porokeratosis natural treatment
Porokeratosis typically doesn't require treatment. Hello how are you, I would like to find out if there is a natural treatment for porokeratosis? However, when you do have symptoms, the most common effect is a noticeable odor from the feet.This is due to the skin infection on the bottom of the feet. Porokeratosis plantaris, palmaris, et disseminate A third type of porokeratosis [abstract]. Learn about the underlying causes and, Burns are categorized into different types, depending on severity. Happle R. Segmental forms of autosomal dominant skin disorders: differenttypes of severity reflect different states of zygosity. An ointment mill in use to provide reduced particle sizes and a smooth, elegant formulation for a unique compounding treatment for porokeratosis. If you have the condition, you may pass a predisposition for it down to your children. Oakley A. However, whereas DSAP appears only in sun-exposed areas, DSP can also affect areas of the body that do not get exposure to the sun. It also affects the face, shoulders, neck, and even the genitals. Gu C-Y, et al. The patient was a 35-year-old man, who complained of pruritic papules and plaques in the perianal and buttock region for thirteen years. Type 2 segmental manifestation of disseminated superficial actinic porokeratosis in a 7-year-old girl. (2003). The information on this website has not been evaluated by the FDA and is not intended to diagnose, treat, prevent, or cure any disease. You take them by mouth or rub them on your skin. The most common subtype, DSAP, may get worse in the summer and subside in the winter. And your site is so intelligently arranged. (2010). In any event if you consider that the feet can have as many as 250,000 sweat glands it is easy to see how some of them could get "clogged" from constant friction and pressure and cause this condition to occur. Localized hair loss. What are the causes of porokeratosis? Kudos to you! Pediatrics. You should also wear UV-protectant clothing, a wide-brimmed hat, and sunglasses for added protection. First, I want to let you know that you have the best web site I've found related to foot issues. Some types of porokeratosis, such as PM, LP, and PPPD, start out small and grow in time over larger areas. These lesions may be . 1996 Dec. Dervis E, Demirkesen C. Generalized linear porokeratosis. Porokeratosis should be monitored for malignancy. Disseminated superficial actinic porokeratosis (DSAP) is a very common form of porokeratosis. People describe the discomfort as if there were several pebbles stuck to the bottom of their foot or in their shoe. So, the obvious questions to ask are:1. Federal government websites often end in .gov or .mil. Home / Foot Facts / Foot Dermatology / Porokeratosis. 90, 91 Table 4 summarizes the different topical, systemic, and physical treatment . We performed a systematic literature search in an electronic database for published literature. A good review of the possible benefits to taking glucosamine, chondroitin or MSM for arthritis. There is a risk that cancerous cells may develop, and these healthcare professionals can regularly monitor the affected areas to check for this outcome. A review. It is not a contagious disease. Did you make your own lavender oil? , Porokeratosis of Mibelli. Facial porokeratosis: A series of six patients. DermNet provides Google Translate, a free machine translation service. Surgical Care. There are six main subtypes of porokeratosis, which vary in color, size, and where they appear on the body. I have mostly the red irritated spots that contain lumps of keratin--some are linear and some are round with raised edges; those raised edges also contain keratin. If you have a porokeratosis, you are strongly advised to visit your doctor regularly to watch for any signs of skin cancer or worsening of the condition. Porokeratosis suggestions porokeratosis freeze porokeratosis and psoriasis porokeratosis is it porokeratosis on the ball of my foot??? Current treatment options in In 2021, the market is growing at a steady rate and with . Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. At first, you may notice a small patch of brown bumps. Dip a cotton ball or swab into the mix and apply it to the affected areas several times each day. Int J Clin Exp Pathol. