Ointment for neurodermatitis - treatment of the disease on the arms, legs and body with hormonal and non-hormonal drugs. Review of ointments from neurodermatitis

Neurodermatitis - chronic inflammation skin caused by malfunctions within the body. It is quite difficult to completely get rid of it, and treatment is often symptomatic. It is based on various ointments from neurodermatitis, the action of which is aimed at restoring the skin and alleviating the patient's condition.

What worries a person with neurodermatitis?

Symptoms of neurodermatitis:

  1. Intolerable itching.
  2. The appearance of wounds after scratching the skin.
  3. Change in skin pattern and surface layer.
  4. Change in pigmentation.
  5. Peeling and dryness in problem areas.

To get rid of the symptoms, you need to fight not only with the result skin changes. It will be effective to prevent exacerbations and increase the protective properties of the skin. Presumably, neurodermatitis is of a neuro-allergic nature, so ointments that act on this mechanism will also be used.


Causes of neurodermatitis

The mechanism of occurrence of rashes is not fully understood, but it is known that stress is one of the main provoking factors.

In addition, the cause of neurodermatitis can be:

  1. Hormonal disorder.
  2. neurological disorder.
  3. emotional or physical strain.
  4. Prolonged infectious or inflammatory processes.
  5. Immaturity immune system and a decrease in the protective properties of the skin.

Ointment from neurodermatitis should help eliminate the cause, block the developing pathological process and restore normal condition skin.


External treatment

With neurodermatitis in adults, treatment with ointments occupies the main place in the therapy regimen. Proper alternation and selection of drugs will help alleviate the patient's condition and prolong the period of remission. For this, several groups of ointments are used.

Moisturizing and protecting

In healthy hydrated skin metabolic processes proceed more intensively and qualitatively. Dryness is one of the main problems with neurodermatitis., therefore, it is imperative to use products that will restore elasticity and metabolism in tissues.

There are no restrictions on the use of moisturizers. They are used on the hands and other parts of the body, as often as possible. by the most a simple means, which can be attributed to this group - baby cream. It is quite effective when used during remission.

During an exacerbation, it is necessary to apply special means care products that prevent moisture loss are emollients. They can be found in the department of cosmetic products, which are sold in pharmacies.

Related article:

How to cure allergic dermatitis? Causes and diagnosis. Folk methods

The most popular emollients for the treatment of neurodermatitis:

  1. Mustela funds.
  2. Trixera line from Avene.
  3. Topicrem.
  4. Lipicar.

Bepanten cream, which is made on the basis of vitamin B 5, will help prevent dry skin, moisturize and accelerate its healing. It is absolutely harmless and can also be used without restrictions.


AT complex treatment neurodermatitis important role plays local therapy- usage various ointments. Severe itching when scratching is one of the most unpleasant symptoms illness.

With this disease, patients have red spots on the skin, under which swelling sometimes forms. The usual places of localization of rashes are the neck and hands: closer to the feet and wrists.

Ointment against neurodermatitis is designed to relieve discomfort and prevent infection of damaged skin areas.

As a rule, at the first stage, the treatment of neurodermatitis includes ointments of a non-hormonal nature. Their task is to dry the irritated areas of the skin, prevent the development of inflammation on the skin or eliminate the inflammatory manifestations that have already appeared.

Such products contain tannin, resorcinol, boric acid. How effective these drugs will be depends on various factors, including the severity of the course of the disease and the prevalence of the process.

Hormones against disease

If a non-hormonal agents do not help, the doctor may prescribe medications made with the use of glucocorticoid hormones. They actively "work" against edematous phenomena and inflammation. And effectively reduce or completely eliminate itching.

However, such drugs have more contraindications than non-hormonal ones, their use may be accompanied by large quantity side effects.

Therefore, you cannot prescribe such medicines for yourself: only a doctor can do this.

Choice hormonal drugs goes on increasing. First apply more weak ointments. If the effect cannot be achieved, drugs with more high content hormones are potent.

For the treatment and prevention of skin diseases and the appearance of acne and warts, our readers successfully use Father George's Monastic collection. It contains 16 useful medicinal plants, which have extremely high efficiency in the treatment of skin diseases and cleansing the body as a whole.

