Medical News Today: Physicians: Five extraordinary hobbies to keep burnout at bay

From stand-up comedy to knitting teddy bears, some physicians have unique ways to unwind from daily stress and keep the looming threat of burnout, which hangs over the medical profession, at bay.
Physician burnout
Can hobbies help to stave off burnout?

Burnout rates among physicians in the United States are at an all time high. In fact, the levels of burnout among physicians are substantially higher than in the general population.

Satisfaction with work-life balance is also on the decline.

In the United Kingdom, a recent survey by the British Medical Association revealed that more than half of general practitioners (GP) — the U.K. equivalent of family physicians — live with stress and that 1 in 10 had taken time off work due to it in the past year.

Recent research has examined successful strategies to address burnout at both the workplace and in the physician’s self-care.

How do physicians spend their time after work, and what activities could help them to cope with the demands of the medical profession? Medical News Today spoke with five healthcare professionals to find out about their unconventional hobbies.

Playing the strings

Dr. Cho LSO
Dr. Michael Cho, who describes being part of the LSO as ‘great therapy.’
Image credit: Peter Xiong

For Dr. Michael Cho, a pulmonary and critical care medicine physician from Boston, MA, playing the violin and viola as a part of the Longwood Symphony Orchestra (LSO) is something he described as a “huge de-stressor.”

Music plays a big part in Dr. Cho’s life. A student of the violin since the age of 5, he added the viola to his repertoire from age 20. Dr. Cho joined the LSO in 2003.

Dr. Cho said that being part of the orchestra is great therapy.

“My work can be very stressful and it is wonderful to be able to meet up with my colleagues and make music. I am able to put my mind to something else that is completely different,” Dr. Cho explained to MNT.

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Mixing medicine and comedy

Dr. Patrick
Dr. Ed Patrick combines medicine and comedy in his stand-up routines.
Image credit: Edward Moore

Try not to ask U.K.-based emergency medicine physician and stand-up comedian Ed Patrick to choose between his love of medicine and his love of comedy. He simply couldn’t.

“I love doing medicine and I love stand-up and comedy too,” Dr. Patrick told MNT. “I couldn’t imagine doing one without the other. Comedy helps to put things into perspective.”

On some days, he explained, he might have a challenging day at the hospital but a great gig the same night. “It becomes a release almost. One really complements the other,” he said.

Dr. Patrick’s routine is packed with anecdotes about his experiences as a junior doctor. “You’re put into so many different situations in medicine, and I find a lot of the things I talk about come from exploring my feelings and reactions to them. Of course, I try to make it funny as well!”

Dr. Patrick is currently performing across the U.K.

Knitting teddies and harvesting strawberries

Dr. Baker
To relax, Dr. Kate Baker knits teddy bears and visits her allotment.

For GP Dr. Kate Baker, who works in Cardiff, U.K., work has never been so busy.

She is a partner at her medical practice and is currently working with the health board on a new health center development. She is also involved with the local medical committee.

“When sitting in the evenings,” Dr. Baker told us, “I’m generally knitting teddies for special friends and family.”

“In addition,” she said, “my weekends are spent working on our allotment [fruit and vegetable garden] and walking our […] puppy. It provides a real escape from my busy professional life.”

Dr. Baker has enjoyed being creative since she was a child and added that the patchwork quilt she created when she was 18 still lives on in her spare room.

Knitting teddies is something of an unusual way to unwind, and she explained that it was a birthday gift from her mother — a book on teddy knitting — that was the catalyst to finding this outlet. “I enjoy making them so much,” Dr. Baker said.

As someone who grew up in the countryside, the outdoor release that the family’s allotment offers is just the tonic for Dr. Baker.

The allotment has recently had its first harvest of strawberries, cucumbers, peas, and radishes. “I feel like I’ve been on holiday when I have time to unwind among everything growing,” she explained.

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‘I felt compelled to paint’

Dr. Brown
Dr. Jeffrey M. Brown calls the notion of painting being relaxing a ‘myth.’

What is the first word that pops into your head when you think about painting? If it’s “relaxing,” Dr. Jeffrey E. Brown has news for you.

“There is a myth that surrounds painting,” said the family practitioner from California, “that it must be so relaxing.”

“Personally,” he continued, “I get worked up after having made countless decisions about composition, balance, color, and meaning.”

“I feel exhausted but satisfied by the end of the process!”

Dr. Brown’s interest in painting developed through his love of collecting art. “After having spent so much time with artists, [in] galleries, and museums, I just felt compelled to begin to paint,” he said.

“Some oil paintings provoke strong feelings of pleasure in me, both to collect and to paint. I’m happy to continue riding the wave!”

‘Writing offers a specific type of stress relief’

Dr. Macdonell-Yilmaz
Dr. Rebecca Macdonell-Yilmaz’s first career goal was to write.

Dr. Rebecca MacDonell-Yilmaz is a pediatrician and hospice and palliative medicine fellow at Rhode Island Hospital in Providence.

“I have always loved to write and being a writer was actually my first career goal,” Dr. MacDonell-Yilmaz told MNT.

Dr. MacDonell-Yilmaz got into poetry via a local poetry writing group and soon found that she was hooked.

“Once I had felt the rush of relief that comes from words tumbling out onto the page,” she explained, “I knew that I wouldn’t stop writing.”

Writing essays and poetry offers a specific type of stress relief in that I’m often writing about things I have encountered or struggled with at work. I end up getting not only the benefit of taking time out for creativity but also the chance to process very challenging or emotional situations related to my work.”

Dr. Rebecca MacDonell-Yilmaz

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Finding your own outlet

Finding a creative activity that you enjoy may have benefits beyond providing much-needed stress relief; it might also make you a better healthcare professional. That’s according to research from psychologists at San Francisco State University in California.

Getting creative — whether that’s via the arts, crafts, or by getting out into the great outdoors — can not only help you to unwind, but it could also provide an effective way to manage stress and recover from the demands of your professional life.

The start of the New Year might be a good time to rekindle old hobbies or to start something new and unique to you.

