Pores or sebaceous follicles are the small openings in the skin that allow oils and toxins to be excreted through the integument. Pores are also responsible for regulating temperature through dilation and constriction. The presence of clogged pores involves the build-up or blockage of sebum and other dirt particles in the pores.

Clogged pores are medically termed as comedones. There are two types of clogged pores:

• Blackheads – Blackheads, also known as open comedones, are usually black or yellow bumps located on the skin. Blackheads, which contain sebum and keratin, are pores that have been partially clogged; they  allow dirt particles to accumulate, leading to oxidation which causes the black or dark color of the comedones.

Blackheads

• Whiteheads – Whiteheads, which are closed comedones, remain white because they do not have an opening to cause oxidation of the materials. They contains similar materials such as sebum as the blackheads; the difference is that they are completely blocked pores.

Whitehead pimples

Clogged pores may result in acne when they have worsened. The skin may have a rough texture due to the presence of small bumps in the pores.

The causes of clogged pores is not directly related to poor hygiene. Specific causes of blocked pores include the entrapment of oil in the pores as a result of build-up of sebum. Build-up of sebum occurs when the sebaceous glands have increased production. The activity of the sebaceous gland is directly affected by the presence of androgen testosterone.

An increase in testosterone level increases the activity of the sebaceous gland, leading to an increase in oil production. Men have higher incidences of clogged pores due to active sebaceous glands as a result of high testosterone levels.

There is also an increase in the production of sebum in women with high testosterone levels. Many women take oral contraceptive pills with anti-androgenic properties to reduce the appearance of comedones and acne.

Clogged pores usually occur in areas of the body where there is a greater number of sebaceous glands such as in the following sites:

• Clogged pores on the nose – The nose is one of the most common sites for the presence of comedones. It is also one of the common sites where comedones are more evident because the surface of the nose is usually smooth. People with blackheads are able to remove the blackheads on the area due to their accessibility.

• Clogged pores on the face – The rest of the face may also have comedones since sebaceous glands are most prevalent on the face. Furthermore, the face is also exposed to environmental toxins and dirt, making it an ideal area for clogged pores.

Clogged Pores on face

• Clogged pores on the forehead – The forehead may also have comedones; however, it is more uncommon than the nose and the area around it. The T-zone on the face comprises the forehead which forms the top of the T, the nose, the area around the mouth, and the chin, which forms the end of the tail. A high level of sebum secretions are found on the forehead.
• Clogged pores on the chin – The chin is also a site for clogged pores because it is usually where sweat flows.

Other causes of comedones include pores that are larger than usual. Large pores, which are a result of aging or excessive exposure to the sun, increase the chance of building up more sebum in the area.

Furthermore, genetics is also a factor for having large pores.
Cleanliness has been an important factor for removing and preventing the occurrence of clogged pores.

Poor hygiene is not a direct cause of comedones, but it can precipitate the accumulation of sebum and dirt when the face is not cleaned regularly.

Treatment of Clogged Pores

The primary treatment for clogged pores is extraction. It can be performed in a dermatologic clinic or at home. Extraction of blackheads and whiteheads involve a steam bath to dilate the pores and a comedone extractor to remove the clogged particles. The extractor is used by pressing it on the clogged pore to remove the particles out from the pores.

How to Clean Clogged Pores?

How to clean clogged pores without extraction is one of the questions people have when it comes to their face. Besides manual extraction, other procedures can be done to clear the pores. These include the following:

• Exfoliation – Exfoliation involves the removal of dead skin cells from the surface of the skin with the use of exfoliants. Exfoliant cleansers may be used to polish the skin and remove pore clogging impurities. Exfoliation should only be done two to three times a week because frequent exfoliation may result in more oil production as the skin compensates for the loss of oil from the procedure.
• Salicylic acid – Salicylic acid is a substance used to control skin cell growth. This substance cleans the skin and prevent pore clogging. Salicylic acid can be placed over the areas of the face which have high sebum production such as the T-spot.
• Microdermabrasion –  Microdermabrasion uses abrasive materials to remove the upper layer of dead skin cells and comedones that occur on the skin in order to reveal a natural glow of healthy skin.
• Comedone remover gun – A comedone remover gun is a vacuum-like device that uses suction to remove blackheads or whiteheads from the skin. This is a non-invasive method and is also less painful than the use of a comedone extractor.

Home Remedies for Clogged Pores

Home remedies for clogged pores are also beneficial and involves herbal preparations and organic substances to remove pore clogging impurities. These remedies include the following:

• Parsley – The liquid that is strained from soaking parsley in boiling water can be applied to the face as a compress.
  