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Multiple clinical variants of porokeratosis exist. Would like to know what other people have used with success. The lesions are usually pink to brownish-red in color. DermNet does not provide an online consultation service.If you have any concerns with your skin or its treatment, see a dermatologist for advice. These are the most common courses of treatment for porokeratosis: Topical 5-fluorouracil - improves the symptoms and induces remission of all forms of porokeratosis. Sasson M, Krain AD. Looking up tacalcitol, it is this:encyclopedia.thefreedictionary.com/TacalcitolTacalcitol is a synthetic vitamin D3 analogue that is used to treat psoriasis. These bumps may slowly spread over the skin and usually do not cause symptoms, though they sometimes cause itching or discomfort while walking. Thepathologyof porokeratosisis very distinct, but it may be necessary to point out the clinical features for the pathologist to find a cornoid lamella within the pathological specimen. Again, I want I used to work for a podiatrist (front desk) back during summers in DSAP is more common on your arms and legs but may also affect skin that is damaged from the sun. If you notice any change in color or size, see your doctor. Since then, several variations have been identified. These professionals can monitor the area and check for any signs of skin cancer developing. (4, 5). DSAP Cluster of Vacuolated Spinous Keratinocytes: A Clue to Cornoid Lamellation and a Case of Porokeratosis Disseminata. Several different treatments have been attempted over the years including injections into the base of the lesions with dehydrogenated alcohol, debridements, and exfoliating agents. Andy. Thank you for responding. Over the years, your porokeratosis may expand to cover more of your skin. An article revealing that older type 2 diabetics have a higher incidence of cancer then non-diabetics. Topical creams, gels and solutions are prescribed for use in patients with numerous or widespread actinic keratoses. It is a must to protect the skin from extreme heat of the sun so as to prevent the possibility of having skin cancer. These types of porokeratosis can be found anywhere along the bottom of the feet, and depending on their location, can become . FOIA Your doctor or dermatologist can help with identification. Types of natural remedies for actinic keratosis. If you use an antifungal cream on porokeratosis, you wont see the results you expect. Just dab a bit of apple cider vinegar directly on the . The two most common types, PM and DSAP, tend to be on your arms and legs. (1971). The pathology of porokeratosis is very distinct, but it may be necessary to point out the clinical features for the pathologist to find a cornoid lamella within the pathological specimen. DSAP is caused by an ultra-sensitivity to sunlight. Treatment of porokeratosis. A person should also consider consulting their doctor if they experience any pain, itching, discoloration, or bleeding around the affected sites. Your individual risk is determined by your: You may also be more at risk if youre regularly exposed to direct sunlight. Top 10 Best Nursing Shoes For Women And Men In 2022. There is no known cure for porokeratosis and treatment is generally disappointing. I have had this condition for some time. Careers. Actinic keratoses can be removed by freezing them with liquid nitrogen. Copyright 1999 - It is suggested that cancer may surpass CVD as the number one cause of death in older diabetics. An All Natural Ointment to Remove Skin Lesions and Growths. Porokeratosis is a rare, acquired or inherited disorder of keratinization characterized by one or more atrophic macules or patches, each surrounded by a distinctive hyperkeratotic, ridge-like border called a "cornoid lamella" ( picture 1A-B) [ 1,2 ]. By accessing or using this website, you agree to abide by our Medical Disclaimer, Terms of Service, and Privacy Policy agreements. However, people may also have an inherent genetic risk of developing this type of porokeratosis. It works by removing the surface layer of the skin. Following the most effective types of natural remedies for actinic keratosis: Apple Cider Vinegar; Apple cider vinegar has some amazing effects on the body. Is the ketogenic diet right for autoimmune conditions? the amount of, or lack of fat on the bottom of the foot. Foods that are known to have immune boosting, anti-cancer properties are garlic, cabbage, tomatoes, onion, olive oil, grapes, white fish, cabbage, hot peppers, and green tea. A good review of the causes of warts and protective measures you can take to prevent developing them. Photo Source: www.researchgate.net, Picture 4: Typical signs and symptoms of punctate porokeratotic keratoderma. doi: 10.7759/cureus.26923. In benign cases, your doctor will monitor the lesions and watch for signs of malignancy. About Us · Contact Us · Disclaimer · Privacy and Cookie Policy. The main complication of porokeratosis isaskincancer, whichcan develop within a porokeratosislesion. However, even if this does reduce discomfort, a person should still consider seeing a dermatologist who can prescribe appropriate