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Medical News Today: What is the difference between Botox and dermal fillers?

Botox and dermal fillers are cosmetic treatments given through injections, usually in a doctor’s office. They are minimally invasive, meaning they do not involve surgery. That is where their similarities end, however.

Botox and dermal filler treatments are popular, accounting for more than 9 million procedures in 2015, according to the American Society of Plastic Surgeons (ASPS).

Botox contains purified bacteria that freeze muscles. In doing so, Botox can help minimize the appearance of lines and wrinkles caused by facial expressions.

Dermal fillers contain ingredients that add fullness to areas that have thinned due to aging. This thinning is common in the cheeks, lips, and around the mouth.

People should be aware of the costs and risks of treatments and have realistic expectations of what they can do.

What is Botox?

botox injection Botox vs fillers
Botox may help to correct dynamic wrinkles, such as crow’s feet around the eyes and horizontal lines on the forehead.

Botox is a purified form of the botulinum toxin that is obtained from bacteria. Though it is deadly in larger amounts, the tiny, regulated amount of Botox given to correct wrinkles has been used safely for decades.

Botox works by blocking nerve signals in the muscles where it is injected. When those nerve signals are interrupted, the affected muscle is temporarily paralyzed or frozen. Without movement of these selected muscles in the face, certain wrinkles may be softened, reduced, or even removed.

Botox and other treatments made with botulinum toxin are sometimes called neuromodulators or neurotoxins.

Treatments made with botulinum toxin are sold under the brand names Botox Cosmetic, Dysport, and Xeomin.

What can Botox correct?

Botox only works on wrinkles that are caused by muscle movement. These are known as dynamic wrinkles, and are often called “expression lines.”

The most common dynamic wrinkles that Botox can treat are lines on the upper face, such as the “11” between the brows, horizontal lines on the forehead, and crow’s feet around the eyes. These lines are caused by smiling, frowning, squinting, and other facial expressions.

Botox will not work on fine lines and wrinkles caused by sagging or loss of plumpness in the face. These are known as static wrinkles. Static wrinkles include lines in the cheeks, neck, and jowl areas.

Botox is not a permanent treatment. Repeated treatments are necessary for continued wrinkle-reducing effects. Most people find that the muscle-relaxing effect of Botox lasts for 3 to 4 months.

Botox side effects and considerations

The ASPS considers Botox to be safe, and 6.7 million procedures were performed in 2015. As Botox wears off over time, most side effects are only temporary.

Possible side effects of Botox include:

  • drooping of the eyelid or brow if injected near the eye
  • weakness or paralysis of nearby muscles
  • hives, rashes, or itching
  • pain, bleeding, bruising, swelling, numbness, or redness
  • headache
  • dry mouth
  • flu-like symptoms
  • nausea
  • trouble swallowing, speaking, or breathing
  • gallbladder problems
  • blurry vision or vision problems

The treatment may also fail to work due to antibodies that fight the toxin. This happens in less than 1 percent of people who have repeated Botox treatments, however.

The ASPS advise people not to rub or massage the area of the injection after having Botox treatment. This could spread the toxin to surrounding skin, causing muscle drooping and other problems.

The average cost of a Botox injection is $385, according to 2016 statistics from the ASPS.

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What are dermal fillers?

Dermal fillers for the lips
Dermal fillers may help to plump up thinning lips.

Dermal fillers, sometimes called soft tissue fillers, are substances designed to be injected beneath the surface of the skin to add volume and fullness.

Substances used in dermal fillers include:

  • Calcium hydroxylapatite, which is a mineral-like compound found in bones.
  • Hyaluronic acid, which is found in some fluids and tissues in the body that add plumpness to the skin.
  • Polyalkylimide, a transparent gel that is compatible with the body.
  • Polylactic acid, which stimulates the skin to make more collagen.
  • Polymethyl-methacrylate microspheres (PMMA), a semi-permanent filler

Each one of these is designed to treat different signs of aging or other cosmetic issues.

The time they take to work, as well as how long they last, also vary. Some fillers last 6 months, while others last up to 2 years or longer.

People should discuss their individual needs and expectations with their doctor to determine what filler would be the best choice for them.

What can dermal fillers correct?

Different types of dermal fillers are designed to treat varying signs of aging. Depending on the filler selected, they may:

  • plump up thinning lips
  • enhance or fill in shallow areas on the face
  • decrease or remove the shadow or wrinkle under the eyes caused by the lower eyelid
  • fill in or soften the look of recessed scars
  • fill in or soften static wrinkles, especially on the lower face

Static wrinkles include those around the mouth and along the cheeks. These wrinkles are usually a result of a loss of collagen and elasticity in the skin.

Dermal filler risks and considerations

Dermal fillers are considered to be safe but side effects can occur. The most common problems include:

  • skin rash, itching, or pimple-like eruptions
  • redness, bruising, bleeding, or swelling
  • undesirable appearance, such as asymmetry, lumps, or overcorrection of wrinkles
  • skin damage that causes a wound, infection, or scarring
  • ability to feel the filler substance under the skin
  • blindness or other vision problems
  • death of skin cells due to loss of blood flow to the area

The cost of dermal filler treatments varies and depends on the provider performing it, the area being treated and the type of filler selected. The ASPS 2016 statistics list the following cost per syringe:

  • calcium hydroxylapatite, such as Radiesse: $687
  • hyaluronic acid, such as Juvederm, Restylane, or Belotero: $644
  • polylactic acid, such as Sculptra: $773
  • polymethyl-methacrylate microspheres, such as Bellafill: $859

These costs may be more or less, depending on how much filler is used. Using less than a full syringe of filler may be cheaper than using a full syringe or more than one.

The provider may also charge additional fees for their professional services, office visit, or other costs.

Key differences

In summary, the differences between Botox and fillers are:

  • Botox: This freezes muscles to stop creases and wrinkles caused by facial expressions. These are typically found in the upper face, such as the forehead and around the eyes.
  • Dermal fillers: These use hyaluronic acid and similar substances to “fill in” or plump areas that have lost volume and smoothness. This includes wrinkles around the mouth, thin lips, and cheeks that have lost fullness. They may also be used on forehead wrinkles, scars, and other areas that need extra volume for a smoother look.
  • Botox results last 3 to 4 months. Dermal filler results vary, depending on which filler is used.