• Thyme – Thyme has antibacterial properties which help prevent and manage clogged pores. A mixture of  dried thyme and water can be used to rinse the face after cleaning.
• Baking soda – Baking soda can also be used to clear the pores. A paste made with baking soda and water can be applied to the face. Baking soda should be rinsed immediately because it is abrasive and may cause skin irritation.
• Others – Oats, fruit grains, and sugar are also effective remedies to remove blackheads. These can be used to exfoliate the skin to reveal a glowing skin.

There are natural ways to induce labor. Older people usually recommend these natural labor induction methods in order to have a normal and vaginal delivery and avoid Cesarean and other instrument-assisted deliveries. Such methods are also used to prevent medical induction of labor, which usually arise from fetal and maternal risk factors such as maternal and fetal distress. However, these natural methods are not ways to start the labor process but serve to speed up the labor process especially at 39 or 40 weeks of gestation. These natural labor induction ways should also be combined with health maintenance during pregnancy such as smoking cessation during pregnancy in order to ensure favorable pregnancy outcomes. It is also important to review pregnancy symptoms week by week in order to identify the right time to start these natural labor induction ways because delivery below 37 weeks is considered to be pre-term. It is important to induce labor when the fetus is ready to be delivered such as at 37 weeks, 38, weeks, 39 weeks or 40 weeks of gestation. It is also important to consult an obstetrician before starting any labor induction remedies in order to ensure safe labor and delivery. Here are the top 50 natural ways to induce labor:

1. Walking

Walking is the simplest means to induce labor. Walking aids in the descent of the fetus, enhancing the ripening of the cervix which can help the fetal head engage deeper in the pelvis. Walking should be started at 37 weeks of gestation, but it may be done during the early stages of pregnancy to ensure adequate exercise.

2. Sex

Sex may also be used to induce labor. Sex may increase the production of oxytocin which helps the uterus to  contract. An increase in oxytocin production peaks when a woman reaches orgasm.

3. Nipple stimulation

Nipple stimulation is also a natural way to induce labor because stroking the nipples is a great way to increase oxytocin production. In fact, nipple stimulation is used during the delivery process to maintain regular uterine contractions.

4. Castor oil

Castor oil may be taken after consultation with the obstetrician because it may cause meconium staining in the fetus. It must only be used when the mother is past her due date at 41 or 42 weeks of pregnancy.

5. Acupuncture

Acupuncture is also used to induce labor in women who are ready to give birth.

6. Acupressure

Placing pressure on acupressure points may also stimulate labor. Acupressure may also be used to relieve different aches associated with pregnancy and delivery.

7. Exercise ball

The use of an exercise ball can help the descent of the baby. Spreading the legs while lying over the ball can help induce labor.

8. Meditation or relaxation techniques

Relaxing the mind reduces stress and thereby inducing a healthy labor. Doing this during 39 weeks of pregnancy may help women prepare for labor.

9. Evening primrose oil

Evening primrose helps to thin and soften the cervix during labor. Evening primrose oil can be inserted in the vagina to help ripen the cervix, but this may only be done by the health care provider.

10. Spicy foods

Some proponents believe that spicy foods help the uterus to contract.

11. Massage

Massage may also help to jump-start the labor because massage increases the release of oxytocin, which is a labor inducer. Massage also relaxes the pregnant woman helping the woman undergo labor easier.

12. Balsamic vinegar

Starting at 38 weeks of pregnancy, balsamic vinegar can be added to a salad  to help induce labor.

13. Blue or black cohosh

This herb is used to improve uterine contractions during labor. Although there are studies which claim that this may cause bad effects for the mother and fetus, it is best to consult the physician.

14. Basil

Basil is also a safe way to induce labor, and it can be added to dishes.

15. Borage seed oil

This oil, which is similar to the effects of evening primrose oil, also helps cervical effacement and dilatation.

16. Bumpy car ride

This may help, but women with history of placenta previa and abruption placenta should avoid it due to possible bleeding.

17. Chinese cuisine

Some women have claimed that Chinese food help induce labor. However, the exact mechanism is unknown, and whether Chinese food really induces labor is still in question.

18. Dancing

Just like walking, dancing may help stimulate labor.  But avoid overdoing it, including pole dancing .

19. Clary sage oil

This can be used as an aromatherapy to relax the mind and help stimulate oxytocin production.

20. Eggplant

Many people have reported that eating eggplant can induce labor, although there is no strong evidence to support this claim. It’s worth a try because it does not have any side-effects.

21. Galloping

Imitating the movement of a horse may also be used to induce labor because it aids in the descent of the baby. Avoid overdoing it to prevent strains.