Synthetic drug

The well-known prednisolone ointment is considered a universal option. Its main ingredient is the hormone prednisone, of synthetic origin. It works both as an antihistamine, having a good anti-allergic effect, and as an anti-inflammatory agent.

When applied to the affected skin, the ointment is quickly absorbed and enters the bloodstream, which carries it throughout the body. It is necessary to lubricate painful areas once or twice a day, as directed by a doctor. The course of treatment should not exceed fourteen days.

No more than four weeks

With extensive weeping edema, neurodermatitis is treated with ointments containing the hormone topical glucocorticosteroid, of a synthetic nature. Its action is also aimed at eliminating the symptoms of allergies and inflammation.

In the process of treatment, the drug is applied to the skin, sometimes covered with gauze or other dressing. The usual duration of therapy is ten days. For more than four weeks, this ointment should not be used.

Antibacterial action

Often, neurodermatitis is accompanied by a viral or bacterial infection. Then an ointment can be prescribed that has an appropriate action against bacteria and viruses. It may contain triamycinol, as well as miramistin.

Against peeling

With severe peeling and increased dryness of the affected areas with neurodermatitis, a slightly different treatment tactic is used. In this case, it is important to prevent the aggravation of the process. Means are selected based on a combination of prednisolone and urea. They relieve itching and inflammation while softening dry skin.

A complex approach

It is important to understand that the use of ointment in the treatment of neurodermatitis is only one of the components complex therapy. Other components - taking antihistamine (antiallergic) drugs, special hypoallergenic diet, elimination of inflammation that may appear in places of rashes.

Neurodermatitis is a dermatological disease chronic type, characteristic feature which is allergic origin.

He belongs to the group atopic dermatitis. The disease is widespread throughout the world and requires long-term treatment. This article will cover the most effective methods to combat neurodermatitis.

General description and classification of the disease

Neurodermatitis on the face in adults - photo:

Neurodermatitis manifests itself in the form rashes on the surface of the skin having a red tint. Gradually, they merge with each other and form sore seals.

Such a defect on the face looks extremely unattractive, which causes a lot of inconvenience to the patient. The foci of inflammation are accompanied by the appearance of severe itching and unpleasant pain.

There are several main types of neurodermatitis on the face:

  1. depigmented. This type of rash is characterized by scleroderma-like changes and loss of skin pigment. Therefore, this type is often called white neurodermatitis.
  2. diffuse. It has a limited nature of rashes and appears as a result of an allergic reaction.
  3. Warty. Hypertrophic neurodermatitis, in which seals look like warts.
  4. Broca's neurodermatitis. For rashes of this type, hyperpigmentation of the skin and oval dimensions are characteristic.
  5. Exudative. A feature of such neurodermatitis is the formation of small bubbles, similar to edema.
  6. Psoriasiform. The rash looks like dense red foci, covered on top with numerous keratinized scales.

Reasons for the appearance

Neurodermatitis occurs due to exposure to the body external or internal stimuli.

Revealed a number of factors, contributing to the formation of neurodermatitis on the surface of the skin.

These include:

  • hereditary predisposition;
  • frequent stress and prolonged depression;
  • hormonal disorder;
  • overstrain, both physical and mental;
  • significant violations in the diet and schedule of the day;
  • diseases of internal organs;
  • allergic reactions;
  • chronic type infections;
  • intoxication;
  • disorders in the immune system.

All of these factors can cause the appearance of neurodermatitis, but the main and most common cause is an allergy to various external stimuli.

For example:

  • on pollen or wool;
  • for cosmetic products or household chemicals;
  • on food products and harmful additives;
  • for medicines or clothing material.

Important advice from the editor

If you want to improve the condition of your skin, Special attention It is worth paying attention to the creams that you use. A frightening figure - in 97% of creams of famous brands there are substances that poison our body. The main components, because of which all the troubles on the labels are referred to as methylparaben, propylparaben, ethylparaben, E214-E219. Parabens have a negative effect on the skin, and can also cause hormonal imbalance. But the worst thing is that this muck gets into the liver, heart, lungs, accumulates in the organs and can cause oncological diseases. We advise you to refrain from using products containing these substances. Recently, the experts of our editorial team conducted an analysis of natural creams, where the first place was taken by funds from Mulsan Сosmetic, a leader in the production of completely natural cosmetics. All products are manufactured under strict quality control and certification systems. We recommend visiting the official online store mulsan.ru. If you doubt the naturalness of your cosmetics, check the expiration date, it should not exceed one year of storage.

