Lumbar Intervertebral Disc Desiccation

Lumbar intervertebral disc desiccation (LIDD) is the progressive loss of water content inside the shock-absorbing discs that separate the five lumbar vertebrae. Healthy lumbar discs are 70 – 90 % water; the inner gel (nucleus pulposus) depends on hydration for height, elasticity, and nutrient diffusion. When desiccation sets in, the disc thins, stiffens, and loses its ability to cushion spinal loads. That dehydration is biochemical (fragmentation of proteoglycans, failure of aquaporin water channels, oxidative stress) and mechanical (repetitive compression “squeezes out” fluid faster than it can be re-absorbed). Disc desiccation is the earliest visible sign of degenerative disc disease (DDD) and often precedes annular fissures, herniation, Modic vertebral-end-plate changes, and facet arthropathy. Although desiccation itself does not always hurt, it alters spinal kinematics, raises intradiscal pressure on pain-sensitive structures, and sensitises the sinuvertebral nerve, setting the stage for chronic low-back pain and sciatica. NCBIijhsr.org

Lumbar intervertebral disc desiccation refers to the age- or injury-related loss of water content in the discs that sit between the vertebrae of the lower spine. Healthy discs are composed of a gel-like nucleus pulposus surrounded by a tough annulus fibrosus. Over time—or following repetitive strain, trauma, or genetic predisposition—the nucleus pulposus loses hydration, the annulus fibers weaken, and the disc’s height and shock-absorbing capacity diminish. This process can contribute to biomechanical instability, altered load distribution, and ultimately low back pain and radicular symptoms CLEAR Scoliosis Institute.

Pathophysiologically, desiccation begins with matrix degradation: proteoglycan loss reduces the disc’s ability to attract and retain water, collagen cross-linking increases stiffness, and small fissures form in the annulus. Continued mechanical stress propagates these fissures, exacerbating dehydration and disc collapse. Clinically, patients may report chronic low back stiffness, localized pain aggravated by sitting or bending, and in advanced cases, nerve root irritation leading to sciatica Healthline.

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Anatomy & Physiology Refresher

Lumbar Disc Structure – Each disc has a jelly-like nucleus pulposus wrapped by a 15-20-layered fibrocartilaginous annulus fibrosus and capped by porous cartilaginous end plates. The nucleus is avascular; nutrition reaches it by diffusion through end plates.
Overnight unloading allows discs to re-absorb water; daytime loading pushes water out. Aggrecan and other proteoglycans create high osmotic pressure that attracts water. Ageing, inflammation, smoking, and metabolic syndrome reduce proteoglycan synthesis and curb the disc’s “sponge effect,” leading to persistent dehydration. Frontiers

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Types of Lumbar Disc Desiccation

By Severity (Pfirrmann Grades I–V) – MRI T2-weighted images show progressive signal loss and disc height reduction from Grade I (bright, hydrated) to Grade V (black, collapsed). Radiopaedia
By Segmental Location – L4-L5 and L5-S1 desiccate first because they bear the highest bending and torsional stresses.
By Morphology – (a) Central desiccation, (b) annular rim desiccation, (c) global disc desiccation.
By Etiology – (a) Age-related idiopathic, (b) post-traumatic, (c) inflammatory-mediated, (d) metabolic/endocrine-mediated, (e) genetic collagenopathies (e.g., COL9A2 variants).
By Imaging Signature – Classic dark nucleus on T2 MRI; “vacuum cleft” on CT indicating nitrogen gas in severely dried discs; discography opening pressure < 50 psi supports desiccation. PMC

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Causes

1. Natural Ageing – Cellular senescence slows proteoglycan production after the third decade, so discs lose their internal water-magnet molecules.

2. Repetitive Heavy Lifting – Chronic axial compression squeezes water out faster than end-plate capillaries can shuttle it back.

3. High-Impact Sports – Activities like gymnastics, weightlifting, or cricket fast bowling transmit sudden spikes of force that accelerate micro-fissures and fluid loss.

4. Sedentary Lifestyle – Prolonged sitting sustains static disc pressure, diminishing the “fluid pumping” effect generated by normal movement.