22. Golden sea

This may be taken in tablet form to induce labor.

23. Wine

Drinking a glass of wine at 40 weeks of pregnancy may help, but drinking too much during pregnancy may possibly cause fetal alcohol syndrome.

24. Pelvic rocking

Kneeling on the floor with the hands on the floor and swinging the hips back and forth may also induce labor.

25. Mandarin oil

Some women may benefit from using this oil to induce labor.

26. Licorice
    

This herb may help stimulate the gastrointestinal tract (GIT) and uterine contractions.

27. Motherwort

This can be taken in the form of tea or pill.

28. Oregano

Oregano leaves may be added in food to help induce labor.

29. Pineapple

Eating fresh pineapples can help jump start labor due to the chemicals it contains.

30. Raspberry leaf

Raspberry leaf is known to increase the tone of the uterus and strengthen the uterus, leading to shorter labor and delivery. Raspberry leaf in pill or tea form can be taken at 37 weeks of gestation.

31. Quinine

Quinine in liquid or pill form can be taken, but before consuming quinine, a physician should be consulted first.

32. Sperm

Sperm cells also help ripen and dilate the uterus. Engaging in sex is fine as long as there are no contractions and the membranes (bag of water) are still intact.

33. Squats

Performing squats is one of the most effective and traditional measures to naturally induce labor. Squats done  everyday from the 37th to 40thweek of pregnancy helps the baby descend and move into position.

34. Membrane sweep

Midwives and doctors can perform this procedure by inserting a finger in the vagina and sweeping around the cervix to slightly separate the amniotic sac from the uterine wall.

35. Squaw vine

There is no strong evidence for its use, but it is worth a try after consulting with the doctor.

36. Swinging on a swing
    

Swinging back and forth helps stimulate the baby and encourages the baby to descend.

37. Swimming

Swimming may help induce labor.

38. Thyme

Thyme may be taken in the form of a tea.

39. Yoga

Yoga is also a great way to stimulate and facilitate the birth process. This may be done throughout all stages of pregnancy.

40. Visualization exercises

Guided imagery, which stimulates the mind, is also a good way to induce labor. Listening to someone narrate the labor process and imagining these happenings would be an example of guided imagery. Through visualization, which is aimed at creating a scene, the physical information of the labor and delivery process is used on an imaginary level.

41. Walking up and down the stairs

Walking up and down stimulates the descent of the baby. It may be more beneficial than walking on flat surfaces. It is advised to move carefully to prevent accidental falls.

42. Cinnamon stick tea

Cinnamon sticks may be added to tea to help relax and prepare for labor.

43. Cumin tea

Cumin tea may also be consumed to help women induce labor.

44. Curry

Curry is especially spicy and may induce labor, stimulating the gastrointestinal tract (GIT) and causing the uterus to contract.

45. Homeopathic remedies

Pulsatilla is a homeopathic remedy for labor induction. For the medication, a homeopathic provider needs to be approached, but it is advisable to inform the physician first.

46. Blowing up balloons

Blowing up balloons increases the abdominal pressure which may stimulate the uterus to contract. It is also a good way to exercise breathing in preparation for delivery.

47. Weepy video

Some mothers have tried watching a weepy video and said that labor was imminent following a good cry, but there is no scientific evidence to show that it is really effective.

48. Preparation of nursery
    

Some excited women may have labor induction after preparing the nursery of their future newborn.

49. On the go

Although excessive activity may be bad for pregnant women, it is advised to maintain a good deal of activity during pregnancy to enhance uterine contractions, particularly near the due date. Women who are sedentary have a higher risk of labor complications.

50. Talking to the baby

Yes! Some women who were overdue sometimes took advantage of the opportunity to talk to their baby, requesting that they come out quickly. This activity also establishes maternal and child bonding.

These are natural recommendations for labor induction. Women who may not experience post-maturity pregnancies may still go into labor without using these natural methods, but such methods may also help women to have easier and shorter deliveries, thereby reducing maternal stress during the process. It is still essential to consult an obstetrician before using some of these natural labor induction ways, especially those that require ingestion. Walking and exercise are the most effective and safest natural ways to induce labor, and even doctors recommend them.

Definition of Relative Afferent Pupillary Defect

Relative afferent pupillary defect (RAPD), also known as Marcus Gunn pupil, is a condition wherein the pupils react minimally to bright light. RAPD was named after Scottish ophthalmologist Robert Marcus Gunn.