Because Botox and fillers are different substances designed for different uses, they can sometimes be combined in one treatment. For instance, someone may use Botox to correct lines between the eyes and a filler to correct smile lines around the mouth.

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Rejuvenation botox fillers
Botox and fillers are considered safe, with side effects occurring in less than 1 percent of recipients.

Millions of Botox and filler procedures are performed each year, and they have a good track record of safety.

A study in JAMA Dermatology found that Botox and filler procedures are very safe when performed by experienced board-certified dermatologists. Side effects occurred in less than 1 percent of recipients, and most of these were minor.

Though Botox and fillers are minimally invasive, they still carry some risks. An individual should be aware of all possible risks and benefits before having these treatments.

Botox and fillers are not recommended for women who are pregnant or breastfeeding. People who have certain health conditions or who take any medications should discuss whether Botox or fillers are safe for them.

People should also discuss what Botox and fillers can realistically do for their appearance. Though they can enhance a more youthful look, the results are typically not as powerful as having a surgical procedure, such as a facelift.

Using a qualified medical provider, such as a board-certified dermatologist, plastic surgeon, or cosmetic surgeon helps ensure the procedure is done safely and properly. People should discuss the provider’s experience and training in dermal fillers and Botox before making a decision.

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Medical News Today: Perfectionism on the rise among millennials, but to what effect?

Millennials may be the most perfectionist generation yet, a new study shows, but their drive to achieve success and remain on the peak may pose important threats to their mental health.
young woman lonely in a crowd
Is perfectionism an epidemic among millennials?

Perfectionism, if one were to judge by its name alone, does not sound like an undesirable trait. After all, it is commendable to strive to do our best in all settings — from work to family life.

Often, however, perfectionism can give rise to an intense sense of pressure that could affect our psychological well-being.

A study recently conducted by Thomas Curran, from the University of Bath, and Andrew Hill, of York St. John University — both in the United Kingdom — now shows that millennials are the generation most predisposed to perfectionism.

This may well be affecting their mental health in ways that their parents and grandparents may not have experienced.

The study’s findings were published in the journal Psychological Bulletin.

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Steep rise in perfectionism by 2017

In their published paper, Curran and Hill define perfectionism as “a combination of excessively high personal standards and overly critical self-evaluations,” which explains why many people prone to this take in life may find it more difficult to achieve satisfaction.

The researchers examined data from 41,641 college students from the United States, Canada, and the U.K. These data were sourced from 164 samples wherein the students had completed the Multidimensional Perfectionism Scale, which measures the different predispositions toward perfectionism across generations, from the late 1980s to 2016.

Curran and Hill used a model that took into account three different types of perfectionism:

  • self-oriented, which is when “individuals attach irrational importance to being perfect [and] hold unrealistic expectations of themselves”
  • socially prescribed, which is when “individuals believe their social context is excessively demanding, […] and that they must display perfection to secure approval”
  • other-oriented, which is when “individuals impose unrealistic standards on those around them”

From the samples, it became apparent that the younger cohorts of college students scored higher for all three types of perfectionism than previous generations of students.

The data revealed that, from 1989 to 2016, an average college student’s score for self-oriented perfectionism increased by 10 percent, and for socially prescribed perfectionism it increased by as much as 32 percent. Meanwhile, a 16 percent rise was noted in other-oriented perfectionism.

Curran and Hill suggest that several reasons may stand behind this steep increase in millennials’ expectations of themselves and of others.

These could range from the fact that Western cultures are increasingly encouraging a sense of competitiveness and stronger individualism, to “anxious and controlling parental practices.”

Social media also seems to be an important factor when it comes to millennials’ anxiety about body image and social integration, as unrealistic representations push the younger generations to seek unachievable, perfect bodies and increase the individuals’ sense of isolation.

However, Curran adds that this theory needs to be confirmed by further research.

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Too much pressure on millennials

Other factors, including ever-higher educational demands and the pressure to find a high-paying job, may also play a role in this generation’s inflated sense of perfectionism.

The rise of meritocracy could also be to blame, Curran explains. “Meritocracy,” he says, “places a strong need for young people to strive, perform, and achieve in modern life.”

Young people are responding by reporting increasingly unrealistic educational and professional expectations for themselves. As a result, perfectionism is rising among millennials.”

Thomas Curran

The researchers’ data show that roughly half of high-school graduates in the 1976 cohort aimed to finish college. By 2008, more than 80 percent of high-school seniors expected to get a degree.

“These findings suggest that recent generations of college students have higher expectations of themselves and others than previous generations,” Curran notes.

He adds, “Today’s young people are competing with each other in order to meet societal pressures to succeed and they feel that perfectionism is necessary in order to feel safe, socially connected, and of worth.”

In their conclusion, Curran and Hill express their concern that millennials’ high perfectionism levels may be to blame for the recent increase in mental illnesses that affect “a record number of young people.”

Millennials “are experiencing higher levels of depression, anxiety, and suicide ideation than they did a decade ago,” the study authors write.

Reflecting on this worrying context, Hill encourages schools and other social authorities to lighten the sense of competitiveness they normally incite among peers, considering the threats it may pose to mental health.

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Medical News Today: What you should know about alopecia totalis

People with alopecia totalis lose all of the hair from their scalp. It is a rare autoimmune disease, in which genetics plays a role. It is an advanced form of the hair-loss condition alopecia areata.

Not everyone with alopecia areata will go on to develop alopecia totalis (AT). It is an unpredictable disease that has no cure, though sometimes, it can resolve itself.

What are the symptoms?

Some people with the condition will have scalp discomfort, such as soreness, itching, or tingling sensations. Many compare this to having a ponytail that has been tied too tight.

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Back of head of man with alopecia totalis, in front of computer at work.
Alopecia totalis causes complete loss of hair from the scalp, and may be caused by a problem with the immune system.