5. Smoking – Nicotine causes vasoconstriction of lumbar end-plate capillaries, starving discs of nutrients and oxygen, hastening matrix dehydration.

6. Obesity – Excess body weight increases compressive load and systemic inflammation, both of which dehydrate discs.

7. Poor Core Muscle Endurance – Weak multifidus and transverse abdominis muscles fail to share load with discs, so discs bear an unfair share and dry out.

8. Genetic Predisposition – Variants in collagen IX, aggrecan, and MMP-3 genes weaken disc matrix, making it lose water early.

9. Diabetes Mellitus – High glucose promotes advanced glycation end products (AGEs) that stiffen disc collagen and impede fluid binding.

10. Chronic Low-Grade Infection – Propionibacterium acnes inside discs triggers inflammatory cascades that break down proteoglycan gel.

11. Rheumatoid & Spondylo-arthropathies – Systemic cytokines (IL-1β, TNF-α) accelerate nucleus pulposus catabolism.

12. Vitamin D Deficiency – Reduces disc-cell autophagy and anti-oxidant defences, promoting dehydration. ijhsr.org

13. Malnutrition & Dehydration – Insufficient dietary water and micronutrients deprive nucleus cells of the raw materials for glycosaminoglycans.

14. Hormonal Changes (Menopause) – Oestrogen decline impairs collagen cross-link repair and disc water balance.

15. Chronic Corticosteroid Use – Steroids suppress disc-cell metabolism and vascular supply.

16. Traumatic Injury – Vertebral end-plate microfracture disrupts nutrient diffusion, leading to localised disc drying.

17. Micro-instability (Spondylolisthesis) – Abnormal segmental motion repetitively crushes the disc and pumps out fluid.

18. Metabolic Syndrome – Dyslipidaemia and systemic inflammation damage disc micro-vasculature.

19. Persistent Vibration Exposure – Truck drivers and heavy-machine operators experience axial vibrations that hasten water loss.

20. Radiation Exposure (Cancer Therapy) – Ionising radiation damages disc progenitor cells and vascular channels, leading to dehydration.

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Common Symptoms

1. Dull Low-Back Ache – Dehydrated discs lose height, straining facet joints and ligaments, generating a constant ache.

2. Morning Stiffness – Overnight discs re-hydrate slightly; pain flares when getting out of bed because water is rapidly squeezed out again.

3. Activity-Related Pain – Bending, lifting, or prolonged sitting worsens discomfort as intradiscal forces rise.

4. “Deep” Axial Pain – Patients localise pain to the spine’s midline rather than paraspinal muscles.

5. Referred Buttock Pain – Desiccated L5-S1 discs can mimic sacro-iliac pain.

6. Sciatica-Like Leg Pain – If desiccation co-exists with bulge, nerve-root irritation produces radiating pain down the leg.

7. Transient Tingling – Dehydration can narrow foramina, brushing against dorsal-root ganglia and causing paresthesia.

8. Decreased Spinal Flexibility – Lost disc height reduces segmental range of motion, making it hard to tie shoes.

9. Crepitus or “Grating” Sensation – Collapsed discs alter facet alignment, causing audible clicks.

10. Positional Relief (Recumbency) – Lying flat unloads discs, often easing pain in minutes.

11. Pain on Sneezing or Coughing – Increased intrathecal pressure jarringly compresses the desiccated disc.

12. Muscle Guarding – Paravertebral muscles spasm to stabilise the compromised segment.

13. Fatigue – Chronic pain disturbs sleep, leading to daytime tiredness.

14. Psychological Distress – Unrelenting back pain fosters anxiety and depression.

15. Height Loss – Multiple dried discs can cumulatively shorten trunk height.

16. Altered Gait – Patients may adopt an antalgic lean to offload painful segments.

17. Hip-Flexor Tightness – Protective posture shortens iliopsoas.

18. Reduced Proprioception – Degenerated discs house fewer mechanoreceptors, impairing spinal position sense.

19. Episodic Flare-Ups – Patients report “good days and bad days,” linked to activity level and hydration status.

20. Incidental Asymptomatic Finding – Up to 40 % of MRI-detected lumbar desiccations cause no pain at all, underscoring the importance of clinical correlation. HealthlineSpine Surgery