Symptoms

The very first sign of neurodermatitis is the formation on the surface of the skin reddish or pink papules.

Their appearance is always accompanied by severe itching.

The second criterion for recognizing the disease is recognized spots on the cheeks without clearly defined boundaries.

They are also itchy and deliver discomfort: they constantly itch and the skin at the site of their distribution begins to peel off a lot.

Itching can become a prerequisite for the appearance of scratching, which leads to the formation microtrauma. As a result of such processes, the skin acquires an uneven shade and pigmentation appears.

Microtraumas represent additional danger, since microbes can get into them during combing, and as a result, the spread of the infectious process can begin.

Additional clinical symptoms indicating the spread of neurodermatitis are:

  • lack of appetite;
  • increased irritability;
  • sharp weight loss;
  • sleep disturbance;
  • low blood pressure;
  • weakness and fatigue;
  • low blood glucose levels.

Diagnostics

When the first symptoms of the disease are detected, it is worth making an appointment with dermatologist, dermatovenereologist or allergist. Their main task is to accurately determine the type of skin disease and recognize neurodermatitis.

To solve this problem, they row diagnostic procedures:

  1. Questioning and examination of the patient with clarification of the necessary information.
  2. Grade clinical signs rashes.
  3. Purpose general analysis blood to detect the level of lymphocytes and immunoglobulin.
  4. Ultrasound procedure skin.
  5. Biopsy of the epidermis.
  6. Allergen test.

The peculiarity of all the listed diagnostic procedures is their painlessness, so you should not be afraid of them and it is better to contact a specialist immediately.

You can learn about what diet to follow for allergies on the skin of the face from ours.

Treatment Methods

How to treat neurodermatitis on the face? Before starting treatment, it is necessary be sure to consult your doctor. Only he can determine the type of skin disease, namely, the success of therapeutic therapy depends on its correct detection.

For the treatment of neurodermatitis are prescribed medications various pharmacological groups.

Creams and ointments

Ointments and creams for external use.

For fast elimination itching and resorption skin lesions ointments and creams should be used.

The most effective ones include:

Cream:

  • Gistan;
  • Eplan;
  • Bepanthen;
  • Epidel;
  • Friderm zinc;
  • Zinocap;
  • Isotrexin;
  • Adaklin.

Ointments:

  • Sinalar;
  • Fluorocort;
  • Advantan;
  • Trimestin;
  • Hydrocortisone;
  • Skincap;
  • Ecolorm;
  • Zinc ointment.

Antihistamines

Their action is aimed at blocking allergic reactions and getting rid of itching and pain symptoms:

Sedatives

Appointed for solving problems of a nervous nature, getting rid of stress and depression:

  • Aminazin;
  • Nanoofin;
  • Hexonium;
  • Librium.

Immune

Drugs that act on increase the protective functions of the body and strengthen the immune system:

  • Methyluracil;
  • T-activin;
  • Sodium nucleinate.

Antibiotics

They are prevent infection and blood poisoning that may appear in the patient, since itching can lead to suppuration:

  • Penicillin;
  • macrolide;
  • Fluoroquinolone;
  • Cephalosporin.

Enzymatic preparations or sorbents

Appointed when the functioning of the digestive system is disturbed:

  • Bifidumbacterin;
  • Bificol;
  • Hilak Forte;
  • Polyphenan;
  • Linex.

Vitamin complexes

For maintaining the beauty of the skin and increasing the effectiveness of treatment recommends taking vitamins:

  • Complivit;
  • Aevit;
  • Revivon;
  • Perfectil.

The main course of treatment of neurodermatitis also includes:

  1. Strict observance of the daily regimen.
  2. Balanced and rational nutrition.
  3. hormone therapy.
  4. Physiotherapy.
  5. Taking therapeutic baths.

All of the above drugs and treatments prescribed by a doctor.

Only a competent specialist will be able to accurately determine the severity and characteristics of the disease and prescribe effective methodology recovery.

Folk remedies

How to treat neurodermatitis at home? Can be cooked at home effective means for quick release from neurodermatitis.

Such recipes do not require costs and special skills, and ease of preparation is their added benefit. Consider the most effective of them.