treatment. Clinical analysis and etiology of porokeratosis. Your doctor may also do a biopsy if it looks like a lesion may have a cancerous growth. $53.99 1 oz. I usually do my research on the Mayo clinic website. It consists of a keratinization disorder, which may appear in several clinical forms and can undergo malignant . arrow-right-small-blue So far this seems to be working but it is very slowMy lesions are on my calves and thighs. A variety of factors may cause DSAP to develop. Eczema is also called dermatitis. Do you know which type you have been diagnosed with? Learn the causes of and treatment for hypertelorism, a wider than typical space between the orbits of your eyes. In some cases, your doctor may prescribe topical or . Porokeratosis refers to a group of skin conditions that typically appear as small patches with a raised edge. (4, 5) Tea tree oil - It is effective in the treatment of actinic keratosis. 1996;192(3):255-8. doi: 10.1159/000246378. Herein, a case of porokeratosis ptychotropica was reported. There is no known cure for linear porokeratosis, and treatment generally produces disappointing results. Please help, I am not sure what to do now! Some types cover large areas of skin (DSP, DSAP, and PPPD) and others are more localized (PM, LP, and PP). Porokeratosis is an uncommon diagnosis. These lesions generally occur on the weight bearing part of the foot which is the ball of the foot and the heel but may also occur in the mid arch. However, a wide age group of adults may be affected (27-84 years) Both males and females may be affected, although a high male predominance is noted (male-female ratio is 9:1) Individuals of all racial and . A 2017 review of treatment for porokeratosis lists the following options: The exact causes of certain subtypes of porokeratosis are unknown. Treatment of disseminated superficial actinic porokeratosis (DSAP) is poorly standardized. Each porokeratosis lesion has a characteristic ridge on its border and a central furrow. Board-certified dermatologist who specializes in cosmetic, laser, and medical dermatology . The patient says it has increased in size since it was debrided by another DPM. Food choices that raise your risk of type 2 diabetes, the type of shoe a patient wears, thin soled shoes are worse then cushioned shoes, the amount of walking a person does during the course of a day. However, older research suggests that people may inherit PPPD. is a group of skin conditions in which there is abnormal, patches on the palms and soles that later spread to the limbs and trunk, In some types of porokeratosis, a family history is present, Kaur S, Thami GP, Mohan H, Kanwar AJ. Put it in a jar then add apple cider vinegar until it covers the eggplant. autoimmune and inflammatory diseases, including. By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. 2019 Health Fixit. Have started using Apple Cider Vinegar with mother but have not seen any improvement. "Successful treatment of porokeratosis of Mibelli with diamond fraise dermabrasion". A presentation of newer skin protection combinations in an effort to better protect the skin from the hazards of sun exposure. I hope you can find something useful in the above. DSAP, the most common type, affects areas of the body exposed to sunlight. Porokeratosis: A review of unique group of keratinizing disorder. Keep in mind that while porokeratosis of Mibelli may appear on several parts of your body, it doesnt spread via contact. It is more frequently seen in women, probably because they more readily seek advice for cosmetic concerns. There were no randomized controlled trials on the treatment of PK, but mainly case reports and case series. Linear porokeratosis is a rare form of porokeratosis that usually occurs in early childhood. Alerts and Notices Synopsis Porokeratosis is a disorder of keratinization characterized by a distinct peripheral, thin, ridge-like scale that corresponds histologically to a thin, angled column of epidermal parakeratotic cells that extends through the stratum corneum. This discussion is limited to punctate porokeratosis. Hence, it is believed that anyone can get porokeratosis regardless if you have the family history or not. You can learn more about how we ensure our content is accurate and current by reading our. No studies showing the value of prophylactic nonexcisional surgical treatment in reducing the incidence of malignancy within porokeratosis have been reported. When going out in the sun, make sure you wear sunscreen or wear long sleeves. People with DTD have many health complications related to their. Cardiovascular health: Insomnia linked to greater risk of heart attack. Other possible causes or porokeratosis are weakened immune system, excessive exposure to ultraviolet