Uterine Fibroid

Semalam seorang pesakit wanita, berusia 54 tahun belum berkahwin datang untuk meneruskan rawatan fibroid pada rahimnya. Sebelum itu beliau telahpun menerima rawatan semenjak 7 Ogos 2008 dengan membawa salinan ultrasound yang mengesahkan saiz fibroid ialah 8.7 cm X 7.4 cm. Pada 17 Februari 2009, saiz fibroid menjadi 2 ketulan iaitu 4.6 cm X 1.8 cm dan 2.0 cm X 1.0 cm. Melihat kepada salinan tersebut jelas menunjukkan bahawa daripada satu ketulan besar kini telah berubah menjadi 2 ketulan lebih kecil dan sekiranya dijumlah saiz terbesar iaitu 6.6 cm X 2.8 cm. Ternyata hampir 5 bulan rawatan, saiz fibroid telah mengecil. 

Mengikut kaedah rawatan homeopati, fibroid ini berlaku akibat daripada ketidakseimbangan hormon yang mempunyai kaitan langsung dengan tekanan hidup membujang dan cara hidup  dan makan yang tidak teratur. Fibroid bukanlah satu penyakit. Ia hanya sebagai kesan daripada gangguan yang berlaku terhadap sistem normal tubuh pesakit. Gangguan inilah yang telah memberi kesan dengan terbentuknya fibroid pada rahim. Oleh itu pendekatan rawatan yang perlu diberi keutamaan ialah membetulkan semula sistem dalam tubuh yang diterjemahkan melalui beberapa tanda dan gejala termasuklah fibroid. Bukanlah dengan membuat pembedahan mengeluarkan fibroid itu satu-satunya jalan untuk menyembuhkan pesakit. Pembedahan hanya sekadar membuang fibroid tetapi punca yang menyebabkan berlakunya fibroid tidak boleh dibuang dengan pisau pembedahan.Pendekata, yang sebenarnya sakit bukanlah fibroid di rahimnya tetapi manusia disebalik tubuh fizikal itu yang sakit. Malah ada kata-kata yang mashur,"There is no disease but a patient".

Maklumat lanjut tentang Uterine Fibroid

Uterine fibroids (singular Uterine Fibroma) are benign tumors which grow from the muscle layers of the uterus. They are the most common benign neoplasm in females. Often asymptomatic, they cause symptoms in about 25% of white and 50% of black women . Uterine fibroids often do not require treatment, but when they are problematic, they may be treated surgically or with medication — possible interventions include a hysterectomy, hormonal therapy, a myomectomy, or uterine artery embolization. Estrogen receptors on uterine fibroids cause fibroids to be larger in reproductive years and shrink dramatically in size after a woman passes through menopause. Uterine fibroids are more common in overweight women and women of coloured decent.

Fibroids are named according to where they are found. There are four types: Intramural fibroids are found in the wall of the womb and are the most common type of fibroids. Subserosal fibroids are found growing outside the wall of the womb and can become very large. They can also grow on stalks (called pedunculated fibroids). Submucosal fibroids are found in the muscle beneath the inner lining of the womb wall. Cervical fibroids are found in the wall of the cervix (neck of the womb). In very rare cases, malignant (cancerous) growths on the smooth muscles inside the womb can develop, called leiomyosarcoma of the womb.

Pathology and histology

Leiomyomas grossly appear as round, well circumscribed (but not encapsulated), solid nodules that are white or tan, and whorled. The size varies, from microscopic to lesions of considerable size. Typically lesions the size of a grapefruit or bigger are felt by the patient herself through the abdominal wall.

Microscopically, tumor cells resemble normal cells (elongated, spindle-shaped, with a cigar-shaped nucleus) and form bundles with different directions (whirled). These cells are uniform in size and shape, with scarce mitoses. There are three benign variants: bizarre (atypical); cellular; and mitotically active.

Leiomyomas arise from the smooth muscle (myometrium) and of the components of the Extracellular matrix (ECM).

Leiomyomas are estrogen sensitive and have estrogen receptors. They may enlarge rapidly during pregnancy due to increased estrogen levels. Fibroids tend to regress following menopause because of lowered levels of estrogen. Hormonal therapy is based on these facts.

