This one in particular caught my eye. Treatment of keratosis pilaris and its variants: a systematic review. Everyday when I get out of the shower, I spray on the mixture (I keep it in a small spray bottle) and rub it into my skin. of signs you need emergency medical attention or call 911. Medicinal use of this product has not been approved by the FDA. Fish oil and borage oil are other useful Even water irritates it if the water isn't dried fast. 14. Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have ever had: bleeding problems or a blood-clotting disorder; a stomach disorder called gastroesophageal reflux disease (GERD); cancer of the breast, uterus, ovary (or other hormone-sensitive conditions). (In eng). It's a great feeling, and I will not be embarrassed to wear short sleeves anymore. Dry, rough skin in the areas with bumps. I was diagnosed with keratosis pilaris over 10 years ago by a dermatologist who said there was nothing he or I could do about it. She has a passion for natural, toxin-free living, particularly when it comes to managing issues like anxiety and chronic Lyme disease (read about how she personally overcame Lyme disease here). "Avoid super-hot showers or baths on a regular basisthey contribute to dry skin, which makes KP more likely," says Villafranco. Br J Dermatol 1994;130(6):711-3. (In eng). a very common, dry skin condition caused by keratin accumulation Botanic Tree Glycolic Acid KP Exfoliating Wash. Botanic Tree offers a wide range of skin and body care products that are powered by organic and natural ingredients. Perhaps it is this sebaceous gland aplasia that is at the crux of keratosis pilaris pathophysiology, at least for some KP subtypes. Both of these skin conditions tend to run in families and appear in patches on the skin. Inflammation, redness and scarring may occur. Curcumin should not be taken for 2 weeks before surgery because it has blood-thinning properties. Some people who have plaque psoriasis will also have nail psoriasis. Most plans take a few weeks to take effect. Topical retinoids encourage normal follicular keratinisation with improvement in the appearance in some patients but may irritate. Keratosis Pilaris and its Subtypes: Associations, New Molecular and Pharmacologic Etiologies, and Therapeutic Options. In African Americans, psoriasis often looks violet and the scale may be gray. Without sebaceous gland-derived lipids (i.e., sebum) corneocytes are unlikely to mature and shed properly, and hair shafts are unlikely to properly form, leading to hyperkeratinization of the acroinfundibula and subsequent chronic inflammation. In a study by Gruber et al., skin biopsies were taken from ten subjects with KP of lesional and non-lesional skin.19 There was a striking absence of sebaceous glands in biopsies from lesional skin compared to non-lesional skin histology of the same individual in all cases. The Minimo Glow is a powerful, but gentle turmeric-based exfoliator that naturally buffs away surface dark spots on the skin. The turmeric root is also used to make alternative medicine. 13. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. 2. WebKeratosis pilaris (KP) is a common skin disorder characterized by rough follicular papules, giving it the unfortunate nickname chicken skin. 1 It is most often seen in children and adolescents and is estimated to affect between 50 and 80 percent of all adolescents. Bromelain, an enzyme found in pineapple, increases the absorption and anti-inflammatory effects of curcumin. I've been using this soap for a few months now and the bumps on my arms almost gone. Whether you are treated by a medical doctor or a practitioner trained in the use of natural medicines/supplements, make sure all your healthcare providers know about all of your medical conditions and treatments. According to the National Psoriasis Foundation, this may often be the case despite the fact that psoriasis can be more severe in skin of color, covering a larger surface area of skin. I've had kp for a long time and I've always had trouble drinking milk. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Because, again, inflammation. Baking soda mixed with warm water makes a paste that you can rub onto your skin in small, circular motions for about five minutes. Dermatol Online J 2012;18(4):7. Stick to short showers, and clean and exfoliate your skin gently. Br J Dermatol 1985;112(6):679-85. 