rays of the sun, radiation, and side effects of therapeutic phototherapy. Please consult a healthcare practitioner before making changes to your diet or taking supplements that may interfere with medications. Reply . Any statements made on this website have not been evaluated by the FDA and any information or products discussed are not intended to diagnose, cure, treat or prevent any disease or illness. THANKS FOR A WONDERFUL AND VERY HELPFUL SITE! By accessing or using this website, you agree to abide by the Medical Disclaimer, Terms of Service, Privacy Policy, and Affiliate Disclosure. (n.d.). Anecdotal evidence suggests that aloe vera may alleviate the itching that some people with certain subtypes of porokeratosis may experience. Learn about identification and, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. It can be triggered by allergies, irritating chemicals and other factors. There is no known cure for porokeratosis and treatment is generally . Your doctor may suggest monitoring its growth over time. Porokeratosis of Mibelli in transplant recipients. The physician applies these creams and gels directly to affected areas of the skin to treat visible and invisible lesions with minimal risk of scarring. 2022 Feb 15;15(2):56-62. eCollection 2022. In some cases, your doctor may prescribe topical or systemic drugs to help reduce your symptoms. All rights reserved. Porokeratosis is a disorder of keratinization that presents with keratotic papules or annular plaques with a well-defined ridge-like border 2. DOI: Lanka P, et al. 2017 Aug;18(4):435-449. doi: 10.1007/s40257-017-0271-3. Learn about causes, possible symptoms, complications, and more. Last medically reviewed on September 12, 2017, How you treat a swollen eyelid depends on its cause. Methods: Other forms of treatment for porokeratosis plantaris include the use of, These lesions may also be injected. While porokeratosis of Mibelli is more common in children and young adults, DSAP is more common in older adults. . Testimonies from users of ACV have stated that applying it directly to the keratosis for a protracted . To the PubMed site, part of NIH, part of HHS:http://www.ncbi.nlm.nih.gov/pubmed. A total of 88 articles fulfilling our inclusion criteria were found. What Causes a Swollen Eyelid, and How Is It Treated? it usually appears in adulthood, starts on the palms of the hands and soles of the feet and gradually spreads over the skin. This site needs JavaScript to work properly. Is your poro keratosis on the sole of your feet? As your skin heals, the damaged cells slough off, allowing new skin to appear. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Content may not be reproduced in any form. Punctate porokeratosis palmaris et plantaris. American Osteopathic College of Dermatology. DSAP may be itchy, leading to bleeding from scratching. We describe a patient with this condition whose skin lesions responded to topical tacalcitol. Current therapeutic modalities include topical agents, systemic medications, and surgical interventions that have variable efficacy. In studies, researchers have found that artificial sunlight has produced DSAP lesions. No controlled clinical trials have evaluated the efficacy of the different treatment options available for symptomatic porokeratosis, and existing recommendations are based mainly on case reports, small series with fewer than 20 patients, and 2 systematic reviews. official website and that any information you provide is encrypted Leave on as long as possible or overnight. 1187-8. A rare case of disseminated superficial porokeratosis-Case report. Porokeratosis plantaris discreta (porokeratosis) is a seed-like hyperkeratotic lesion which may be found on the soles. Can diet help improve depression symptoms? Disseminated superficial actinic porokeratosis (DSAP). Several different treatments have been attempted over the years including injections into the base . Less common types are porokeratosis palmaris et plantaris disseminate and linear porokeratosis.. It is called linear because they are arranged in one or more lines. Included is detail on types of hyperkeratosis and when to see a, Actinic keratosis is a precancerous skin condition that causes patches of rough, patchy lesions. I have porokeratosis. In many people they are a non-issue but in others they can be very painful. There is a high possibility of developing skin cancer. expected, by itself, to be definitive treatment; or CPT 17000 (CPT 17003, CPT 17004) - destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), benign lesion . We hypothesized that topical therapy that aims to replenish cholesterol, an essential mevalonate pathway end-product, and block the accumulation of mevalonate pathway toxic metabolites could