Though the cause is unknown, AT is thought to be an autoimmune condition — meaning it is caused by a faulty immune system. Researchers believe that the immune system mistakenly identifies hair follicles as a threat and attacks them.

In the past, the condition has been linked to stress, yet there is little evidence to support this.

Around 20 percent of people with AT have a family member who has alopecia. This suggests there may be genetic factors at play in the development of the condition.

Scientists believe having specific genes will make someone more susceptible to developing alopecia, meaning they are more likely to develop it if they come into contact with other factors, such as allergies, viruses, and toxins.

AT can occur at any age, but it is more likely to affect teenagers and young people between 15 and 29 years old. It is more common in people with other autoimmune conditions, such as an overactive thyroid or diabetes. Men and women are affected in equal numbers.

About 5 percent of children with alopecia areata will go on to develop AT.

What treatments are available?

There is no cure, and the available treatments are not usually effective for severe forms of the condition, such as AT.


Corticosteroids, either as injections or pills, are a common treatment, though not often effective in AT. If they do work, they cannot be used long-term, as they have potentially dangerous side effects.

Sometimes, doctors recommend short-term ‘pulse steroid therapy.’ This includes a treatment called diphencyprone (DPCP), which is thought to benefit some people with AT. It is a topical treatment, meaning it is rubbed onto the scalp and is applied weekly in the hospital or clinic. It is a chemical that causes an allergic reaction, which in turn may stimulate hair growth.


A group of drugs called biologics is currently being tested for AT. These drugs contain particular proteins and are designed to dampen down the immune system.

The hope is that these drugs, which are used successfully to treat other autoimmune conditions, will turn off the inflammatory response thought to cause alopecia.

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Recovery rate

Bald woman with alopecia outside with hat on.
It is unlikely that AT will resolve itself, and there is currently no cure.

Sometimes, the immune system can stop attacking the hair follicles and hair may start to grow again. This can happen for no apparent reason and often years after the first symptoms appear.

However, the chances of alopecia areata resolving itself after it has progressed to AT are small.

If someone has had AT for more than 2 years, it is unlikely that their hair will grow back. If it did, this could be fully or partially.

There is currently no cure for AT. Most people with this severe form of alopecia find the available treatments do not work and opt to wear a wig.

Hair loss can cause emotional issues, and many people who experience it feel they are losing a part of their identity. People who have received a diagnosis of alopecia may take many months to come to terms with it.

It is typical for a person diagnosed with AT to experience emotions including sadness, depression, hopelessness, guilt, fear, isolation, loneliness, anger, and frustration.

Many organizations offer support to people living with AT and their families. These include:

  • American Hair Loss Association
  • Children’s Alopecia Project
  • National Alopecia Foundation

People with AT need to take extra care in the sun, as they are more susceptible to burns on the head, especially if they have light-colored skin. These may leave them at a greater risk of developing skin cancer, so covering up with sunscreen, as well as a wig, bandana or hat, is recommended.


Alopecia areata refers to the autoimmune condition that causes hair loss, and AT is a severe form of this.

Alopecia areata is a form of hair loss that affects nearly 2 in every 100 people in the United States. It usually starts as one or two smooth, bald patches but can sometimes spread to cover the entire scalp — this is AT.

When alopecia areata spreads to cover the whole body, including the scalp, eyebrows, lashes, beard, and pubic hair, it is known as alopecia universalis. When alopecia is restricted to just a man’s beard, it is called alopecia barbae.

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Natural remedies

Some people have claimed that certain dietary supplements and ointments can help in the treatment of alopecia in all its forms, but there is little evidence to support these claims.

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Medical News Today: What you should know about hair dye allergies

When someone has an allergy to hair dye, they are most likely allergic to one of the chemicals in the dye rather than the entire product. The most common cause of these allergic reactions is para-phenylenediamine, also called PPD.

PPD is found in most commercially produced hair dyes. The PPD is usually mixed with peroxide in the dye to alter the hair color. What happens before this reaction is fully complete also makes the PPD more likely to interact with the skin and cause an allergic reaction.

PPD can be found in commercial hair dyes under many alternative names. These include names such as PPDA, 1,4-Benzenediamine, and Phenylenediamine base.

Another common chemical found in hair dye is para-toluenediamine (PTD), which can be tolerated better than PPD but may still cause an allergic reaction in many people.

Hair dye allergy symptoms

Hair dye allergy
PPD may be the most common cause of allergic reactions to hair dye.

Allergic contact dermatitis is a reaction caused by the skin being touched by something it is allergic to. Once sensitized, the affected skin will usually become inflamed and red when exposed to the offending allergen.

The scalp, ears, beard, or neck may become red and inflamed. The eyes also may itch, and the eyelids may swell as the reaction develops.

Most contact dermatitis from a hair dye allergy is classified as type 4 hypersensitivity, and it usually takes hours or more for symptoms to occur upon exposure.

Hives may also show up after a hair dye application. The symptoms of these are red, raised, and itchy patches on the body. Someone may experience difficulty swallowing and respiratory problems, such as wheezing and sneezing.

Anaphylactic shock

It is also possible, but far less common, for someone to have an immediate, anaphylactic allergic reaction or type 1 hypersensitivity to hair dye, leading up to anaphylactic shock.

Symptoms may include hives, swelling of the face and airways, shortness of breath, and a drop in blood pressure with a fast heart rate and possibly loss of consciousness. Anaphylactic shock can be fatal, and anyone experiencing these symptoms needs immediate medical attention.


One of the difficulties in identifying a reaction to PPD is that symptoms typically will not show up until after the second usage of the product.

The body becomes allergically sensitized to an invading substance the first time it is used. Once it is applied a second time, reactions will often start to appear. Reactions may also get worse with more applications of the product.

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Hair dye intolerance

a woman with eczema on her neck
Non-allergic contact dermatitis may affect people who are not allergic to hair dye.

It is also possible for people who are not allergic to hair dye to react when using it, leading to non-allergic contact dermatitis or other symptoms.