1. I now am constantly rubbing my SMOOTH ARMS, just feel to them, as I never had them without bumps before. Curcumin-containing supplements, which are available without a prescription in the U.S., may cause gastritis and peptic ulcers if taken on an empty stomach. They are not painful or significantly pruritic in most patients. Mayo Clinic: Keratosis Pilaris Symptoms and Causes, American Academy of Dermatology: Keratosis Pilaris Overview, Robert Anolik MD, board certified dermatologist and Fellow of the American Academy of Dermatology, U.K. National Health System: Keratosis pilaris, National Library of Medicine: Keratosis pilaris, Nationwide Childrens Hospital: Keratosis Pilaris, American Academy of Family Physicians: Keratosis Pilaris, Johns Hopkins Medicine: Keratosis Pilaris, American Academy of Dermatology: Keratosis Pilaris: Who Gets and Causes, American Academy of Dermatology: Keratosis Pilaris: Signs and Symptoms, Mayo Clinic: Keratosis Pilaris Diagnosis and Treatment, American Academy of Dermatology: Keratosis Pilaris Diagnosis and Treatment, Cleveland Clinic: "Dermatitis Herpetiformis", Dry, rough skin that feels like sandpaper, The bumps can be the same color as your skin or they can be red, brown or white. Common side effects of turmeric may include: This is not a complete list of side effects and others may occur. A randomized, single-blind crossover study showed that oral administration of hempseed oil for 20 weeks resulted in significant changes in plasma fatty acid profiles and improvement in skin dryness and itchiness, along with decrease in use of topical medications.26 This may be due to the fact that hempseed oil is an abundant source of omega-6 and omega-3 polyunsaturated fatty acids (PUFAs). (Because the palms of your hands and soles of your feet don't have hair follicles, they aren't affected by keratosis pilaris.). The apple cider vinegar (being acidic) and teeth don't play nice together. "Anyone can get it, but children and adolescents have a higher incidence of KP than adults: Itsextremely common in people under 50, and less common in the elderly. 10. Turmeric is commonly used to flavor or color curry powders, mustards, and other foods. Eat Better Get Fit Feeding filaggrin: effects of l-histidine supplementation in atopic dermatitis. (2013, October). Turmeric taken by mouth may lower testosterone levels and sperm motility in men. So far it doesn't seem to be working, but I'll keep at it for a few weeks to see. 7. I have Keratosis Pilaris and I have read on how ACV can help this condition I have. If you choose to use turmeric, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. All rights reserved. You can learn more about how we ensure our content is accurate and current by reading our. I bought some products from a website that touted they could get rid of "chicken bumps". Keratosis pilaris is marked by bumpy skin that often feels dry and rough. (In eng). In their final analysis, Kootiratrakarn et al. 25. Nelson, K. M., Dahlin, J. L., Bisson, J., Graham, J., Pauli G. F., & Walters M. A. That being said? Patients with keratosis pilaris may report having rough and prickly goose bumps on their skin. Shingles and psoriasis are both skin conditions that can lead to itchy, uncomfortable rashes. KP also has a strong link with atopy, ichthyosis vulgaris and xerosis.22,23 Thus, oral supplements that have been shown to improve atopic dermatitis and skin dryness could be useful for KP. popcorn) as helpful as drinking it?? Psoriasis and scabies are both skin conditions that can cause annoying symptoms. Dermatology 2016;232(1):122-5. Can poor sleep impact your weight loss goals? DOI: 10.1067/mjd.2002.122733. Efficacy of dietary hempseed oil in patients with atopic dermatitis. Eliminate synthetic fragrances from all of those products as well.". "Don't scrub or try to exfoliate these areas like you would with a brush or pumice, or you'll aggravate it.". Keratosis pilaris (KP) is a common skin disorder characterized by rough follicular papules, giving it the unfortunate nickname chicken skin.1 It is most often seen in children and adolescents and is estimated to affect between 50 and 80 percent of all adolescents.2 It predominantly occurs on the extensor surfaces of the arms and legs but can also affect the face, buttocks, and trunk. 9. 3. Not all possible interactions are listed in this product guide. You provide the water by not drying off, and the body oil seals in that moisture as you rub it in with your hands," says Villafranco. I cannot believe it.. ", You can certainly try all of these strategies at once to up your chances of success, but if you do, just keep in mind that it may be hard to tell which particular strategy is working best. I wash my arms with the ACV. Although not all side effects are known, turmeric is thought to be likely safe for most people when used as directed for up to 8 months. To remove dead skin cells (exfoliate), use a cream or lotion designed to slough off dead skin (called a keratolytic) once a day. But more surprisingly, your diet may also