alleviate porokeratosis. A dermatologist will inspect the affected areas and possibly perform dermoscopy. A porokeratosis lesion in a patient with disseminated superficial actinic porokeratosis. There are six main subtypes of porokeratosis: The most common subtype of porokeratosis, DSAP usually appears in people in their 20s or 30s. 2005 - 2023 WebMD LLC. The biopsy should include the raised edge of the lesion. I have used small cotton round that women use to remove make up as they are flat and inexpensivecut a small square the size of areaand put a few drops of the ACV or Oil on the small square. Simultaneous co-occurrence of porokeratosis of mibelli with disseminated superficial actinic porokeratosis. Porokeratosis is associated with mevalonate pathway gene mutations. What is the latest research on the form of cancer Jimmy Carter has? Image Source: img.medscapestatic.com, Image 3: A patient demonstrating the symptoms of linear porokeratosis. This characteristic border is called the "cornoid lamella" and is best seen with a microscope or . Disseminated superficial actinic porokeratosis (DSAP). Schedule a consultation to learn which . If you notice any changes in your skin or you notice new lesions, you need to inform your doctor right away. (2004). Dry skin. These reddened, raised plaques on the surface of the skin can be diagnosed as porokeratosis via a biopsy examined under the microscope. This can be done alone or in conjunction with curettement in an effort to extend the period of relief. 2006Sep;45(9):10779. Some people even drink it to reduce weight, women who bloat during their period also drink it to make the blood thin, but most importantly . Surgical approach is intended for malignant form of porokeratosis. A distinctiveclinical variant of porokeratosis of Mibelli. BTW, if you're not Caucasian you will have a much harder time getting enough D3 made through sun skin action, even if in southern latitudes nearer the Equator and even if between 10 AM-2 PM! American Osteopathic College of Dermatology: DISSEMINATED SUPERFICIAL ACTINIC POROKERATOSIS., Genetic and Rare Diseases Information Center: Porokeratosis of Mibelli., Indian Dermatology Online Journal: Porokeratosis - Head to toe: An unusual presentation., The MalaCards human disease database: Porokeratosis (DSAP).. Int J Dermatol. You should also talk to your doctor before trying any home or over-the-counter medications. There are several varieties of porokeratosis. If that helps at all, it is very very slow. Disclaimer. Do chronic wounds need to be dressed daily? (8). DOI: Gupta M. (2016) Disseminated superficial actinic porokeratosis. rarediseases.info.nih.gov/diseases/10983/disseminated-superficial-actinic-porokeratosis, jamanetwork.com/journals/jamadermatology/article-abstract/532436, dermnetnz.org/topics/linear-porokeratosis, dermnetnz.org/topics/porokeratosis-of-mibelli, dermnetnz.org/topics/disseminated-superficial-actinic-porokeratosis/, rarediseases.info.nih.gov/diseases/4438/porokeratosis-of-mibelli, rarediseases.info.nih.gov/diseases/8180/punctate-porokeratosis. Advanced treatment approach is also needed to significantly improve the condition of the patient. Porokeratosis is the general term for a group of skin conditions causing small, discolored bumps with a raised border to appear on the skin. Healthline Media does not provide medical advice, diagnosis, or treatment. Topical imiquimod cream stimulates a local immune response in the skin, leading to destruction of the actinic keratosis cells. This natural product is known to cure different types of skin ailments. The Global Porokeratosis Treatment market is anticipated to rise at a considerable rate during the forecast period, between 2023 and 2028. Explain the natural course of the lesions and that most of them can be relatively difficult to treat. It is important to limit sun and UV exposure to the affected areas of your skin. The degree of discomfort a patient will experience will vary from person to person. Thank you for that. Also discover home remedies and when to see a. The spots covered entirely my legs and arms, such that . Earth Clinic can help you find Natural Remedies for Porokeratosis, a clonal disorder of keratinization characterized by one or more atrophic patches. The biopsy should include the raised edge of the lesion. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527053/, https://escholarship.org/uc/item/5n1901d5, https://www.bad.org.uk/patient-information-leaflets/disseminated-superficial-actinic-porokeratosis/?showmore=1&returnlink=https%3A%2F%2Fwww.bad.org.uk%2Fpatient-information-leaflets#.X_Cb0Kr7TeR, https://www.spandidos-publications.com/10.3892/etm.2014.1803, https://escholarship.org/uc/item/5j96k8qd, https://www.ncbi.nlm.nih.gov/books/NBK459202/, https://www1.racgp.org.au/ajgp/2019/november/precancerous-skin-lesion-often-misdiagnosed, https://rarediseases.info.nih.gov/diseases/4438/porokeratosis-of-mibelli/cases/36175, https://rarediseases.info.nih.gov/diseases/8180/punctate-porokeratosis, https://clinmedjournals.org/articles/ijdrt/journal-of-dermatology-research-and-therapy-ijdrt-5-063.pdf, https://www.researchgate.net/profile/Arfan_Bari/publication/288775438_Porokeratosis_A_review_of_unique_group_of_keratinizing_disorder/links/5ee98151299bf1faac5c7c34/Porokeratosis-A-review-of-unique-group-of-keratinizing-disorder.pdf, https://www.sciencedirect.com/science/article/pii/S1578219020302055, https://pubmed.ncbi.nlm.nih.gov/28283894/, https://dermnetnz.org/topics/porokeratosis/, https://www.ncbi.nlm.nih.gov/books/NBK532290/. Porokeratosis is an uncommon diagnosis that presents with keratotic papules or annular plaques with an elevated border. Image Source: escholarship.org. Specialty. Health Benefits of Phyllanthus Niruri- Gale of the Wind, People with pale skin, freckles, light-colored eyes (blue or lighter), and blonde or red hair, Have previously had actinic keratosis or skin cancer, People with compromised immune systems (typically from organ transplant medications, chemotherapy, leukemia, or autoimmune disorders such as AIDS). Porokeratosis of Mibelli is a skin condition that usually develops in children or young adults. DOI: Mehta V, et al. It can be applied at home and is typically used two to three times a week for up to 16 weeks, making this a longer course of treatment compared to topical fluorouracil. Surgical treatment is essential for porokeratosis lesions that have undergone malignant transformation. Arch Dermatol. (2012). The .gov means its official. If the condition gets worst, a surgery might be needed. DermatolSurg. Porokeratosis is usually diagnosed by its appearance. 2009 Jan-Feb;19(1):25-8. doi: 10.1684/ejd.2008.0567. In order to debride porokeratosis correctly, it is important that the core of the lesion is removed. Annular pancreas is an extra ring of pancreatic tissue surrounding the small intestine. However, the appearance may improve with the following measures: Sun protectionis important as exposure toultraviolet radiationmay result in the development of askin cancerwithin the linear porokeratosis. Adverse events did not seem to be any better or wors. Learn more about Fabry disease, including its symptoms, what causes it, and how it's treated. Their size, onset and distribution depends on the specific type of porokeratosis. 2023 Earth Clinic LLC. Disseminated superficial actinic porokeratosis (DSAP) is a chronic condition characterized by numerous atrophic papules and patches with a distinctive peripheral keratotic ridge, typically found on sun-exposed areas. I was ashamed to go into public. Make wet enough, but not dripping. People that met me thought that is was a communicable disease. Unable to load your collection due to an error, Unable to load your delegates due to an error. It takes only a few minutes and can be done in . It is more common in females than in males. eCollection 2022 Jul. Cortisone injections are usually of no value but. But there are rare occurrences of a similar ridge appearing alongside other kinds of skin lesions, so your doctor may perform a biopsyto rule out other diagnoses. The best course of action is preventing further sun damage. Porokeratosis: a differential diagnosis to consider in benign lichenoid keratosis. As PPPD is an extremely rare subtype of porokeratosis, there is a lack of research exploring its causes and potential triggers. I'd try either apple cider vinegar (ACV) or Castor oil. Theres also evidence that laser treatments have improved the appearance of porokeratosis. Truly, it is uncommonly kind. Can you get a doctor to give you an Rx for the D3 skin cream used for psoriasis, to try on your skin for your condition? Porokeratosis is most commonly found among children and young adults. This type of porokeratosis develops on your skin, and may also affect other tissue in your body. A good review of how blood sugars can become elevated and the harm that can do. Background: As in other clonal keratinocyte disorders, treatment for porokeratosis is primarily focused on lesion destruction by using cryotherapy, photodynamic therapy, carbon dioxide lasers, 5-fluorouracil, or a combination of these therapies. You have an unusually clear, informative and well-written website for laypersons. Porokeratosis of Mibelli. Currently, there is no cure for porokeratosis. Often misdiagnosed as chronic UV-damage or actinic keratoses, patients are treated for years with different therapeutic options with little success.
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