Some skin types are more sensitive to chemicals, including PPD. This type of reaction may be more common when someone switches brands with different dye formulations.

Most people will find that their skin may become dry, stretched, or cracked. The scalp may tighten or feel as if it is burning.

Symptoms of irritation will usually appear within 48 hours. At the same time, many people with a hair dye intolerance may have an almost immediate reaction to PPD or other hair dye components.

Treatment for hair dye allergy

If any symptoms of a hair dye allergy show up, the hair should be washed immediately. The excess dye can be removed through multiple gentle washes with a mild soap and plenty of rinses with clean water.

Hydrogen peroxide

It may also help to rinse the hair with a solution of 2 percent hydrogen peroxide after washing the excess out. This helps to oxidize the PPD fully and make it non-reactive. This step has mixed results, and it should be avoided if it makes symptoms worse.

Creams and emollients

Creams with alcohol or certain other chemicals may irritate the skin. Natural creams or simple wet compresses of olive oil and lime may help.

Steroid creams may be used to reduce inflammation with swelling and irritation in cases of stronger allergic reactions.

Some over-the-counter steroid creams may work well enough to manage symptoms if they are less severe. However, more severe allergic reactions may require a prescription steroid cream or possibly oral steroid therapy.

How long do symptoms last?

Symptoms of hypersensitivity to hair dye may last anywhere from a few days to a week or more, depending on the severity of the reaction.

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Synthetic and natural alternatives to PPD

Many alternatives to PPD-containing hair dyes are on the market, though color options may be more limited.

They are PPD-related chemicals, such as hydroxyethyl-p-phenylenediamine sulfate (HPPS), or they do not contain PPD at all, and they work by getting deep into the hair and staining it. Some of these alternative dyes are only available in limited ranges of color, so they may not work for everyone.


Henna is another option for people looking to avoid irritating PPD. True henna is made from crushed plant matter.

Henna usually ranges from an orangish to red-brown color, depending on the other ingredients in it and how it is prepared before it is applied.

Henna is considered to be more allergy-friendly, though there is still the possibility of reacting. A patch test should be used for any henna-containing dye if someone wants to be sure.

It is also crucial to be certain the henna is in fact true henna. Many companies add PPD or its derivatives to their henna-containing hair dyes and market it as henna. These may still cause a PPD-related reaction.

Semi-permanent and lead-containing dyes

Some people can tolerate semi-permanent hair dyes or lead-based hair dyes, though these options may not be right for everyone. A dermatologist can help determine any chemicals that may be right for every individual they test.

Avoiding a reaction

Avoiding a reaction to hair dyes is easy if a few steps are followed. Any or all of these methods can be used to help test for reactions or avoid them

General precautions

Using gloves for hair dye allergy
It is recommended to use gloves when handling hair dye.

The instructions for each particular dye should be followed closely to help prevent any reactions caused by incorrect usage.

It is important not to leave hair dye in for longer than recommended. While most chemicals in hair dye are considered safe to use, leaving the chemicals on the scalp for too long can be irritating for most people.

Gloves should be worn whenever handling or applying hair dye.

Typically, for permanent dye, the hair and scalp should be washed thoroughly after the application is complete. Poor washing and rinsing leave bits of dye on the hair and scalp. This could cause irritation if the unnecessary dye is left reacting on the scalp longer than necessary. Additional washes and rinses may be required to be certain all the extra dye is washed off the hair and scalp.

Patch tests

Patch tests are done by a doctor and involve putting small, precise amounts of allergen substances in chambers on a small portion of the skin, usually the upper back, to check for allergic reactions.

With oxidizing hair dyes, a person can do an at-home test in a similar way, using the hair dye mixture. One of the simplest places to test is just behind the ear. Following the dye’s instructions on what to do after applying the dye is the best way to ensure a proper test.

Any irritation, reaction, or feeling of being unwell is a sign that the rest of a person’s scalp will have a bad reaction to the product. The product should be avoided in favor of another kind of dye.

Allergy clinics

If home patch testing or hair dyeing become a regular necessity, many people choose to go to an allergy clinic. Allergy clinics can do their own patch test to help determine what chemicals a person is intolerant of or allergic to. The list of possible irritants can then be checked against the ingredients of hair dyes to find the best one for their use.

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Any potentially irritating chemicals should be avoided. A person should be tested to ensure they are not allergic to a chemical or chemicals in hair dye to prevent a reaction. Avoiding further use of the product is key to preventing the recurrence of an allergic reaction.

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Medical News Today: What to know about hypercapnia

Hypercapnia, or hypercarbia, as it is sometimes called, is a condition arising from too much carbon dioxide in the blood.

It is often caused by hypoventilation or disordered breathing where not enough oxygen enters the lungs and not enough carbon dioxide is emitted. There are other causes of hypercapnia, as well, including some lung diseases.

This article discusses the symptoms and causes of hypercapnia and outlines some of the treatment options available to help manage the condition.


In cases where symptoms are mild and develop slowly over time, people may not even realize they have hypercapnia. Therefore, it is important to be aware of both mild and severe symptoms.

Mild symptoms

Dizzy woman on train experiencing headache and fatigue.
Symptoms of mild hypercapnia may include headaches, dizziness, and fatigue.

The following are considered to be mild symptoms of hypercapnia:

  • dizziness
  • drowsiness
  • excessive fatigue
  • headaches
  • feeling disoriented
  • flushing of the skin
  • shortness of breath

These symptoms of hypercapnia may arise from shorter periods of shallow or slow breathing, such as during deep sleep.

They may not always be a cause for concern, as the body is often able to correct the symptoms and balance carbon dioxide levels in the bloodstream without intervention.

However, if the above symptoms persist for several days, it is advisable to see a doctor.

Severe symptoms

The symptoms of severe hypercapnia require immediate medical attention, as they can cause long-term complications. Some cases may be fatal.

Severe hypercapnia symptoms include:


There are many causes of hypercapnia including the following:

Chronic obstructive pulmonary disease or COPD

Doctor using stethoscope to listen to patients breathing.
Various respiratory conditions, including COPD, may cause hypercapnia.