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 Diagnostic Tests

Physical-Examination Tests

1. Inspection & Posture Analysis – Look for loss of lumbar lordosis, trunk list, or pelvic tilt indicating disc-related pain behaviour.
2. Palpation – Central spinous tenderness over the affected level suggests discogenic origin.
3. Range-of-Motion Assessment – Limitation in forward flexion hints at disc dehydration and strain.
4. Pain Provocation on Extension – Extension loads posterior annulus; increased pain supports L4-L5 or L5-S1 pathology.
5. Gait Analysis – Shortened stride or toe-walking deficiency may reveal L5-S1 involvement.

Manual Orthopaedic Tests

6. Straight-Leg-Raise (SLR) – Reproduction of back rather than leg pain at < 60° suggests discogenic rather than radicular cause.
7. Slump Test – Spinal flexion with neural tension isolates disc contribution to sciatic symptoms.
8. Prone Instability Test – Pain that lessens with trunk muscle activation hints at instability secondary to disc degeneration.
9. Crossed-SLR – Pain in the opposite leg predicts central disc desiccation with bulge.
10. Kemps (Extension-Rotation) Test – Combined motion narrows the intervertebral foramen; pain indicates disc/facet compromise.

Laboratory & Pathological Tests

11. High-Sensitivity C-Reactive Protein (hs-CRP) – Low-grade systemic inflammation correlates with disc-matrix catabolism.
12. Erythrocyte Sedimentation Rate (ESR) – Helps rule out infectious spondylodiscitis masquerading as desiccation.
13. Vitamin-D 25-OH Level – Deficiency is common in disc dehydration cohorts.
14. Fasting Glucose & HbA1c – Detects diabetic microangiopathy affecting disc nutrition.
15. Genetic Panel (COL9A2, MMP-3) – Emerging tests identify hereditary risk of early disc desiccation in selected patients.

Electrodiagnostic Tests

16. Surface Electromyography (sEMG) – Measures paraspinal muscle guarding amplitude; excessive activity aligns with painful disc segments.
17. Needle EMG – Rules out radiculopathy when weakness or numbness accompanies disc desiccation.
18. Nerve Conduction Studies (NCS) – Clarify whether leg pain stems from peripheral neuropathy versus disc origin.
19. Quantitative Sensory Testing (QST) – Elevated pain-pressure thresholds can flag central sensitisation due to chronic disc pain.
20. Evoked Potentials (Somatosensory EPs) – Detect subclinical conduction delay when foraminal narrowing accompanies desiccation.

Imaging Tests

21. Magnetic Resonance Imaging (MRI) T2-Weighted – Gold standard: dark-signal nucleus confirms water loss; Pfirrmann grading quantifies severity.
22. MRI T1-rho Mapping – Quantifies proteoglycan depletion before gross signal loss appears.
23. Diffusion-Weighted MRI (ADC Mapping) – Lower apparent diffusion coefficients correlate with advanced dehydration.
24. Upright (Weight-Bearing) MRI – Shows dynamic height loss under load, revealing occult desiccation.
25. Computed Tomography (CT) – Identifies vacuum clefts and osteophytes secondary to disc collapse.
26. Dual-Energy CT (DECT) – Differentiates calcified annulus from vacuum phenomenon.
27. Plain Lumbar X-ray (Standing) – Disc-space narrowing, end-plate sclerosis, and traction spurs suggest dehydration.
28. Discography with Pressure Profiling – Low opening pressure plus concordant pain indicates painful desiccated disc.
29. CT-Discography – Post-discogram CT delineates radial annular tears related to dehydration.
30. Ultrasound Elastography (Experimental) – Measures annulus stiffness; increased shear modulus indicates water loss. PMCPMC

Non-Pharmacological Treatments

Physiotherapy & Electrotherapy Therapies

Physical modalities and manual interventions form the cornerstone of conservative management. The following therapies, supported by randomized trials and meta-analyses, aim to reduce pain, restore mobility, and promote disc health.