More recent studies have revealed a possible role of progesterone and progestins to fibroid growth as well, and applicability of progestin agonists as part of treatment are currently being considered.

Symptoms

The symptoms depend on the size, location, number, and the pathological findings. Fibroids, particularly when small, may be entirely asymptomatic. The U.S. Department of Health & Human Services states that "Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma (leye-oh-meye-oh-sar-KOH-muh). Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman's chances of getting other forms of cancer in the uterus."  Generally, symptoms relate to the location of the lesion and its size. Important symptoms include abnormal gynecologic hemorrhage, heavy or painful periods, abdominal discomfort or bloating, back ache, urinary frequency or retention, and in some cases, infertility.There may also be pain during intercourse, depending on the location of the fibroid. During pregnancy they may be the cause of miscarriage, bleeding, premature labor, or interference with the position of the fetus.

Location

Fibroids may be single or multiple. Most fibroids start in an intramural location, that is the layer of the muscle of the uterus. With further growth, some lesions may develop towards the outside of the uterus (subserosal or pedunculated), some towards the cavity (submucosal or intracavitary). Lesions affecting the cavity tend to bleed more and interfere with pregnancy. Secondary changes that may develop within fibroids are hemorrhage, necrosis, calcification, and cystic changes. Less frequently, leiomyomas may occur at the lower uterine segment, cervix, or uterine ligaments.

Diagnosis

Diagnosis is usually accomplished by bimanual examination, better yet by gynecologic ultrasonography, commonly known as "ultrasound." Sonography will depict the fibroids as focal masses with a heterogeneous texture, which usually cause shadowing of the ultrasound beam. In cases where a more precise assay of the fibroid burden of the uterus is needed, also magnetic resonance imaging (MRI) can be used to definite the depiction of the size and location of the fibroids within the uterus. This imaging modality is required when non surgical treatment such as uterine fibroid embolization is suggested. While no imaging modality can clearly distinguish between the benign uterine leiomyoma and the malignant uterine leiomyosarcoma, because of the rarity of the latter and the prevalence of the former until that time, for practical purposes, there is no result unless it is evidence of local invasion is present, though more recent studies have improved diagnostic capabilities using MRI.[9] For this reason, biopsy is rarely performed and if performed, is rarely diagnostic. Should there be an uncertain diagnosis after ultrasounds and MRI imaging, or should there be questions regarding whether the fibroid is interfering with fertility, a laparoscopy is one option for further information to be gathered regarding the exact size and location of the fibroid. Fibroids may also present alongside endometriosis, which itself may cause infertility.

Treatment

The presence of fibroids does not mean that they need to be treated; it is expectantly depending on the symptomatology and presence of related conditions. The presence of uterine fibroids can cause problems which can be solved by:

Surgery: Surgical removal of a uterine fibroid usually takes place via hysterectomy, in which the entire uterus is removed, or myomectomy, in which only the fibroid is removed. It is possible to remove multiple fibroids during a myomectomy. Although a myomectomy cannot prevent the recurrence of fibroids at a later date, such surgery is increasingly recommended, especially in the case of women who have not completed bearing children or who express an explicit desire to retain the uterus. There are three different types of myomectomy: 

In a hysteroscopic myomectomy, the fibroid is removed by the use of a resectoscope, an endoscopic instrument that can use high-frequency electrical energy to cut tissue. Hysteroscopic myomectomies can be done as an outpatient procedure, with either local or general anesthesia used. Hysteroscopic myomectomy is most often recommended for submucosal fibroids. A French study collected results from 235 patients suffering from submucous myomas who were treated with hysteroscopic myomectomies; in none of these cases was the fibroid greater than 5 cm.