COPD is an umbrella term for several conditions that affect the breathing. Common forms of COPD include chronic bronchitis and emphysema.

Chronic bronchitis leads to inflammation and mucus in the airways, while emphysema involves damage to the air sacs or alveoli in the lungs.

Both conditions can cause increased levels of carbon dioxide in the bloodstream.

The main cause of COPD is long-term exposure to lung irritants. According to the National Heart, Lung, and Blood Institute, cigarette smoke is the most common lung irritant that causes COPD in the United States. Air pollution and exposure to chemicals or dust may also cause COPD.

Although not everyone with COPD will develop hypercapnia, a person’s risk increases as their COPD progresses.

Sleep apnea

The National Sleep Foundation report that between 5 and 20 percent of adults have sleep apnea.

This common condition is characterized by shallow breathing, or pauses in breathing, during sleep. It can interfere with the level of oxygen in the bloodstream and throw off the body’s balance of carbon dioxide and oxygen.

Sleep apnea symptoms include daytime sleepiness, headaches upon waking, and difficulty concentrating.


Rarely, a genetic condition where the liver fails to produce enough alpha-1-antitrypsin (AAT) can cause hypercapnia. Alpha-1-antitrypsin is a protein that is necessary for lung health, so AAT deficiency is a risk factor for COPD development.

Nerve disorders and muscular problems

In some people, the nerves and muscles necessary for proper lung function may not work correctly. For example, muscular dystrophy can cause the muscles to weaken, eventually leading to breathing problems.

Other disorders of the nervous or muscular systems that can contribute to hypercapnia include:

Other causes

Other causes of high blood levels of carbon dioxide include:

  • Activities that impact breathing, including diving or ventilator use.
  • Brainstem stroke, which can affect breathing.
  • Hypothermia, a medical emergency caused by rapid heat loss from the body.
  • Obesity hypoventilation syndromes when overweight people cannot breathe deeply or quickly enough.
  • An overdose of certain drugs, such as opioids or benzodiazepines.

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What are the risk factors

Some people are more at risk than others for the development of hypercapnia, especially if they:

  • Smoke: People who smoke, especially heavy smokers, are at greater risk of COPD, hypercapnia, other breathing difficulties, and lung diseases.
  • Have asthma: Because asthma causes the airways to become inflamed and narrowed, it may impact breathing and the levels of carbon dioxide in the body when it is not well controlled.
  • Work with lung irritants: Those who work with chemicals, dust, smoke, or other lung irritants are at greater risk of hypercapnia.
  • Have COPD: Having COPD, especially if diagnosed at a later stage of disease progression, increases the likelihood of getting hypercapnia.


Some tests used to diagnose hypercapnia include:

  • Arterial blood gas test: This checks for blood levels of carbon dioxide and oxygen.
  • Spirometer test: This test involves blowing into a tube to assess how much air a person can move out of their lungs, and how fast they can do this.
  • X-ray or CT scan: These imaging tests can check for the presence of lung damage and lung conditions.


The treatment for hypercapnia will depend on the severity of the condition and the underlying cause.

Options include:


CPAP sleep apnea ventilation mask.
Non-invasive ventilation, such as a CPAP mask, may help to treat hypercapnia.

There are two types of ventilation used for hypercapnia:

  • Non-invasive ventilation: Breathing is assisted by a flow of air that comes through a mouthpiece or nasal mask. This is helpful for people with sleep apnea to keep the airways open at night and is also known as CPAP or continuous positive airway pressure.
  • Mechanical ventilation: The person will have a tube inserted through their mouth into their airway. This is called intubation.

People with severe hypercapnia symptoms may be put on a ventilation device to assist with breathing.


Certain medications can assist breathing, such as:

  • antibiotics to treat pneumonia or other respiratory infections
  • bronchodilators to open the airways
  • corticosteroids to reduce inflammation in the airway

Oxygen therapy

People who undergo oxygen therapy regularly use a device to deliver oxygen to the lungs. This can help balance out the levels of carbon dioxide in their blood.

Lifestyle changes

To reduce symptoms and avoid complications, a doctor may recommend changes to diet and physical activity. They will also encourage people with hypercapnia to avoid lung irritants by quitting smoking and limiting their exposure to chemicals, dust, and fumes.


If the lungs or airways are damaged, then surgery may be required. Options include lung volume reduction surgery to remove damaged tissue or a lung transplant where a damaged lung is replaced by a healthy lung from a donor.

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How is it prevented

Hypercapnia can be prevented by:

  • treating existing lung conditions
  • quitting smoking
  • maintaining a healthy weight
  • working out regularly
  • avoiding exposure to toxic fumes and chemicals


Hypercapnia is caused by too much carbon dioxide in the blood. There are several reasons why this might happen, and addressing these is key to managing symptoms and improving a person’s quality of life.

As symptoms can be mild and progress slowly over time, it is important to be aware of the symptoms of hypercapnia and to consult a doctor if breathing difficulties or other symptoms are noticed.

Those who require long-term treatment or surgery for their hypercapnia should follow their treatment regimen carefully to reduce the risk of complications.

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Medical News Today: Sticking to New Year’s resolutions could cut cancer risk

Are your New Year’s resolutions already beginning to slip? New research could provide some much-needed motivation, after discovering that people who stick to lifestyle changes may reduce their risk of cancer by a third.
New years resolution for healthy lifestyle
Sticking to healthy lifestyle changes in 2018 could reduce your risk of cancer.

According to a poll conducted by YouGov last month, eating better and exercising more are the top two New Year’s resolutions for Americans in 2018.

Other lifestyle changes, including getting more sleep, quitting smoking, and cutting back on alcohol consumption, also make the top 10.

Unfortunately, more than 40 percent of us fail such resolutions after just 1 month.

But what are the benefits of sticking to them? A new study — recently published in the journal ecancermedicalscience — sheds light.