1. Spinal Mobilization

   • Description: Gentle, passive gliding of lumbar joints by a trained therapist.

   • Purpose: Improve segmental mobility, reduce joint stiffness.

   • Mechanism: Mobilization stimulates mechanoreceptors, modulates pain via the gate control theory, and restores normal kinematics PubMed Central.

2. Spinal Manipulation

   • Description: High-velocity, low-amplitude thrusts applied to restricted lumbar segments.

   • Purpose: Rapid reduction in pain and muscle spasm.

   • Mechanism: Transient cavitation of facet joints stimulates mechanoreceptive and proprioceptive feedback, leading to neuromuscular reset Physiopedia.

3. Mechanical Traction

   • Description: Application of longitudinal force to “decompress” the lumbar spine.

   • Purpose: Reduce intradiscal pressure, enlarge foraminal spaces.

   • Mechanism: Negative pressure within the disc may retract bulging material and improve nutrient inflow MDPI.

4. Transcutaneous Electrical Nerve Stimulation (TENS)

   • Description: Low-voltage electrical currents delivered via skin electrodes.

   • Purpose: Short-term analgesia.

   • Mechanism: Activates large-fiber afferents to inhibit nociceptive transmission (gate control) and stimulates endogenous endorphin release PubMed Central.

5. Therapeutic Ultrasound

   • Description: High-frequency sound waves delivered to lumbar tissues.

   • Purpose: Enhance local circulation and tissue extensibility.

   • Mechanism: Thermal and non-thermal effects increase fibroblast activity, collagen extensibility, and blood flow Sports & Spines.

6. Electrical Stimulation (e.g., IFC, NMES)

   • Description: Alternating medium-frequency currents (IFC) or neuromuscular electrical stimulation (NMES).

   • Purpose: Pain relief and muscle re-education.

   • Mechanism: IFC leverages deeper penetration for analgesia; NMES contracts paraspinal muscles to improve support PubMed Central.

7. Laser Therapy

   • Description: Low-level (cold) laser stimulation of affected tissues.

   • Purpose: Accelerate tissue repair, reduce inflammation.

   • Mechanism: Photobiomodulation enhances mitochondrial activity, ATP production, and anti-inflammatory cytokine release ScienceDirect.

8. Diathermy (Short-Wave/Microwave)

   • Description: Deep-heating modality using electromagnetic radiation.

   • Purpose: Warm deep tissues to relieve stiffness.

   • Mechanism: Increases tissue temperature, blood flow, and extensibility of collagen Sports & Spines.

9. Superficial Heat & Cold Therapy

   • Description: Hot packs or ice application to lumbar area.

   • Purpose: Modulate inflammation and muscle spasm.

   • Mechanism: Heat dilates blood vessels, ice constricts vessels and reduces nerve conduction velocity Healthline.

10. Kinesio Taping

    • Description: Elastic therapeutic tape applied to lumbar muscles.

    • Purpose: Provide proprioceptive input and support.

    • Mechanism: Lifts skin to improve lymphatic drainage, stimulates cutaneous mechanoreceptors to modulate pain Sports & Spines.

11. Dry Needling

    • Description: Insertion of filiform needles into myofascial trigger points.

    • Purpose: Alleviate muscle tautness and referred pain.

    • Mechanism: Disrupts dysfunctional endplates, induces local twitch response and biochemical reset Sports & Spines.

12. Acupuncture

    • Description: Traditional Chinese Medicine technique for pain relief.

    • Purpose: Restore Qi flow and reduce pain.

    • Mechanism: Needle insertion modulates central pain pathways and releases endorphins Sports & Spines.

13. Myofascial Release

    • Description: Manual stretching of fascial tissues around the lumbar spine.

    • Purpose: Reduce fascial tightness and improve mobility.

    • Mechanism: Sustained pressure breaks fascial adhesions and enhances fluid dynamics Sports & Spines.

14. Massage Therapy

    • Description: Rhythmic soft-tissue manipulation by a therapist.