A laparoscopic myomectomy requires a small incision near the navel. The physician then inserts a laparoscope into the uterus and uses surgical instruments to remove the fibroids. Studies have suggested that laparoscopic myomectomy leads to lower morbidity rates and faster recovery than does laparotomic myomectomy.As with hysteroscopic myomectomy, laparoscopic myomectomy is not generally used on very large fibroids. A study of laparoscopic myomectomies conducted between January 1990 and October 1998 examined 106 cases of laparoscopic myomectomy, in which the fibroids were intramural or subserous and ranged in size from 3 to 10 cm.A laparotomic myomectomy (also known as an open or abdominal myomectomy) is the most invasive surgical procedure to remove fibroids. The physician makes an incision in the abdominal wall and removes the fibroid from the uterus. A particularly extensive laparotomic procedure may necessitate that any future births be conducted by Caesarean section. Recovery time from a laparatomic procedure is generally expected to be four to six weeks.
Uterine artery embolization (UAE): Using interventional radiology techniques, the Interventional Radiologist occludes both uterine arteries, thus reducing blood supply to the fibroid. A small catheter (1 mm in diameter) is inserted into the femoral artery at the level of the groin under local anesthesia. Under imaging guidance, the interventional radiologist will enter selectively into both uterine arteries and inject small (500 µm) particles that will block the blood supply to the fibroids. This results in the supposed shrinking of the fibroids and of the uterus, thus alleviating the symptoms. However, it is important to note that significant adverse effects resulting from uterine artery embolization have been reported and documented in the medical literature- death, infection, misembolization, loss of ovarian function, unsuccessful fibroid expulsion, pain, foul vaginal odor, hysterectomy, and failure of embolization surgery .
Medical therapy: First line treatment may involve oral contraceptive pills, either combination pills or progestin-only, in an effort to manage symptoms. If unsuccessful, further medical therapy involves the use of medication to reduce estrogens in an attempt to create a medical menopause-like situation. Gonadotropin-releasing hormone analogs are used for this. GNRH analogs, however, are short term treatments only. Selective progesterone receptor modulators, such as Progenta, were under investigation in 2005, because their use as therapeutic agents was desired.

HIFU (High intensity focused ultrasound), also called Magnetic Resonance guided Focused Ultrasound, is a non-invasive intervention (requiring no incision) that uses high intensity focused ultrasound waves to ablate (destroy) tissue in combination with Magnetic Resonance Imaging (MRI), which guides and monitors the treatment. This technique is relatively new; it was approved by the FDA in 2004.


Malignancy

Very few lesions are or become malignant. Signs that a fibroid may be malignant are rapid growth or growth after menopause. Such lesions are typically a leiomyosarcoma on histology. There is no consensus among pathologists regarding the transformation of Leiomyoma into a sarcoma. Most pathologists believe that a Leiomyosarcoma is a de novo disease.

GELARAN PROFESOR

Sewaktu menyertai Program Khemah Bakti rawatan penyakit demam cikungunya di Felda Semencu lalu, YB Pn. Halimah Mansor menjelaskan betapa beruntungnya penduduk di Felda Semencu kerana kehadiran 4 orang 'Profesor' yang turun padang untuk memberikan rawatan. Jelas beliau lagi, amat sukar untuk mendapat khidmat 'Profesor' dan sangat-sangat beruntung penduduk di Felda Semencu.

Saya tersenyum sendirian ditemani Dr. Ibrahim disisi. Saya cuba untuk merungkai gelaran ini secara sepintas lalu.

Perkataan Profesor berasal dari perkataan Latin yang membawa maksud seseorang yang mempunyai kepakaran dalam bidang sains atau sastera. Didalam negara yang mengamalkan pengajaran didalam bahasa inggeris, gelaran profesor merujuk kepada tenaga pengajar senior yang menjawat jawatan ketua jabatan atau 'kerusi' yang dianugerahkan khusus kepada individu tertentu.

Di negara seperti UK, Ireland, Afrika Selatan, Australia dan New Zealand, gelaran ini digunapakai merujuk kepada jawatan tertinggi tenaga pengajar di universiti. Manakala di US, Kanada dan HongKong, gelaran ini diperluaskan kepada pensyarah atau pengkaji yang berkhidmat di kolej atau universiti tanpa mengira status. Di Austria, Brazil, France, Kosovo, Romania, Slovenia, Serbia, Poland dan Itali memperluaskan lagi penggunaanya sehingga kepada guru-guru yang mengajar di sekolah menengah.

Amalan yang berlaku di universiti eropah, profesor adalah  gelaran terhadap jawatan yang dipegang berdasarkan pencapaian kajian akademik. Gelaran lain diberikan sebagai pensyarah atau pembantu pensyarah.