Study leader Prof. Peter Elwood — of the Division of Population Medicine at Cardiff University in the United Kingdom — and colleagues set out to determine how certain healthy behaviors affect the risk of cancer development.

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A healthy lifestyle ‘is better than any pill’

Cancer remains one of the world’s biggest health burdens. In the United States alone, more than 1.6 million people were diagnosed with cancer in 2016.

Lifestyle factors are major players in cancer development. Smoking, for example, is a leading cause of cancer; it accounts for around 30 percent of all cancer deaths in the U.S. and around 80 percent of lung cancer deaths.

In order to see how healthy lifestyle behaviors affect cancer risk, Prof. Elwood and his colleagues conducted an analysis of data from UK Biobank, which is an ongoing health study of 500,000 adults in the U.K.

The analysis included lifestyle data of 343,150 individuals. Using this information, the researchers looked at how five healthy behaviors impacted the subjects’ risk of cancer over an average of 5.1 years of follow-up.

These behaviors included low alcohol consumption, not smoking, regular physical activity, a healthy body mass index (BMI), and a healthful diet.

During follow-up, a total of 14,285 subjects received a cancer diagnosis.

The researchers found that people who adhered to all five healthy behaviors were a third less likely to develop cancer during follow-up, compared with individuals who followed just one or none of the healthy behaviors.

On looking at the effects of the five healthy behaviors individually, the analysis revealed that each one was associated with an 8 percent reduction in the risk of cancer.

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Additionally, the researchers found that adhering to all five healthy behaviors was linked to a 25 percent reduction in colorectal cancer risk and a 35 percent reduction in breast cancer risk.

So, if you’re tempted to quit the gym or succumb to that takeout already, you might want to refer to the results of this study.

“The take-home message is that healthy behaviors can have a truly tangible benefit,” says Prof. Elwood.

A healthy lifestyle has many benefits additional to cancer reduction — it costs nothing, has no undesirable side effects…and is better than any pill.”

Prof. Peter Elwood

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Medical News Today: Supplements during pregnancy may reduce autism risk

Whether certain supplements, taken before or during pregnancy, can reduce the risk of autism is a hotly debated question. A new large-scale study takes a fresh look.
Boy with autism alone in room
Could taking supplements during pregnancy reduce autism risk?

Autistic spectrum disorders (ASDs) are believed to affect 1 in 68 children in the United States, and their prevalence may be on the rise.

Despite this, the exact causes and risk factors involved are still shrouded in mystery. No one knows why ASDs occur and how they can be prevented.

Over the years, several studies have looked at the links between a mother’s nutritional status and the cognitive abilities of her offspring. The findings, to date, have been inconclusive, but scientists believe that this line of questioning might eventually help to solve the ASD riddle.

For instance, previous work has shown a relationship between low maternal vitamin D and ASD. Similarly, neural tube defects — that is, birth defects of the brain, spine, or spinal cord that occur very early in pregnancy — are known to be prevented by increased folic acid intake.

For these reasons and others, pregnant women are recommended to take multivitamins and folic acid supplements as standard.

Because relationships between multivitamin and folic acid supplementation and ASDs have been inconsistent, a study published this week in JAMA reopens the question.

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Supplements and ASD investigated

The current research team was headed up by Stephen Z. Levine, Ph.D., of the University of Haifa, Israel. Data were taken from 45,300 Israeli children born 2003–2007 who were followed up until 2015.

The scientists gathered information about any prescription supplements taken by the mothers before pregnancy (540–271 days before childbirth) and during pregnancy (270 days before childbirth up to childbirth).

Of the 45,300 children born to 26,702 mothers, 572 were diagnosed with ASD.

The authors concluded that there was a decreased risk of the offspring developing ASD if the mothers took folic acid, multivitamin supplements, or both either before pregnancy, during pregnancy, or both before and during.

To reiterate, supplements taken before pregnancy began, during pregnancy, or both before and during appeared to reduce the risk of ASD in the offspring.

This positive effect remained significant after a range of confounding variables were accounted for. The protective effect was measured in both male and female offspring, but the authors note that the low number of ASD diagnoses in females makes this conclusion less firm.

Among the children of women with psychiatric conditions, the risk of ASD did not diminish with supplementation, although, again, the sample size was relatively small.

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Solid conclusions?

The new results back up earlier conclusions from a Norwegian study that found that maternal folic acid use from 4 weeks before and 8 weeks into pregnancy was associated with a reduced risk of ASD. But although the findings are in line with some previous studies, not all previous research found such an effect.

This current study also marks the first time that links that go back further in time have been found: supplement use 2 years before pregnancy reduced ASD risk. That said, the authors are quick to describe the new experiment’s limitations, which include the lack of a sibling control analysis.

Additionally, information regarding supplement use came from prescription records. It is therefore possible that some mothers bought over-the-counter supplements, which would not have been included in the analysis.

The study is only observational, meaning that a causal relationship cannot be proven. Further studies will be needed to understand whether or not this anti-ASD effect is real.

The authors write in their conclusion, “Reduced risk of ASD in offspring is a consideration for public health policy that may be realized by extended use of [folic acid] and multivitamin supplements during pregnancy.”

Whether the results are replicated or not, advice to pregnant mothers will remain unchanged: multivitamin and folate supplementation will be recommended, regardless.

Hopefully, in time, any nutritional components of ASD risk will be pinned down once and for all.

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Medical News Today: What to know about avoiding depression

Depression is a common and serious medical condition that affects how people feel and act. The illness can lead to emotional as well as physical problems and can cause issues in all aspects of a person’s life.

Many people take medication, such as antidepressants, to treat their depression, but there are a variety of natural methods available that work and reduce the risk of future episodes.

Depression is the most common type of mental illness. The American Psychiatric Association estimate that depression affects around 1 in 15 adults every year and that 1 in 6 people will experience depression at some point during their life.

While depression can affect anyone, it usually occurs for the first time when a person is in their teens or early 20s. Women are more likely than men to have depression.

1. Avoid stress

How to avoid depression
Stress and depression are linked, and a variety of factors may cause stress.