Coniferous home ointment:

Healing home lotion:

  1. We collect herbs:, oregano, succession, thyme, juniper. It can also be purchased at pharmacies.
  2. We mix the herbs together - one tablespoon of each type.
  3. We place the entire amount of the collection in a thermos, and pour 1.5-2 liters of boiling water.
  4. We filter the finished infusion.
  5. We use it during washing, after removing makeup as the main cleanser.

Therapeutic herbal infusion for drinking:

  1. We collect herbs: elecampane, plantain, blueberries, calendula, yarrow, coltsfoot.
  2. We mix them together. The required amount of collection is 2 large dessert spoons.
  3. Add 2 cups of boiling water to the herbal tea.
  4. We insist for 2-3 hours.
  5. We drink 1/3 of a glass three times a day half an hour before meals.

Contraindications and precautions

Before starting treatment, it is worth familiarizing yourself with the contraindications of each procedure and medicines.

Neurodermatitis is a severe and serious illness, therefore, the drugs prescribed during his treatment are potent. Be sure to read the instructions for each one.

It is especially important to be careful in the following cases:

  • during pregnancy or lactation;
  • if there is a predisposition to allergic reactions;
  • if you have health problems;
  • with weakened immunity.

If a parents or relatives in a direct line were susceptible to the occurrence of neurodermatitis you should take some precautions:

  1. Take a blood test for allergens.
  2. Get a preventive consultation with a dermatologist or allergist.

Prevention of relapses

Relapse prevention includes following important rules:

  1. Complete exclusion of contact with possible allergens.
  2. Compliance with the daily routine, giving enough time for sleep and rest.
  3. Compliance with hygiene standards.
  4. Rejection harmful products nutrition.
  5. Emotional state control.

Best and safe treatment is prevention. Monitor the state of your body and listen to the changes taking place.

Then it will be possible to stop the spread of the disease in time and effectively get rid of it. Neurodermatitis is a disease that can be defeated! The main thing is to start treatment as early as possible.

About the causes and methods of treating neurodermatitis in this video:

Neurodermatitis on the hands is a skin disease of a neurogenic-allergic nature, characterized by the appearance of a papular rash, itching and redness of the skin in the lesions. Pathology is different chronic course, with a clear seasonal dependence. In winter, there is an exacerbation of symptoms, in the summer - a complete or partial remission.

AT international classification diseases pathology. But many patients and doctors still call this disease neurodermatitis, since the name directly indicates the connection of dermatosis with the nervous system. Neurodermatitis can affect various parts of the body, but most often manifests itself on the hands. The disease affects mainly children and women, and in young patients, neurodermatitis can disappear on its own during puberty.

Like many others skin diseases, the development of neurodermatitis is provoked by three main factors:

  1. hereditary predisposition
  2. Decreased general immunity
  3. Violations at work nervous system

These reasons prepare fertile ground for the development of pathology, and the accompanying factors become the trigger that triggers the disease:


The allergic factor plays a big role. Skin lesions on the hands often develop in response to eating certain foods (chocolate, citrus fruits, honey, confectionery). Symptoms of neurodermatitis are often provoked by food containing preservatives, flavors, artificial colors or contact with pet hair, plant pollen, or taking medications.

In women, the development of the disease is promoted by the use of perfumes and cosmetics. That is, a violation of biochemical and functional processes in the skin occurs as a result of the body's immune response to contact with allergens.

Symptoms

Manifestations of neurodermatitis on the hands can be divided into primary and secondary. To primary symptoms relate:

  • Excessive dryness of the skin on the fingers, hands and elbows.
  • Redness of the skin in the lesions.
  • The appearance of small nodules or papular rash.
  • Intense itching.
  • Peeling of the skin with exfoliation of dry scales.
  • The appearance of weeping crusts. After they fall off, erosions remain on the skin.
  • Deepening of the skin pattern in the affected areas.

Secondary symptoms develop as a result long course neurodermatitis and are expressed in a variety of neurotic disorders:

  • Weakness, apathy, fatigue.
  • Irritability, insomnia, provoked by constant itching.
  • Lack of appetite and associated weight loss.

The progression of the disease can lead to jumps blood pressure, inflammation lymph nodes. There is a darkening of the skin, a decrease in blood glucose and secretion gastric juice. The course of neurodermatitis adversely affects the state of the adrenal glands, which leads to dysfunction genitourinary system. With absence timely treatment disease acquires chronic, exacerbations occur more often in the cold season (autumn-winter period).