Biasanya tenaga pengajar diberi gelaran pembantu profesor kemudian profesor madya sebelum diangkat menjadi profesor penuh.Gelaran ini mempunyai jangkahayat sehingga bersara daripada memegang jawatan.  Jawatan ini diberi setelah dinilai sumbangan hasil kajian,pengajaran dan juga pentadbiran. Ia mengambil masa 5-6 tahun setelah mendapat jawatan Profesor madya. Sokongan daripada pemerhati luar, laporan kajian oleh rakan sejawat, panel penilai universiti, dekan atau badan yang lebih tinggi. 

Saya berasa cukuplah pandangan rendah para doktor alopati (moden) terhadap homeopati.  Jangan ditambah dengan gelaran yang menunjukkan kedangkalan dan kejahilan doktor homeopati. Buangkanlah gelaran yang sengaja ditambah sendiri. Memalukan dan memualkan. Cukuplah dengan memberikan khidmat terbaik kepada para pesakit sehingga anda sendiri memang telah dianugerahkan gelaran profesor daripada kolej atau universiti yang mana anda sedang berkhidmat. Saudara Aznil berlakon sebagai Profesor Klon didalam filem Cicak Man. Terlalu ramai Profesor Bogus sungguh merimaskan saya.

Hamil menggunakan ubat homeopati

Terasa Cuti Tahun Baru Cinai ini agak lama kerana banyak perkara yang tersangkut. Diantaranya penghantaran produk madu yang dipesan khas dari Sabah belum sampai lagi. Kotak dan label sedang dicetak dijangka dapat diserahkan pada 5 Feb 2009. Kotak bungkusan masih belum selesai perundingan kerana sales exec syarikat pembekal terlibat kemalangan. Alhamdulillah, design terbaru kotak, label, brosur dah siap cuma perlu dihantar ke syarikat percetakan. Begitu juga logo dan kad perniagaan yang baru. Tahun baru ini dimulakan dengan semua yang baru dan segar dalam menghadapi suasana ekonomi muram. 

Dalam masa yang sama, program referal RajaMinda masih lagi dalam pembinaan. Dijangka siap hujung Februari ini. Belum pun siap sepenuhnya program ini, nampaknya ramai yang berminat untuk menyertainya malahan pada hari Isnin 2 Februari ada Marketing Executive Oriva berminat untuk berbincang. Dialu-alukan cuma bende belum siap jadi tidak berapa seronok untuk mempersembahkannya.

Perancangan untuk kem rawatan Chikungunga dan persiapan sedang dibuat. Terpaksa gunakan semua peralatan dan ubatan sendiri memandangkan lebih mudah menggunakan apa yang biasa dipraktikkan.

Hari ini ada sepasang suami isteri yang sudah 2 tahun berumahtangga tetapi masih belum ada cahaya mata. Rupa-rupanya mereka mendapat maklumat daripada seorang teman yang hanya dua kali mendapatkan rawatan tetapi syukur telahpun menimang cahaya mata. Penawar untuk mudah mengandung ini mungkin akan saya komersilkan dimasa hadapan. Diwaktu yang sama, pasangan ini merupakan usahawan membuat sticker kereta. Tepat dengan waktunya, saya mencari syarikat yang boleh mencetak 'batch' kalis air untuk projek RajaMinda. Dia juga memuji kecantikan logo RajaMinda. Saya akan berikan edisi istimewa ini untuk promosi, pengenalan dan jaringan Kelab RajaMinda.

Berbalik kepada kisah kehamilan. Saya berpendapat setiap pasangan jangan terlalu segera sangat untuk mendapat cahaya mata bila berkahwin. Sebaik-baiknya selepas 2 tahun perkahwinan barulah merancang untuk mempunyai cahaya mata. Ini adalah kerana dalam tempoh 2 tahun pertama perkahwinan adalah merupakan masa untuk berbulan madu pasangan bagi mengenali hati budi masing-masing termasuklah keluarga sebelah mertua dan ipar duai. Sekiranya dalam tempoh 2 tahun ini segalanya berjalan lancar dan pasangan amat mengenali hati budi masing-masing dan boleh menerima kelebihan dan kekurangan pasangan disamping kekuatan ekonomi lebih stabil maka masa inilah amat sesuai untuk menadpatkan cahaya mata. Sebaliknya, jika berlaku sesuatu seperti ketidakserasian pasangan atau lain-lain masalah, keputusan untuk berpisah amat mudah diambil dan tidak melibatkan banyak pihak. Namun, sekiranya sudah mempunyai cahayamata, keputusan amat sukar dibuat malahan ada yang sanggup berkorban perasaan demi menjaga perasaan orang lain lebih-lebih lagi perasaan anak.  Jika berlaku juga, kita seringkali dapati, banyak masalah yang timbul seperti perebutan hak penjagaan anak, turun naik mahkamah, soal nafkah anak yang terabai, tanggungjawab yang tidak tertunai terhadap anak biarpun sudah bercerai dan trauma serta pasangan yang sukar untuk mendapat pasangan yang baru kerana sudah ada anak.

