Epicranius muscle fibrosis is a condition in which normal muscle fibers of the epicranius (also called the occipitofrontalis) are gradually replaced by excess scar tissue (fibrous connective tissue). This process stiffens the scalp muscles, limiting forehead movement, causing discomfort, and impairing muscle function. Fibrosis develops when injury or chronic inflammation triggers fibroblasts to lay down collagen and extracellular matrix in place of healthy muscle tissue, resulting in a permanent scar that disrupts normal muscle architecture and elasticity National Toxicology ProgramWikipedia.
Anatomy of the Epicranius Muscle
Structure and Location
The epicranius is a broad, thin muscle group on the top of the skull. It spans from the forehead back to the upper neck region. It consists of two main parts—the frontal belly on the forehead and the occipital belly on the back of the head—connected by a wide, flat tendon called the epicranial aponeurosis Kenhub.
Origin and Insertion
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Frontal belly: Originates from the epicranial aponeurosis near the coronal suture and inserts into the skin and superficial tissues of the eyebrows and forehead.
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Occipital belly: Originates from the superior nuchal line of the occipital bone and inserts into the epicranial aponeurosis just behind the coronal suture KenhubHome.
Blood Supply
Branches of the external and internal carotid arteries supply the muscle:
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Supraorbital artery and supratrochlear artery (branches of the ophthalmic artery) to the frontal belly.
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Occipital artery (branch of the external carotid) to the occipital belly NCBI.
Nerve Supply
Innervation comes from branches of the facial nerve (cranial nerve VII):
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Temporal branches to the frontal belly.
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Posterior auricular branch to the occipital belly College of Medicine.
Functions
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Raises the eyebrows (surprise expression)
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Wrinkles the forehead skin
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Draws the scalp posteriorly
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Helps stabilize the galea aponeurotica during facial movement
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Assists with minor ear movements in some individuals
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Contributes to non-verbal expressions by adjusting forehead tension Study.com.
Types of Epicranius Muscle Fibrosis
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Focal fibrosis – localized to one belly (frontal or occipital).
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Diffuse fibrosis – involving both bellies and aponeurosis.
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Primary (idiopathic) – no identifiable cause.
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Secondary (acquired) – follows trauma, surgery, or injections.
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Acute-onset fibrosis – rapid development after injury.
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Chronic fibrosis – gradual build-up over months to years.
Potential Causes
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Head trauma or scalp injury National Toxicology Program
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Surgical scars (e.g., craniotomy)
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Radiation therapy to the scalp
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Chronic tension or overuse (e.g., frequent eyebrow raising)
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Infections (cellulitis, abscess)
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Chemical irritants (harsh cosmetics)
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Repeated injections (botulinum toxin)
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Burns (thermal or chemical)
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Chronic inflammation (dermatitis)
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Aging-related degeneration
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Hypoxia/ischemia of muscle tissue
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Autoimmune myositis
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Genetic connective tissue disorders
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Nutritional deficiencies (vitamin C)
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Metabolic disorders (diabetes)
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Denervation (nerve injury)
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Chronic scar contracture
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Prolonged immobilization
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Medication side effects (e.g., bleomycin)
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Exposure to radiation during imaging procedures
(Grouped causes based on general muscle fibrosis mechanisms.)
Common Symptoms
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Stiffness of the scalp
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Pain or tenderness over the forehead or back of head
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Limited eyebrow elevation
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Reduced forehead wrinkling
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Tight feeling in scalp
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Headaches or tension-type headaches
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Localized swelling or firmness
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Scalp dimpling or irregularities
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Muscle spasms or twitching
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Difficulty raising eyebrows symmetrically
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Noticeable scar bands on palpation
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Decreased scalp elasticity
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Cosmetic changes (asymmetry)
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Burning or tingling sensations
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Tender nodules in the epicranial aponeurosis
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Reduced forehead mobility when surprised
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Pain aggravated by facial expressions
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Fatigue of the forehead muscles
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Anxiety due to cosmetic appearance
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Secondary neck or shoulder tension
(Symptoms draw from general muscle fibrosis presentation.)
Diagnostic Tests
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Medical history & physical exam – palpation for fibrotic bands.
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Scalp elasticity test – measuring fold recoil.
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Ultrasound imaging – shows increased echogenicity in fibrotic areas.
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Shear wave elastography – quantifies tissue stiffness Nature.
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Magnetic resonance imaging (MRI) – visualizes muscle and aponeurosis changes.
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Computed tomography (CT) – assesses soft tissue density.
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Electromyography (EMG) – evaluates muscle electrical activity and detects impaired function Verywell HealthPMC.
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Nerve conduction studies – rule out neuropathies.
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Muscle biopsy – confirms fibrosis histologically PMCScienceDirect.
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Blood tests – inflammatory markers (CRP, ESR).
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Creatine kinase (CK) – to assess muscle damage.
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Autoimmune panels – ANA, myositis-specific antibodies.
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Tension headache evaluation – to differentiate pain sources.
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Dermal thickness measurement – calipers or ultrasound.
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Thermography – thermal differences over fibrotic tissue.
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Capillaroscopy – microvascular changes in fibrotic areas.
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Genetic testing – if hereditary disorders suspected.
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Biochemical markers – TGF-β levels for profibrotic activity.
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Elastography-guided biopsy – target the stiffest areas.
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Functional mobility tests – forehead-range-of-motion metrics.
Non-Pharmacological Treatments
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Physical therapy – targeted scalp and forehead exercises PubMed.