Symptoms of the disease are exacerbated by exposure to moisture and the use of cosmetics. Washing the affected areas causes pain, and the use of soap and moisturizer increases the severity pathological process. Incessant itching leads to constant scratching of itchy areas and the appearance of microscopic cracks on dry skin, which become the entrance gate for infections. Severe itching prevents sleep at night and causes neurotic disorders.

Treatment of neurodermatitis on the hands is a complex and lengthy process. In order to achieve sustainable positive result it is necessary to identify the provoking factor and, first of all, treat concomitant diseases. When the first symptoms occur, a comprehensive examination should be performed to help make the correct diagnosis. In further complex treatment, the help of specialists of various profiles may be needed: a therapist, a gastroenterologist, an allergist, a dermatologist, an endocrinologist.

Symptoms of neurodermatitis are similar to the manifestations of many skin diseases:

  • eczema,
  • psoriasis,
  • pink lichen,

Therefore, to clarify the diagnosis, you will need to undergo a series of laboratory and instrumental studies.

The patient will be asked to donate blood for analysis, if necessary, a skin biopsy will be done, which will allow you to see the morphological picture characteristic of neurodermatitis. If an allergic nature of the manifestations is suspected, the patient will be prescribed skin allergy tests to identify a contact irritant.

Treatment

Treatment of neurodermatitis on the hands should be comprehensive. It includes not only therapy concomitant diseases, application systemic drugs and funds local action, but also physiotherapy, lifestyle and dietary adjustments.

Drug treatment of neurodermatitis on the hands

Vitamins are prescribed to maintain immunity. mineral complexes, which reinforce protective functions organism and reduce the adverse effects harmful factors. To cleanse the body of toxins and weaken the allergic and inflammatory factor, the appointment of enterosorbents will help (Polysorb, Activated carbon, Polyphepan). To maintain the nervous system and eliminate sleep disorders, prescribe sedatives(tincture of valerian, motherwort, bromine preparations, Seduxen), weak sleeping pills, in severe cases- antidepressants.

Eliminate painful itching and reduce inflammatory process help antihistamines(Suprastin, Claritin, Loratadin, Tavegil). These drugs block allergic reactions to cellular level and when taken orally have a pronounced antipruritic effect. Antiallergic drugs latest generation do not have a pronounced sedative effect do not interfere with driving and performing professional duties.

In case of infection of the affected areas of the skin with pathogenic microorganisms, the patient is prescribed antibacterial drugs. In severe cases, with a strong exacerbation, the doctor may prescribe hormonal drugs. They should be taken in short courses, under the supervision of a doctor, as such drugs are quickly addictive and have serious side effects.

Preparations for external use

To eliminate the painful itching, the doctor may prescribe a variety of water-based talkers, menthol creams, antiseptic solutions (Fukortsin, Castelani liquid). Positive effect give ointments containing zinc in their composition, Birch tar, sulfur, Naftalan oil. These agents have a drying, anti-inflammatory and disinfectant effect. The preparations Bepanten, Panthenol heal the skin well, Apilak ointment, preparations based on ichthyol quickly cope with inflammation. Let's talk more about the most popular tools:

Skin cappopular ointment for neurodermatitis on the hands. The main component of the drug is zinc pyrithione, which prevents the reproduction of pathogenic microorganisms, effectively fights inflammation, helps get rid of peeling and itching, and reduces irritation and redness of the skin. After just a few applications medicinal product patients notice a significant improvement in their condition. Skin Cap for ease of use is available in several dosage forms: ointment, gel, spray.

(cream, ointment, spray) - successfully used for the treatment of neurodermatitis. The basis of the drug is dexpanthenol. The drug has an anti-inflammatory effect and has pronounced regenerative properties. Ointment promotes rapid healing and restoration of the epidermis, normalizes cell metabolism, increases local immunity.

In addition to these remedies, hormonal ointments are widely used to quickly eliminate the symptoms of neurodermatitis:

  • Prednisolone ointment
  • Sinalar
  • Sinaflan
  • Triderm
  • Locoid
  • Celestoderm
  • Dermovate
  • Fluorocort

Such drugs should be prescribed by a doctor. He will select an individual treatment regimen and tell you how to treat neurodermatitis on your hands in order to achieve a stable remission and prevent repeated exacerbations of the disease. When used in short courses, these drugs do not have negative side effects.

