder, 15% had a substance-use disorder, and nearly 20% had an impulse-control disorder. Candidate gene selection is based on the hypothesis that deficient dopamine availability contributes to ADHD. No one gene or its protein derivatives has been found to have a consistent relation with ADHD, which suggests that like most psychiatric disorders, ADHD is the consequence of polygenetic influences. At least six symptoms of inattention or at least six symptoms of hyperactivity or impulsivity have persisted for at least 6 months and occur often enough to be maladaptive and inconsistent with developmental level.
Symptoms do not occur exclusively during course of a pervasive developmental disorder, schizophrenia, or psychotic disorder. Symptoms might not be observable when the patient is in highly structured or novel settings, engages in interesting activity, receives one-on-one attention or supervision, or is in a situation with frequent rewards for appropriate behavior. Symptoms typically worsen in situations that are unstructured, minimally supervised, or boring or that require sustained attention or mental effort. In adolescents (or adults), symptoms include restlessness (rather than hyperactivity, as seen in children), impaired academic performance, low self esteem, poor peer relations, and erratic work record.
Adapted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text rev. Determining whether the patient fulfilled these criteria depends almost exclusively on the patient's knowledge of his or her childhood behavior and school performance.
The difficulty of diagnosing ADHD in adults results largely from the nonspecificity of this behavior-symptom complex. Virtually any type of distress, regardless of the cause, can interfere with normal attention.
Accurate diagnosis of these disorders and determining whether they are comorbid or secondary to ADHD have important implications for treatment selection and prognosis. Baseline measures of weight, heart rate, and blood pressure should be obtained before starting stimulant or nonstimulant medication.
The standard of care for adults has evolved largely from studies in children, and the medications used in adults are the same as those used in children and adolescents with ADHD (Table 3). Central nervous system (CNS) stimulants such as dextroamphetamine, methyphenidate, and dexmethylphenidate are the drugs of choice for ADHD in both children and adults. The dosage of medication must be individualized by increasing gradually to maximal benefit while avoiding side effects.
Stimulant side effects are typically dose related and include nausea, headache, jitteriness, tics, high blood pressure, and high heart rate. It is reasonable to expect that timely and effective treatment should reduce the risk of psychosocial morbidity associated with ADHD.


If the extensive psychosocial morbidity of ADHD can be prevented, then it stands to reason that it should be identified and treated as early as possible.
The challenge for the prescribing physician is to keep stimulant medications out of the hands of persons prone to drug or alcohol addiction. CNS stimulants do not cause a clinically significant reduction in seizure threshold and therefore can be used safely in patients with epilepsy. All CNS stimulant drugs are listed as class C and should therefore be avoided if possible during pregnancy. At least 60% of children with ADHD continue to exhibit clinically significant features of the disorder as adults. Undiagnosed or untreated ADHD is associated with significant morbidity, including higher-than-expected rates of maladaptive behavior, family problems including divorce, problematic employment, substance abuse, motor vehicle accidents, and secondary mood and anxiety disorders. The primary treatment for adult ADHD is a methylphenidate- or amphetamine-based compound supplemented when necessary with structured, skills-based cognitive-behavioral therapy.
At other times, those conditions that appear after conception may have been developing or were bound to develop, irrespective of the pregnancy.
Alternatively, pregnancy was the trigger for the onset of a condition which the woman was predisposed to but had not as yet presented due to the lack of precipitating factors.
The increasing estrogen levels are known to exacerbate allergy-related conditions and may be also be noticed by females using hormone contraceptives or even hormone replacement therapy (HRT). Certain antihistamines like chlorphenamine have a long safety record in pregnancy and can be used for palliating the itch although this should only be done after consulting a doctor or gynecologist. The latter may have been pre-existing and related to allergies earlier in life which may have also presented as as asthma or allergic rhinitis (allergic triad : eczema, asthma, hay fever). Medication that disrupts histamine compounds can treat hives, though it is usually recommended to first attempt to treat the cause, if it is known. There are many different types of antihistamines, and they all work by disrupting the histamine compounds that are activated in a body by the immune system. These types of medications often affect the entire immune system of the patient when being used to eliminate hives and can have serious side effects when used in excess. I get hives basically every day, but it's worse when I'm stressed and during the summer because of the heat. Common comorbidities complicate the array of signs and symptoms that ADHD adults can present with. Despite having clinically significant ADHD, many adults do not fulfill the threshold of six or more criteria defined for children and adolescents. Most adults with ADHD recall some evidence of problems related to either inattention or hyperactivity during childhood.