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Manual myofascial release
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Therapeutic ultrasound – improves tissue extensibility Physiopedia.
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Low-intensity pulsed ultrasound (LIPUS) ScienceDirect.
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Heat therapy – moist heat packs to relax muscles.
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Cold therapy – cryotherapy for pain relief.
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Transcutaneous electrical nerve stimulation (TENS)
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Dry needling / acupuncture
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Laser therapy
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Shockwave therapy
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Serial casting or taping
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Ergonomic adjustments – avoid eyebrow overuse.
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Scalp mobilization techniques
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Postural training – reduce compensatory neck tension.
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Yoga and relaxation exercises
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Biofeedback – control muscle tension.
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Occupational therapy – adaptation of facial movements.
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Trigger-point therapy
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Cupping therapy
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Pilates for core and neck alignment
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Meditation and stress reduction
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Ultrasound-guided percutaneous needle release
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Chiropractic adjustment (cervical focus)
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Proprioceptive neuromuscular facilitation (PNF)
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Scalp massage with essential oils
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Hydrotherapy – warm water exercises.
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Cryoultrasound combination therapy
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Neuromuscular electrical stimulation (NMES)
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Myofascial decompression cups
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Behavioral therapy – to modify facial habits.
Drugs for Epicranius Fibrosis
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Non-steroidal anti-inflammatory drugs (NSAIDs) – ibuprofen, naproxen Wiley Online Library.
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Acetaminophen – for pain relief.
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Muscle relaxants – cyclobenzaprine, baclofen
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Tizanidine – central-acting muscle relaxant.
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Gabapentin / Pregabalin – for neuropathic pain.
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Topical NSAID gels – diclofenac.
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Capsaicin cream
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Lidocaine patch
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Corticosteroid injections – local infiltration.
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Botulinum toxin – reduces muscle overactivity.
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Pirfenidone – antifibrotic agent.
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Nintedanib – tyrosine kinase inhibitor with antifibrotic effects Nature.
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Losartan – angiotensin II receptor blocker with antifibrotic properties Frontiers.
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Pentoxifylline – improves microcirculation.
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Colchicine – antifibrotic in some contexts.
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Geniposide – plant-derived antifibrotic PMC.
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N-acetylcysteine – reduces fibrosis and oxidative stress Oxford Academic.
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Verteporfin – experimental inhibitor of fibrosis signaling UC Davis Health.
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Methotrexate – low-dose in inflammatory myopathies.
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Hydroxychloroquine – antimalarial with anti-inflammatory effect.
Surgical Treatments
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Fasciectomy – removal of fibrotic bands.
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Aponeurotomy – incision into the epicranial aponeurosis.
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Z-plasty – lengthening scar contracture.
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Scar excision and direct closure
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Endoscopic epicranial release
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Autologous fat grafting – restore pliability.
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Microsurgical muscle flap transfer
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Tendon or fascia graft – to bridge gaps.
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Subgaleal tissue expansion
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Combined debridement with physical therapy BioMed Central.
Prevention Strategies
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Use protective headgear during risk activities.
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Avoid repetitive forehead overuse.
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Promptly treat scalp injuries and infections.
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Maintain balanced nutrition (vitamin C, protein).
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Stay hydrated to support tissue healing.
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Practice good posture to reduce muscle strain.
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Limit unnecessary scalp injections.
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Early mobilization after head procedures.
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Minimize radiation exposure to the scalp.
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Regular scalp stretching and massage.
When to See a Doctor
See a healthcare professional if you experience persistent scalp stiffness or pain lasting more than two weeks, noticeable loss of forehead mobility, progressive muscle tightness, or any signs of infection (redness, warmth, fever). Early evaluation helps confirm the diagnosis, rule out serious causes, and start treatment before fibrosis becomes irreversible.
Frequently Asked Questions
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What exactly is epicranius muscle fibrosis?
It’s scarring within the forehead and scalp muscle that replaces normal muscle fibers with stiff connective tissue. -
What causes this fibrosis?
Common triggers are trauma, surgery scars, chronic muscle tension, radiation, and chronic inflammation. -
Can it be reversed?
Early-stage fibrosis may improve with treatments like physical therapy and antifibrotic drugs, but long-standing scars are often permanent. -
How is it diagnosed?
By exam, imaging (ultrasound, MRI), EMG, and sometimes a small tissue biopsy. -
Will injections like Botox cause fibrosis?
Repeated or improper injections can lead to localized scarring. -
Is surgery always needed?
No—most cases respond to non-surgical treatments unless fibrosis is severe. -
What non-drug treatments work best?
Regular physical therapy, therapeutic ultrasound, and myofascial release show good results. -
Which medications help reduce fibrosis?
Antifibrotic agents (pirfenidone, nintedanib), along with anti-inflammatories, can slow progression. -
How long does recovery take?
It varies; mild cases may improve in weeks, while severe fibrosis may need months of therapy. -
Can exercise worsen fibrosis?
Overuse can worsen scarring; a tailored, gentle program is safest. -
Are there home remedies?
Scalp massage, heat packs, and gentle stretching can help maintain flexibility. -
Will appearance return to normal?
Some cosmetic improvement is possible, but deep scars may leave permanent changes. -
Can children get this?
It’s rare but can occur after head injuries or surgeries. -
Is this related to hair loss?
Severe fibrosis under the scalp can affect hair follicles, possibly leading to thinning. -
How to prevent it?
Prompt care of scalp injuries, avoid repetitive strain, and follow surgeon’s post-op recommendations.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members
Last Updated: April 26, 2025.