    • Purpose: Relieve muscle tension and improve circulation.

    • Mechanism: Manual pressure activates mechanoreceptors, increases blood flow, and reduces cortisol Healthline.

15. Postural Correction & Ergonomic Training

    • Description: Education on proper sitting, lifting, and standing techniques.

    • Purpose: Prevent exacerbating loads on lumbar discs.

    • Mechanism: Optimizes spinal alignment to distribute mechanical forces evenly MDPI.

Exercise Therapies

1. Lumbar Stabilization Exercises
   Strengthen transversus abdominis, multifidus, and pelvic floor to support the spine MDPI.

2. McKenzie Extension Protocol
   Extension exercises to centralize pain and improve disc nutrition Strathcona Physical Therapy.

3. Flexibility Exercises
   Hamstring and hip-flexor stretches to reduce posterior chain tension Healthline.

4. Core Endurance Training
   Planks, bird-dogs, and side-bridges to maintain trunk stability MDPI.

5. Aerobic Conditioning
   Low-impact activities (walking, cycling) to enhance blood flow and reduce pain perception Healthline.

Mind-Body Therapies

1. Yoga
   Combines stretching, strengthening, and mindfulness to improve spinal health MDPI.

2. Pilates
   Focused on core control and postural alignment MDPI.

3. Tai Chi
   Gentle martial art promoting balance, flexibility, and pain tolerance MDPI.

4. Mindfulness-Based Stress Reduction (MBSR)
   Teaches awareness of pain and stress management techniques Healthline.

5. Biofeedback
   Uses real-time feedback to teach relaxation of lumbar muscles Healthline.

Educational & Self-Management Strategies

1. Pain Neuroscience Education
   Explains pain mechanisms to reduce catastrophizing and improve adherence MDPI.

2. Activity Pacing
   Balancing activity and rest to prevent flare-ups Healthline.

3. Weight Management Counseling
   Reducing lumbar load through healthy weight loss Healthline.

4. Smoking Cessation Support
   Smoking impairs disc nutrition and healing Healthline.

5. Workplace Ergonomics Training
   Tailored workstation adjustments to minimize lumbar strain MDPI.

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Pharmacological Agents

Below is a summary of first- and second-line medications commonly used for symptom control in disc desiccation. Each entry includes drug class, typical dosage, timing, and key adverse effects.

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 Dietary Molecular Supplements

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Advanced (Regenerative) Drugs

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Surgical Interventions

1. Microdiscectomy

   • Procedure: Minimally invasive removal of herniated disc fragments under microscope.

   • Benefits: Rapid pain relief, short recovery Spine.

2. Lumbar Fusion (TLIF/PLIF)

   • Procedure: Disc space distraction, bone graft, and instrumentation to fuse two vertebrae.

   • Benefits: Stabilizes segment, alleviates instability pain AAFP.

3. Artificial Disc Replacement

   • Procedure: Replace degenerated disc with prosthesis.

   • Benefits: Maintains motion, reduces adjacent segment stress AAFP.

4. Percutaneous Endoscopic Discectomy

   • Procedure: Fiber-optic endoscope removes disc material via posterolateral approach.

   • Benefits: Less blood loss, quicker return to activities Spine.

5. Laminectomy

   • Procedure: Removal of lamina to decompress spinal canal.

   • Benefits: Relieves central stenosis, radicular symptoms Spine.

6. Foraminotomy

   • Procedure: Enlarge intervertebral foramen to free compressed nerve root.

   • Benefits: Alleviates radiculopathy Spine.

7. Disc Nucleoplasty (Radiofrequency Coblation)

   • Procedure: Radiofrequency ablation to remove disc tissue and reduce intradiscal pressure.

   • Benefits: Minimally invasive, pain reduction Spine.

8. Annuloplasty (Intradiscal Electrothermal Therapy)

   • Procedure: Heat outer annulus fibers to seal fissures.

   • Benefits: Stabilizes annulus, reduces pain Spine.

9. Vertebroplasty/Kyphoplasty

   • Procedure: Inject bone cement into collapsed vertebral body (if endplate collapse present).