Compounding the lack of specificity, many adults with long-standing undiagnosed and untreated ADHD develop secondary mood, anxiety, or substance-use disorders, alone or in combination, that become the focus of clinical attention and obscure detection of the more fundamental problem with attention. Therefore, the feature that distinguishes ADHD from other causes of inattention is a lifelong pattern of the behavior-symptom complex. Successful treatment of a comorbid disorder reduces symptom burden, but it does not affect the symptoms and behavior of ADHD.
Other nonstimulant agents whose mechanism of action in ADHD is not fully understood include bupropion and imipramine.
Clinical effects are felt within 15 to 30 minutes of oral administration, and peak blood levels are achieved within approximately 2 hours. The World Health Organization (WHO) Adult Self-Report Screener (ASRS) for Adult Attention Deficit Disorder (ADD) includes six questions rated on a scale from 0 to 4 (0 = never, 1 = rarely, 2 = sometimes, 3 = often, 4 = very often). Geriatric-age patients with a diagnosis of ADHD can benefit considerably from appropriate treatment.
Nonpharmacologic therapies or nonstimulant medications should be tried first in such patients.
In both these instances, pregnancy was not the cause or precipitating factor and these itchy skin conditions were non-specific. Hormonal, immunological or unknown factors relating to pregnancy may serve as a trigger or aggravating factor for pre-existing or chronic skin diseases. Anxiety may play a role in this type of itching (psychogenic) as it is more frequently noted in first time mothers.
Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin.
Steroids are generally a last resort for treating hives, but they can be very effective for hives that are not responsive to other types of treatment. Many antihistamine medications can be acquired without a doctor’s prescription, but there are some that require one.
As a less extreme treatment, topical creams can also be used to distribute some steroid medications. You should ask your doctor about it. I have chronic hives and I'm on multiple medications including an anthisitamine, an immunosuppressant medication and a psychotropic medication.
Abnormal mood, vocational and interpersonal problems, and substance abuse are often the problems that patients present with when the underlying primary diagnosis is ADHD. This points to the fundamental problem of employing a descriptive nosology to define clinical disorders.
Trouble sitting still, frequent fighting, temper outbursts, tendency to daydream, or suboptimal school performance is typical. Although neuroimaging and genetic testing offer attractive diagnostic potential, they are not sufficiently specific or sensitive for routine clinical use. On the other hand, successful treatment of ADHD can result in improvement of secondary anxiety, depression, or substance abuse.
Adding life-skills coaching or cognitive-behavioral therapy, or both, in either individual or group settings can further improve outcome, but by themselves they are generally insufficient. Treatment of such patients should involve close collaboration with an internist or cardiologist. Patients with baseline tachyarrhythmia, hypertension, or structural heart disease are at high risk for stimulant-induced aggravation of these abnormalities. Older patients are more likely, however, to have coexisting cardiovascular abnormalities that warrant careful monitoring during treatment with stimulant medication.


If these are ineffective, however, and the fully informed patient desires a trial of stimulant medication, it should be prescribed with careful monitoring in conjunction with the supervision of a cardiologist or internist to minimize the risk of adverse outcome. However if the itching is persisting, getting worse, affecting sleep or other activities, then it should be investigated.
What works for some people does not always work for others, however, so experimenting with caution may be necessary.
Though antihistamine medications as a whole typically work in similar fashions, they have differing side effects.