Physiotherapy treatment

UV irradiation is recognized as an effective method of treating neurodermatitis on the hands. The procedure allows you to slow down the development of inflammatory mediators, resulting in a significantly reduced immune response skin to contact with an irritant.

  • Cold treatment. Cryotherapy sessions allow stimulating local immunity, as a result of which inflammation decreases, the symptoms of neurodermatitis disappear and the patient's condition improves significantly. The procedure has a positive effect on the state of the endocrine, nervous and circulatory system responsible for normal functioning organs. As a result, it restores mental balance, rise defensive forces organism, which allows you to effectively deal with the manifestations of the disease.
  • Balneophototherapy. The procedure is to treat lesions on the hands saline solution followed by ultraviolet irradiation. In terms of effect, this therapy is similar to spa treatment salty the waters of the Dead seas. The patient is immersed in healing bath With sea ​​salt and then irradiated with ultraviolet light. The procedure enhances the photosensitivity of the skin and prevents the manifestations of neurodermatitis.

Diet

Nutrition adjustment is an important component of successful treatment of neurodermatitis on the hands, compliance special diet help to achieve stable and long-term remission. The main feature of nutrition during an exacerbation of the disease is the elimination of all highly allergenic foods from the diet. These include:

  • Whole milk
  • Chicken eggs
  • Seafood
  • Chocolate
  • Citrus
  • red berries
  • nuts
  • bee products
  • Bananas, grapes

All seasonings, spicy and salty dishes, sweets, strong tea and coffee, flour and confectionery, sweet carbonated drinks. Special care should be taken with products containing preservatives, artificial colors and flavors. For the period of exacerbation, it is better to abandon sausages, canned food, sauces, spices. The use of alcohol is strictly prohibited. During the heat treatment of products, preference should be given to cooking, stewing, steaming.

The basis of the menu should be boiled vegetables (cabbage, zucchini, potatoes), cereals, dairy products. Useful green and light fruits, berries (apples, pears, white currants, gooseberries). You can eat lean dietary meat, mild cheeses, grain bread, make salads with greens and sunflower oil. Recommended to drink green tea, rosehip broth, compote, diluted non-acidic juices, mineral water.

As the symptoms subside, the diet is gradually expanded and added to the menu. pasta, cottage cheese, sour cream, White bread, meat, fruits and berries. It is extremely important to adhere to dietary restrictions during complex therapy, this will help bring the disease into a state of stable remission. After that, it will be possible to eat more varied, but be careful when eating foods with a high degree allergic activity.

Therapy of the disease can be supplemented with prescriptions traditional medicine. To treat the symptoms of neurodermatitis, natural ingredients are used that have a beneficial effect on the skin and do not harmful effects on the body. good effect give lotions based on decoctions medicinal herbs(mint, celandine, chamomile, oak bark, sage, nettle).

They have a softening, anti-inflammatory effect, have a healing effect and help restore the skin. Herbal teas have a strengthening effect. Beautiful therapeutic effect has the use of homemade ointments, healing baths, clay masks.

  • Hand bath. Cooking herbal collection from chamomile, lavender, succession, celandine and nettle. One glass of vegetable raw materials is poured with two liters of boiling water and allowed to brew for an hour. Then the infusion is filtered and added to the hand bath. The duration of the procedure is 20-30 minutes, it can be done daily.
  • Aloe based ointment. For cooking homemade ointment you will need 50 g of interior lard, the same amount of aloe juice and a few drops fir oil. Melt the lard, cool slightly and add the rest of the ingredients to it. Mix the ointment well and leave to cool completely. It is recommended to lubricate the affected skin 2-3 times a day, the ointment perfectly softens and heals the skin.
  • Blue clay mask. Blue clay powder is mixed with fine sea salt in equal proportions. Add a small amount of warm boiled water, diluting the mixture to a state of thick sour cream. The resulting mass is applied to the lesions on the hands and left to dry completely. At the end of the procedure, the mask is washed off. warm water, the skin is blotted with sterile wipes.

Folk methods are good because they have practically no unwanted side effects. But before using them, you should consult with your doctor, this will help to avoid possible complications.