exacerbate symptoms. The very next day after I made and applied the mixture, my arms felt smooth and touchable. While some early outcomes seem to back up at least some of the healing qualities long since attributed to it, a recent study into its medicinal chemistry concluded that curcumin does not appear to have the properties required for a good drug candidate. Learn the different symptoms for the various types of psoriasis. I am using the remedy on one arm and not the other as an experiment and am noticing a difference after only 24 hours so am very hopeful this will be my saving grace! Turmeric is likely to be safe during pregnancy when used in the small amounts that are found in spices or foods. DOI: 10.1046/j.1365-2133.1999.02771.x. Now it covers her legs, is on her arms, and lightly on her cheeks. For Keratosis Pilaris I have discovered that washing with castile soaps with a loofa works wonderfully. Another possible culprit is your clothing: "My theory is that these areas are the places where your clothing tends to rub back and forth on your skin the most, and it stimulates dysfunctional keratin production in the hair follicles," says Villafranco. Studies have suggested that curcumin has protective effects against skin-damaging chemicals and environmental pollutants. "We wouldn't usually need a biopsy," or tissue sample. I find out it was solar keratosis (too much time spent in the sun). The information on this website has not been evaluated by the FDA and is not intended to diagnose, treat, prevent, or cure any disease. Biologics, ultraviolet light therapies, and photochemotherapy may be used to treat more severe cases of psoriasis. Turmeric should not be confused with Javanese turmeric root (Curcuma zedoaria). Keratosis pilaris is a common skin condition that causes small bumps on the skin, much like goosebumps. Brand names: Curcuplex-95, Curcumin 95 Symptoms include: Painless tiny bumps on the upper arms, thighs, cheeks or buttocks. 22. Tell your doctor if you are taking an iron supplement. Keratosis pilaris is a common skin condition that causes small bumps on the skin, much like goosebumps. There is also evidence to suggest that curcumin may help the following skin conditions: Melanoma may benefit from curcumin treatment. Although there is no clear consensus on the solution for KP, many different treatments are available to reduce its symptoms. If you need surgery, dental work, or a medical procedure, stop taking turmeric at least 2 weeks ahead of time. So last night I mixed up some ACV and water, exfoliated my arms well and then put it on. Learn about 10 benefits of turmeric, Cinnamon is a popular spice in the United States and Europe, and it may have health benefits. Papular, profuse, and precocious keratosis pilaris. Rosehip oil is a natural remedy often suggested as an alternative for retinol in the treatment of keratosis pilaris on your face and other skin areas. It has been used in Indian and Chinese traditional medicine for purposes as diverse as treating cancer to repelling mosquitoes. It can be managed, she says, but only with continued therapy. A comparative trial comparing the efficacy of tacrolimus 0.1% ointment with Aquaphor ointment for the treatment of keratosis pilaris. Jakeman A. All rights reserved. Our online classes and training programs allow you to learn from experts from anywhere in the world. Fortunately, keratosis pilaris often goes away permanently with time. In the meantime, you might use one of the many products available to help improve how the skin looks. Keratosis pilaris is a common skin condition that often affects teenagers and young adults. Hidradenitis suppurativa, eruptive melanocytic nevi, and keratosis pilaris-like eruption in a patient treated with vemurafenib. Limiting showers and baths to no more than 10 minutes, Bathing in lukewarm or warm rather than very hot water. These immature skin cells, called keratinocytes, build up on the skins surface. Keratosis pilaris happens when keratin builds up in hair follicles. Heres what to know about these drugs and how theyre different from other psoriasis. Stephanie Eckelkamp is a writer and editor who has been working for leading health publications for the past 10 years. HELP! My daughter is 14 months old and started developing these bumps that her pediatrician diagnosed as Keratosis Pilaris when she was around 7.5 months old. 28. WebHEALTHY GLOWING SKIN: Glow without hassle with #1 our bestseller, the Minimo Glow Turmeric Face Scrub. I also just wanted to say that, for her at least, there's not a possibility that she has this due to anxiety or stress as she is just a baby, nor is it caused by laundry detergant. Avoid using turmeric together with other herbal/health supplements that can also affect blood-clotting. Keratosis pilaris is a very common, benign, heritable disorder of keratinized hair follicles. "So, keratosis pilaris is a buildup of keratin and dead skin cells within the hair follicles, causing them to bulge, giving them the bumpy texture, and often causing them to get irritated and inflamed.". Consult with a licensed healthcare professional before using any herbal/health supplement. 