Another way that clothing can lead to hives is by harboring residues from detergents that are irritating the skin. Removing the source of the allergy, be it a pet animal or latex, can prove to be effective treatments for hives. The psychotropic is basically to relax me so that I don't get hives from mood changes. Right now, I'm happy with my treatment but I think I would like to look into natural treatments for hives for the long-term. Future editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will struggle with this dilemma until the pathophysiologic mechanisms of specific psychiatric disorders such as ADHD are better understood.
Those with clinically significant ADHD who report successful school performance may have compensated with higher-than-average intellectual strengths, had an insufficiently challenging curriculum, or simply do not remember accurately.
Certain disorders that are commonly associated with or have features that can mimic ADHD are listed in Table 2.
The nonstimulant atomoxetine can cause increases in heart rate and blood pressure, but it is far less likely to do so than stimulants are. The Wender Utah Rating Scale (WURS) was originally used as a research instrument and validated as a screener subsequently. Effective treatment of ADHD should reduce the risk of substance abuse, especially when substance abuse is secondary to ADHD.
If problems like these are suspected, switching the types of clothing that is being worn or washing clothing using an ammonia solution and hot water can sometimes be effective treatments for hives. On some days, they work fine, on others, they're not enough. Does anyone else here have chronic hives? The nonstimulants work more gradually and can take days to weeks to achieve a full therapeutic effect.
A score of 46 or more obtained from adding the ratings on items 3-7, 9-12, 15-17, 20, 21, 24-29, 40, 41, 51, 56, and 59 is highly predictive of a diagnosis of ADHD. For persons with ADHD and comorbid substance abuse or dependence, the treatment of choice includes a nonstimulant agent such as atomoxetine, buproprion, or imipramine.
Published questionnaires can be used to capture the necessary information and can assist with (but not confirm) the diagnosis (Box 2). A blanket policy of refusal to prescribe CNS stimulants to patients with a history of drug abuse, however, is ill advised. Ultimately, however, the clinician must rely on the patient's veracity and accuracy of recall. In all cases, substance abuse must be stabilized first, and ADHD treatment can be initiated as soon as the substance abuse is stabilized. An improved definition of immune heparin-induced thrombocytopenia in postoperative orthopedic patients.
Central venous catheters and upper-extremity deep-vein thrombosis complicating immune heparin-induced thrombocytopenia. The incidence of heparin-induced thrombocytopenia in hospitalized medical patients treated with subcutaneous unfractionated heparin: a prospective cohort study. Management of heparin-induced thrombocytopenia: a critical comparison of lepirudin and argatroban.
Failure of current strategies in the prevention of thrombosis in patients with heparin-induced thrombocytopenia: a clinician's perspective. Prevalence of heparin-induced thrombocytopenia in patients undergoing cardiac catheterization. Platelet factor 4 complexed to heparin is the target for antibodies generated in heparin-induced thrombocytopenia. Laboratory testing for the antibodies that cause heparin-induced thrombocytopenia: how much class do we need? Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis.
Frequency of anti-heparin-platelet factor 4 antibodies in hemodialysis patients and correlation with recurrent vascular access thrombosis. Prospective randomised open-label comparison of danaparoid with dextran 70 in the treatment of heparin-induced thrombocytopaenia with thrombosis: a clinical outcome study. Lepirudin in patients with heparin-induced thrombocytopenia -- results of the third prospective study (HAT-3) and a combined analysis of HAT-1, HAT-2, and HAT-3. Bivalirudin during cardiopulmonary bypass in patients with previous or acute heparin-induced thrombocytopenia and heparin antibodies: results of the CHOOSE-ON trial. Bivalirudin for anticoagulation in mechanical aortic valve replacement and heparin-induced thrombocytopenia.
Heparin-induced thrombocytopenia (HIT) in pediatric cardiac surgery: an emerging cause of morbidity and mortality. Reversal of direct thrombin inhibition after cardiopulmonary bypass in a patient with heparin-induced thrombocytopenia.
Treatment dosage recommendation for fondaparinux in a patient with heparin induced thrombocytopenia. Effect of direct thrombin inhibitors, bivalirudin, lepirudin, and argatroban, on prothrombin time and INR values.



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