   • Benefits: Restores vertebral height, stabilizes fracture Spine.

10. Spinal Cord Stimulation

    • Procedure: Implant electrode leads in epidural space to deliver electrical pulses.

    • Benefits: Modulates pain signaling, reduces opioid need Spine.

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Prevention Strategies

1. Maintain healthy body weight to reduce lumbar load Healthline.

2. Practice proper lifting techniques (bend knees, keep back straight) MDPI.

3. Incorporate regular core strengthening exercises MDPI.

4. Take frequent breaks from prolonged sitting Healthline.

5. Use ergonomic chairs and workstations MDPI.

6. Avoid smoking to preserve disc nutrition Healthline.

7. Stay hydrated to support disc matrix health CLEAR Scoliosis Institute.

8. Engage in low-impact aerobic exercise, e.g., swimming Healthline.

9. Wear supportive footwear to maintain spinal alignment MDPI.

10. Manage stress to reduce muscle tension Healthline.

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When to See a Doctor

• Severe or worsening neurological deficits (e.g., weakness, numbness, bowel/bladder changes) AAFP.

• Pain unresponsive to 6–12 weeks of conservative care AAFP.

• Signs of cauda equina syndrome (saddle anesthesia, incontinence) AAFP.

• Unexplained weight loss, fever, or night pain suggesting infection or tumor AAFP.

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“Do’s” and “Avoid’s”

Do:

1. Maintain active lifestyle within pain limits Healthline.

2. Use proper body mechanics MDPI.

3. Apply heat or ice as needed Healthline.

4. Practice deep-breathing and relaxation techniques Healthline.

5. Follow a graded exercise program MDPI.

Avoid:

1. Prolonged bed rest Healthline.

2. Heavy lifting or twisting MDPI.

3. High-impact activities during flare-ups Healthline.

4. Smoking and excessive alcohol Healthline.

5. Ignoring red-flag symptoms AAFP.

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Frequently Asked Questions

1. What is the difference between desiccation and herniation?
   Desiccation is dehydration of the disc matrix; herniation is extrusion of inner nucleus material through a tear in the annulus CLEAR Scoliosis Institute.

2. Can exercise worsen disc desiccation?
   When properly prescribed, exercises strengthen supporting muscles without accelerating desiccation MDPI.

3. Is disc desiccation reversible?
   Complete reversal is unlikely, but nutrition and exercise can improve disc hydration and function CLEAR Scoliosis Institute.

4. How long does conservative treatment take to work?
   Most patients see improvement within 4–6 weeks, with maximal benefit by 3 months AAFP.

5. Are injections safe?
   Epidural steroids and biologic injections carry low risk when image-guided; major complications are rare Spine.

6. Will I need surgery?
   Only 10–20% of patients with severe radiculopathy or instability require surgery AAFP.

7. Do supplements really help?
   Evidence for glucosamine, chondroitin, and collagen is mixed; some patients report symptomatic relief PubMed Central.

8. How can I prevent recurrence?
   Maintain core strength, use proper ergonomics, and avoid smoking Healthline.

9. Can weight loss improve symptoms?
   Yes—every kilogram of weight lost reduces lumbar load by ~4 kg, easing disc stress Healthline.

10. Is smoking really a risk factor?
    Smoking impairs disc nutrition and oxygenation, accelerating degeneration Healthline.

11. What role does hydration play?
    Adequate water intake supports proteoglycan hydration in the nucleus pulposus CLEAR Scoliosis Institute.

12. Are bed rest and opioids still recommended?
    No—prolonged bed rest and long-term opioids are discouraged due to complications and dependency PubMed Central.

13. When should I try advanced therapies like PRP?
    After 3–6 months of failed conservative care, PRP may be considered under specialist guidance ScienceDirect.

14. Is physical therapy painful?
    Some modalities may cause temporary discomfort but should not exacerbate pain long-term PubMed Central.

15. Can disc desiccation cause leg pain?
    Yes—if desiccation leads to herniation or stenosis compressing nerve roots, sciatica can occur Healthline.

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: May 27, 2025.