4. How Bad Is It Really to Not Wash Your Hair After Every Single Workout? In response to the girl who said she exfoliated her arms before using ACV----- you should never use any type of abrasive scrub on your arms. Kootiratrakarn T, Kampirapap K, Chunhasewee C. Epidermal Permeability Barrier in the Treatment of Keratosis Pilaris. This condition tends to appear worse in the winter. Keratosis pilaris treatment often requires the application of topical treatments including apple cider vinegar amd coconut oil. Do not use more of this product than is recommended on the label. I was worried about your ingredients mix, as I thought I would smell like ACV if I applied it. The bright yellow powder derived from the root of the turmeric plant is also known as Golden Goddess and Indian Saffron. These prevent the hair follicles from getting blocked. 29. Case Rep Dermatol 2016;8(1):91-6. If it doesn't help then I was going to try the AV. Curcumin has blood-thinning properties, and people should not take it with other blood thinners, including aspirin. We totally get it if you want to treat it. Psoriasis, particularly in more severe cases, warrants a doctor visit to manage the symptoms. MNT is the registered trade mark of Healthline Media. Another helpful facial product for battling keratosis pilaris, this gel moisturizer works to deeply hydrate dry, irritated skin with hyaluronic acid, explains Engelman. Hi everyone, I've been doing a lot f research on the internet and found a few people saying they either switched their milk to coconut milk or used coconut milk soap and their Keratosis Pilaris (kp) has reduced by about 90% or completely gone. J Am Acad Dermatol 2021 (In eng). Best Keratosis Pilaris Treatment Kit Glytone Glytone KP Kit $69 at Dermstore To that end, these are the best keratosis pilaris treatments, according to dermatologists. Lori S. Kim is a fourth-year medical student at the University of Illinois at Chicago College of Medicine. 1 table spoon of soy lecithin (emulsifier) Keratosis pilaris often develops in patches that have a rough, sandpapery feel. People have attributed turmeric with seemingly miraculous healing properties for nearly 4,000 years. If you are experiencing serious medical symptoms, please see the Turmeric is often sold as an herbal supplement. Turmeric has also been used to treat stomach ulcers. Keratosis pilaris, or KP, is simply a buildup of keratin and dead skin cells within the hair follicles, which causes them to bulge and become irritated and inflamed 1, giving your skin a bumpy texture. And if you're a Reddit skincare enthusiast, you might've also read about this ingredient treating keratosis pilaris, too. No, we haven't switched detergants, but all summer long she has been in a onsie or sundress, shorts and T shirt, and her trunk does not have KP at all. Keratosis pilaris is a common and harmless skin condition affecting children and adults. I also eat a spoonful a day, usually melted into my coffee. in journalism from Syracuse University with a minor in nutrition. Macdonald JB, Macdonald B, Golitz LE, LoRusso P, Sekulic A. Cutaneous adverse effects of targeted therapies: Part II: Inhibitors of intracellular molecular signaling pathways. DOI: 10.2147/ccid.S146760. Initially I did feel and see a slight difference, but it didn't last. KP is more common in women than men and often occurs in people with a history of asthma or eczema," says Villafranco. 12. For this reason, derms, like Airan and Villafranco, recommend avoiding long, hot showers or baths, which can suck moisture from the skin, and always following up with a moisturizer of some kind. Apply it to damp skin within 5 minutes of bathing. I apply coconut oil on my skin after I shower and that seems to help me a lot but there still is a lot of kp left and I want to find a way to get rid of it completely. The best skin care ingredients to use for keratosis pilaris treatment include coconut oil, jojoba oil, lavender essential oil, sea salt, raw honey, avocado and Castile soap. Rethink hair removal: Shaving or waxing skin with keratosis pilaris can cause more bumps. Scleroderma causes the immune system to attack otherwise healthy connective tissue, resulting in scarring. Copyright 1996-2023 Cerner Multum, Inc. The type of psoriasis and severity of the disease