Pendekata, selepas 2 tahun perkahwinan hingga tahun ke 5, sekiranya masih belum mendapat cahaya mata, baharulah boleh mendapat khidmat nasihat daripada pakar. Namun begitu, realitinya pihak keluarga yang seringakli mengusik menjadikan pasangan ini terpaksa berbuat sesuatu. Ada banyak cara untuk membantu pasangan mendapatkan zuriat namun apa yang ingin saya dedahkan ialah pendekatan yang saya gunapakai untuk membantu pasangan ini. 

Pasangan mestilah sihat dan lebih baik sekiranya telah membuat pemeriksaan dalaman termasuk pengiraan sperma dan struktur sistem pembiakan wanita. Selepas itu, persediaan mental untuk mendapatkan cahayamata mestilah ada pada kedua-dua pasangan dan bukan atas desakan mana-mana pihak. Selesai pemeriksaan, ubatan yang sesuai akan diberi. Tempoh  rawatan ialah 6 bulan dimana ubat diambil setiap bulan sehingga hamil oleh kedua-dua pasangan. Ada yang bertuah mendapat cahayamata hanya dengan sekali rawatan sahaja. Pasangan perlu mementingkan gaya hidup yang sihat dan cara pemakanan yang boleh menambahkan lagi tahap kesuburan. Teknik penentu masa subur juga amat penting. Pelbagai cara boleh digunakan seperti menggunakan alatan pengukur tahap hormon, suhu badan, kelikatan cairan faraj, edaran haid dan naluri seksual. Yang penting sekali doa dan solat menambahkan lagi peluang untuk mendapat zuriat.

Terasa puas bila mendengar maklumbalas daripada pesakit dan ini menambahkan semangat untuk terus berbakti membantu sesama insan. 

Program Rawatan Demam Cikungunya

1 Feb 2009, saya dipelawa oleh Persatuan Pengamal Sains Perubatan Homeopathy Negeri Johor untuk membantu memberikan rawatan di Dewan Serbaguna Felda Semencu mulai jam 9.00 pagi. InsyaALLah, saya akan hadir disamping membawa peralatan dan ubatan yang perlu bagi memberi peluang para pesakit mengenali lebih rapat perubatan homeopati dan kemampuannya dalam memberikan kesembuhan yang segera dan berkesan.

Sebenarnya, banyak lagi penyakit yang mampu dirawat secara homeopati dan peluang-peluang seperti ini harus diberikan bagi membuka mata masyarakat bahawa adanya satu pilihan rawatan alternatif yang saintifik dan berkesan. Penyakit demam denggi, keracunan makanan dikalangan pelajar dan beberapa penyakit wabak yang lain harus diberi peluang untuk dirawat secara homeopati. 

Saya memetik beberapa informasi mengenai chikungunya.

Chikungunya (in the Makonde language "that which bends up") virus (CHIKV) is an insect-borne virus, of the genus, Alphavirus, that is transmitted to humans by virus-carrying Aedes mosquitoes. There have been recent outbreaks of CHIKV associated with severe morbidity. CHIKV causes an illness with symptoms similar to dengue fever. CHIKV manifests itself with an acute febrile phase of the illness lasts only two to five days, followed by a prolonged arthralgic disease that affects the joints of the extremities. The pain associated with CHIKV infection of the joints persists for weeks or months.

Signs and symptoms

The incubation period of Chikungunya disease is from two to four days. Symptoms of the disease include a fever up to 40 °C (104 °F), a petechial or maculopapular rash of the trunk and occasionally the limbs, and arthralgia or arthritis affecting multiple joints. Other nonspecific symptoms can include headache, conjunctival infection, and slight photophobia. Typically, the fever lasts for two days and then ends abruptly. However, other symptoms, namely joint pain, intense headache, insomnia and an extreme degree of prostration last for a variable period; usually for about 5 to 7 days. Patients have complained of joint pains for much longer time periods depending on their age.