The mechanism involved in RAPD may be an unequal optic nerve transmission between the two eyes, thereby resulting in an unequal pupillary response to light. When light is shone into the normal or unaffected eye, the pupil normally contracts to control the amount of light that goes in, but when light is shone in the affected eye, the pupil dilates due to the inability to detect bright light, or when it does constrict, it may be less than the unaffected eye, revealing a reduced pupillary sphincter constriction.

RAPD is different from anisocoria, which is characterized by the unequal size of the pupils at the same time. Anisocoria is more an efferent defect rather than an afferent one.

Relative Afferent Pupillary Defect Symptoms

Symptoms of RAPD are usually seen following diagnostic tests. It is not apparent in the eyes unless light is shone into the eyes. The symptoms of RAPD are identified using a swinging light test.

Swinging light test is done in a dimly lit room to adequately observe for the pupillary changes. Light is shined on the eye and constriction is observed. The light is then shone on the other eye, and the action should produce similar effects. When light is shined on one eye, both pupils must constrict. The swinging light test may be repeated until a specific category is found. There are four categories of degrees of RAPD. These include:

• No relative afferent pupillary defect: This is a normal finding, and the pupils constrict equally to light with absence of re-dilation.
• Mild relative afferent pupillary defect: There is a presence of weak pupillary constriction followed by pupillary dilation when light is directed in the affected eye .
• Moderate relative afferent pupillary defect: There is an absence of initial constriction followed by dilation when light is shone into the affected eye.
• Severe relative afferent pupillary defect– There is an immediate dilation when light is shone into the affected eye.

Causes

There are a lot of possible causes of RAPD, including:

• Optic nerve disorders: Optic nerve problems may cause inability of pupils to react in same way. Optic nerve disorders may include:

• Optic neuritis
• Glaucoma
• Ischemic optic neuropathies
• Optic nerve tumor
• Traumatic optic nerve neuropathy
• Orbital disease
• Optic nerve infection
• Optic nerve inflammation
• Radiation optic nerve damage
• Papilledema induced optic nerve atrophy
• Optic nerve damage due to surgery (plastic surgery, eye surgery, orbital surgery, pituitary tumor, and resection)

• Retina disorders: Severe cases of retinal diseases may result in RAPD. These include:

• Ischemic ocular disease
• Ischemic retinal disease
• Retinal detachment
• Retinal infection
• Severe macular degeneration

• Cerebrovascular disease: Stroke may also cause RAPD as a result of homonymous hemianopsia.

• Amblyopia: Severe cases of amblyopia may lead to RAPD.
• Multiple sclerosis: Multiple sclerosis may also cause RAPD due to optic nerve damage.

Differential diagnosis

The main diagnosis of RAPD is the use of the swinging light test as described earlier. The specific degree of pupillary defect is needed to detect mild, moderate, and severe defects. Other tests which may also be performed to detect the specific cause of the condition include:

• MRI

MRI may be able to detect problems related to the presence of inflammation or tumor in the optic nerve or retina. It may also detect the presence of cerebrovascular diseases.

• Ophthalmology exams

Ophthalmologists may also perform other tests to detect the presence of glaucoma, retinal detachment, macular degeneration, and other related conditions.

The correct diagnosis should be employed in order to have a clearer picture of the condition, and proper treatments will be employed according to the cause. Ophthalmologists identify whether RAPD is caused by:

• Optic nerve problems
• Retinal problems
• Stroke
• Multiple sclerosis

The following conditions usually do not result in RAPD, so other diagnosis should be considered:

• Refractive error
• Strabismus
• Cataract
• Hyphema
• Corneal scar
• Vitreous hemorrhage
• Third cranial nerve palsy
• Diabetic retinopathy
• Non-ischemic vein occlusions
• Retinitis pigmentosa
• Cerebral infarction

Relative Afferent Pupillary Defect Treatments

Treatments for RAPD depend on the cause. These include:

Steroid therapy

Cases of optic neuritis may require the use of corticosteroids to reduce swelling in the optic nerve. Steroids may be in the form of prednisone or methylprednisolone. The presence of papilledema my also require steroid therapy.

Antibiotic therapy

Presence of infections in the optic nerve may also require antibiotic therapy to kill the causative microorganisms.

Miotics

Miotic eye drops are also employed in the case of glaucoma to reduce the pressure in the eye and optic nerve.

Interferons

Interferons may be instituted for patients with multiple sclerosis-induced RAPD in order to promote myelination of the nerves.

Surgery

Surgery is applied to those who who do need it and those who do not respond to conventional therapies. Patients with glaucoma may need iridectomy, and retinal detachment may require repair of the damaged retina. Other surgeries may be deemed necessary by physicians.

ICD 9 code

RAPD has an icd 9 code of 379.49 under the category of other anomalies of pupillary function.