determine which approach to take for treatment. Maghfour J, Ly S, Haidari W, Taylor SL, Feldman SR. 24. These are available both over-the-counter and by prescription. in journalism from Syracuse University with a minor in nutrition. Keratosis Pelasis is caused by a buildup of keratin, a protein that forms to protect the skin from infection and foreign substances. Dr. Lio is an advisor with stock options for KPAway, a skin care company focused on solving keratosis pilaris. Source - I work in Mental Health. You can find them infused in body washes or treatments. Often referred to as "chicken skin" or "goose bumps," keratosis pilaris is a common condition marked by tiny bumps on different parts of the skin. Pimples on the Upper Arms That Won't Go Away. I tried apple cider vinegar as suggested and I am amazed at the results. Hoste E, Kemperman P, Devos M, et al. It burned my arms, and just made them more red. The accumulation of keratin debris within the follicular orifices appears to cause the rough and bumpy texture of KP-involved skin. I'm also a believer in mind/body connection. Although this was a small study of 68 Black and white adults, the authors hypothesized that people who are Black may be less familiar with biologics than people who are white. Doctors may sometimes use a handheld device called a dermatoscope to get a closer look at the skin and hair follicles and confirm a diagnosis. DOI: 10.1155/2015/205012. The overall goal is to reduce abnormal folliculocentric thickening and dryness so treatments for related skin disorders such as atopic dermatitis should be considered when treating the symptoms of KP. Use a moisturizer that contains urea or lactic acid. Subsequent filaggrin proteolysis releases L-histidine as an important component of natural moisturizing factor (NMF), therefore L-histidine can potentially improve skin hydration by improving barrier function.24 A randomized, double-blind, placebo-controlled nutritional supplementation pilot study showed that L-histidine significantly increased both filaggrin formation and skin barrier function.25. Or was it on other parts of your body? I hope you all find what works best and that I can figure out what works for my little girl! Unique Cutaneous Reaction to Second- and Third-Generation Tyrosine Kinase Inhibitors for Chronic Myeloid Leukemia. It is not certain whether turmeric is effective in treating any medical condition. The way the conditions look on the skin and how theyre treated is different. Turmeric is also known as Curcuma, Curcumin, Halada, Haldi, Haridra, Indian Saffron, Nisha, Pian Jiang Huang, Rajani, Safran Bourbon, Safran de Batallita, Safran des Indes, Turmeric Root, and Yu Jin. Only Glycolic Acids (like fish oil supplements ). And ALAs as gentle peels. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use. pathologic hair shaft development; and/or 3.) DOI: 10.1159/000437383. Evid Based Complement Alternat Med 2017;2017:5469125. Call your doctor for medical advice about side effects. Ma L, Dominguez AR, Collins GR, Kia KF, Cockerell CJ. Here's what else you need to know about this common skin condition. Here are a few options: You can also use a loofah or washcloth to exfoliate. Therapeutic roles of curcumin: Lessons learned from clinical trials. $4/ounce) and 6.7 ounces (Approx. These medications usually contain ingredients such as: In some instances, your doctor may recommend using a corticosteroid cream or laser treatment. Pediatr Dermatol 2012;29(3):285-8. 2004 Mar 1;50(3):P39. What is the latest research on the form of cancer Jimmy Carter has? Well, it's not totally clear. Am Fam Physician 1978;17(2):151-2. Keratosis pilaris medications like treatment creams Retin A or Retinol may be prescribed for more severe cases, says Dr. Ceilley. Keratosis pilaris is not harmful, but there are some things you can do to manage it if it bothers you. 4 oz of organic coconot oil Other names for keratosis pilaris include KP or chicken skin because it looks like goose bumps. Keratosis pilaris typically appears on your upper arms, but it can also appear on any other part of your body that has hair follicles. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. For the keratosis pilaris on my face: A sulfate-free face wash morning and night A gentle lactic acid serum every other night A fragrance-free moisturizer morning Racial differences in perceptions of psoriasis therapies: Implications for racial disparities in psoriasis treatment. Baden HP, Byers HR. A buildup of keratin that is not properly exfoliating causes it. If this doesn't work after about six weeks or if the symptoms are severe, contact your primary care doctor or a dermatologist to see if more can be done. Dermatology Research and Practice 2015;2015:205012. She received her B.S. All Rights Reserved. Turmeric has assumed an almost mythical status in some cultures for its use in an extraordinarily broad range of ailments. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. There seems to be too many methods of consuming ACV here, so Im kinda confused :( Thanks! Please note that we use cookies necessary for the functioning of our website, cookies that optimize the performance. "It's really more of an annoyance," says board-certified dermatologist Roger I. Ceilley, MD, FAAD, clinical professor of dermatology at the University of Iowa Carver College of Medicine and past president of the American Academy of Dermatology (AAD). In this article, we look at whether turmeric can be beneficial for skin health, including psoriasis and acne. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. 27. Native to South Asia, This list is not complete. The active curcumin component that gives turmeric its color may have therapeutic benefits for the skin. These bumps which some people describe as pimple-like usually don't hurt or itch, according to the Mayo Clinic. You may not need to be treated for keratosis pilaris unless you find it uncomfortable or unhappy with your skins appearance. According to the Cleveland Clinic, some 50 to 80 percent of teenagers and 40 percent of adults will have keratosis pilaris at some point. Do not take turmeric without medical advice if you are using a medication to treat any of the following conditions: any type of infection (including HIV, malaria, or tuberculosis); anxiety, depression, or a psychiatric disorder; heartburn or gastroesophageal reflux disease (GERD); high blood pressure, high cholesterol, or a heart condition; psoriasis, rheumatoid arthritis, or other autoimmune disorders; or. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination. Curcumin is thought to clean-up dysfunctional cellular components. Do not give any herbal/health supplement to a child without medical advice. Store as directed, or at room temperature away from moisture and heat. B. Stick to unscented products (this goes for soap as well) to avoid irritating and drying out the skin. "It contains fewer ingredients, which is always a plus when dealing with irritated skin. Turmeric is thought to be possibly safe when used short time as a mouth rinse or as an enema. And any medical word with 'pilo' in it is related to hair," says physician and founder of Osmia Organics Sarah Villafranco, M.D. She received her B.S. Learn how to identify these two conditions. Actinic keratoses can be treated with Diclofenac topical gel,20,21 an anti-inflammatory agent, and this may be a potential treatment option for KP, although studies are needed to investigate this hypothesis. Continue reading below for more many detailed tips from Earth Clinic readers. (In eng). The Cleveland Clinic has these suggestions: Dry skin, which happens more often in winter months, can make the bumps more pronounced, per the AAD. Never use vinegar on sensitive skin Just had to write: I was doing some research on what was causing crusty white patches on my hands. The turmeric root is also used to make alternative medicine. Keira Barr is a dual board-certified dermatologist and founder of the Resilient Health Institute. While my upper arms still look "bumpy", they feel totally smooth to the touch. Fragrance is a common irritant. Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema. It will require trial-and-error testing to determine which food(s) are causing the problem. Keratosis pilaris treatment at home usually includes a regular regimen of gentle exfoliation and moisturizing. Hi everyone I stopped using the coconut milk because it was hurting my stomach and as I said before I have a intolerance to some kinds of milk and unfortunately coconut milk was one of them, however I did start to eat coconut cream. This is when nails become pitted and crumble easily. Lastly, consideration of the sebaceous gland aplasia concept as a possible root cause of KP should be considered as a potential pathway to alternate therapeutic venues. I want to wear a dress in 2 days and I need my arms to look better. I'm so glad I read this article and took a chance on trying the home remedy. No success there. It may completely disappear by the age of 30, although some cases persist well into adulthood. The defining symptom of keratosis pilaris are tiny bumps at the hair follicle, which most commonly appear on the upper arms, thighs and buttocks, although they can show up anywhere. In people with psoriasis, skin cells reach the surface of the skin in 4 to 7 days. DOI: 10.1111/j.1365-2133.1994.tb03406.x.
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