Causes

Chikungunya virus is indigenous to tropical Africa and Asia, where it is transmitted to humans by the bite of infected mosquitoes, usually of the genus Aedes. Chikungunya virus belongs to alpha-vus under Toga virdae family.It is an "Arbovirus"(Ar-arthropod,bo-borne). CHIK fever epidemics are sustained by human-mosquito-human transmission. The word "chikungunya" is thought to derive from description in local dialect of the contorted posture of patients afflicted with the severe joint pain associated with this disease.The main virus reservoirs are monkeys, but other species can also be affected, including humans.

Prognosis

Recovery from the disease varies by age. Younger patients recover within 5 to 15 days; middle-aged patients recover in 1 to 2.5 months. Recovery is longer for the elderly. The severity of the disease as well as its duration is less in younger patients and pregnant women. In pregnant women, no untoward effects are noticed after the infection.

Ocular inflammation from Chikungunya may present as iridocyclitis, and have retinal lesions as well.

Pedal oedema (swelling of legs) is observed in many patients, the cause of which remains obscure as it is not related to any cardiovascular, renal or hepatic abnormalities.

Epidemiology

Chikungunya virus is an alphavirus closely related to the O'nyong'nyong virus,the Ross River virus in Australia, and the viruses that cause eastern equine encephalitis and western equine encephalitis.
 

Chikungunya is generally spread through bites from Aedes aegypti mosquitoes, but recent research by the Pasteur Institute in Paris has suggested that chikungunya virus strains in the 2005-2006 Reunion Island outbreak incurred a mutation that facilitated transmission by Aedes albopictus (Tiger mosquito).Concurrent studies by arbovirologists at the University of Texas Medical Branch in Galveston Texas confirmed definitively that enhanced chikungunya virus infection of Aedes albopictus was caused by a point mutation in one of the viral envelope genes (E1).Enhanced transmission of chikungunya virus by Aedes albopictus could mean an increased risk for chikungunya outbreaks in other areas where the Asian tiger mosquito is present. A recent epidemic in Italy was likely perpetuated by Aedes albopictus.[20]

In Africa, chikungunya is spread via a sylvatic cycle in which the virus largely resides in other primates in between human outbreaks.

History

The name is derived from the Makonde word meaning "that which bends up" in reference to the stooped posture developed as a result of the arthritic symptoms of the disease. The disease was first described by Marion Robinson[21] and W.H.R. Lumsden[22] in 1955, following an outbreak in 1952 on the Makonde Plateau, along the border between Mozambique and Tanganyika (the mainland part of modern day Tanzania).

According to the initial 1955 report about the epidemiology of the disease, the term chikungunya is derived from the Makonde root verb kungunyala, meaning to dry up or become contorted. In concurrent research, Robinson glossed the Makonde term more specifically as "that which bends up." Subsequent authors apparently overlooked the references to the Makonde language and assumed that the term derived from Swahili, the lingua franca of the region. The erroneous attribution of the term as a Swahili word has been repeated in numerous print sources. Many other erroneous spellings and forms of the term are in common use including "Chicken guinea", "Chicken gunaya," and "Chickengunya".[citation needed]

Since its discovery in Tanganyika, Africa in 1952, chikungunya virus outbreaks have occurred occasionally in Africa, South Asia, and Southeast Asia, but recent outbreaks have spread the disease over a wider range.

Use as a biological weapon

Chikungunya was one of more than a dozen agents that the United States researched as potential biological weapons before the nation suspended its biological weapons program.

Rawatan

Sebagai pengenalan, saya ingin menerangkan satu jenis penawar yang diberi nama Eupatorium perfoliatum (Thoroughwort). Penawar ini dikenali sebagai "Bone-set" kerana kemampuannya mengurangkan kesakitan pada anggota kaki dan tangan dan juga otot-otot yang seringkali diidapi oleh pesakit yang diserang demam malaria atau influenza.  Bryonia alba dan Rhus toxicondendron adalah antara penawar pilihan dalam menilai kes ini.