There is considered to be a relationship between stress in a person’s life and depression or anxiety.

A 2012 study conducted with veterinary students found stress had a negative impact on mental health, life satisfaction, and general health.

A variety of factors, including work, education, family life, or relationships, can cause stress. It is important to try managing and addressing these stressful situations when they arise.

2. Exercise

Exercise offers a range of health benefits including helping prevent depression. Both high-intensity and low-intensity exercise is beneficial in this respect.

High-intensity exercise releases the feel-good chemicals, known as endorphins, into the body.

Low-intensity exercise sustained over an extended period helps release proteins called neurotrophic factors, which improve brain function and make a person who is exercising feel better.

Many people who are depressed have low motivation for exercise, so it is a good idea to start with 5 minutes of walking or doing an enjoyable activity and gradually increase the length of time over the coming days, weeks, and months.

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3. Diet

a selection of fruits and vegetables
Adding more fruit and vegetables to the diet may help people with depression.

The brain needs the right mix of nutrients to function properly.

The British Dietetic Association (BDA) outlines some dietary changes people with depression can make that may help prevent relapses:

  • eating unsaturated fats by cooking with olive or grapeseed oil and adding nuts and seeds to meals
  • avoiding trans fats found in processed meat, ready meals, cookies, and cakes
  • eating more whole grains, fruits, and vegetables
  • eating protein with tryptophan, found in fish, poultry, eggs, and spinach
  • eating oily fish containing omega-3 oils or taking omega-3 supplements at least twice a week
  • drinking 6 to 8 glasses of water a day
  • avoiding caffeinated drinks, such as coffee and soda

4. Sleep

Not getting enough sleep has a significant impact on people psychologically and physically, and insomnia is associated with depression.

Depression can also cause insomnia, but there are techniques people can try in order to get more sleep naturally. These include:

  • creating a bedtime routine
  • avoiding using electronic equipment before going to bed
  • spending 30 minutes doing a relaxation exercise or reading a book before trying to go to sleep.
  • going to a quiet spot and doing more relaxation exercises if still struggling to sleep
  • practicing breathing exercises by breathing in slowly through the nose and out through the mouth, following the steady rise and fall of the abdomen

5. Avoid alcohol and drugs

There is a close link between depression, as well as anxiety disorders, and alcohol or other substance-use disorders.

The Anxiety and Depression Association of America estimates that around 20 percent of people who have depression also have an alcohol or drug disorder.

For most people, moderate alcohol consumption is not a problem, but for people with depression, alcohol or drug use can make their symptoms worse.

It can be a vicious cycle, but while many people take medication, there are natural techniques available that can help deal with both disorders at the same time.

For example, cognitive behavioral therapy (CBT), which looks at ways to change thinking patterns, is often useful. Many people see benefits after 12 to 16 weeks of therapy.

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6. Try talking therapy

therapy and counseling may help by addressing the root cause of flat affect
Talking therapy, such as CBT, may help people with depression.

CBT is one effective way in which talking is used to help people with depression and, in many cases, it has been found to be more effective than medication.

However, CBT is not the only type of talking therapy. A doctor or psychiatrist can help identify what kind of therapy may be most beneficial to an individual diagnosed with depression.

Often people find it easier talking to a trained stranger, such as a counselor or therapist, than they do talking to family and friends.

It can help the person talk about their symptoms differently and identify ways to deal with them.

Talking therapy is often in a one-on-one situation, but there are also support groups that other people find effective.

7. Avoid common triggers

As much as possible, a person should avoid triggers associated with the onset of their depression symptoms.

This, of course, is not always simple, and in some cases, it can be impossible. For example, if a particular person or group of people are a trigger, the individual will have to weigh the advantages and disadvantages of avoiding them.

A job could be a trigger, but leaving a job is not always possible. Any life-changing decisions, such as these, need to be thoroughly thought out.

However, the most important thing is that the individual identifies what triggers their depression and works toward a way of managing and avoiding them as much as possible.

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Medical News Today: How to get rid of an unwanted erection

Erections are the product of a healthy bodily function that is useful when a man wants to have sex or masturbate. Sometimes, however, an erection happens when a man does not want one. What are the best ways to stop an unwanted erection?

The most obvious way to stop an erection is to ejaculate. This is not always possible or appropriate, so it can be helpful to understand other ways to get rid of one.

As erections start in early life, this article also details how parents can talk to their children about erections.


Man in jeans covering an unwanted erection with his hands over his crotch area
It is common for adult men to experience erections multiple times a day.

Erections start in early life. They are healthy bodily functions that happen several times a day for most men. A 2013 study found that the average erection is 5.6 inches long.

In adulthood, erections may happen when a man is sexually aroused or for other reasons. The different types of erection include:

  • Reflexogenic: These occur in response to touch.
  • Psychogenic: These happen in response to sexual thoughts or fantasies.
  • Nocturnal: These happen while a man is asleep. On average a man experiences five of these a night, and they last for an average of 30 minutes.

Testosterone plays a role in erectile function. In an erection, a small amount of blood travels to the penis. That action, together with hormones, muscles, and nerves, makes the penis stiffen.

Erections make sexual intercourse possible, but having an erection does not always mean a man wants to masturbate or engage in sexual activities.

Random, unwanted erections affect many men. They are not usually a sign of a health condition, but they may make a person feel uncomfortable or embarrassed.

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Seven ways to stop an erection

Reaching orgasm and ejaculating will usually get rid of an erection, but this is not always appropriate or desirable.

It may be helpful for a man to learn other methods of stopping an erection. These include:

1. Waiting calmly

A simple way to deal with an unwanted erection is to wait for it to go away. The following may help:

  • sitting down
  • breathing slowly
  • remaining calm

To reduce embarrassment, covering the erection with a long jacket, shirt, or laptop may help. It is important to remember that while the erection may seem obvious to the person experiencing it, most people will not have noticed, so there is no reason to be anxious.

2. Meditation

Man practicing mindfulness by meditating in yoga pose alone.
Meditation and waiting calmly may help to get rid of an unwanted erection.

Meditation can help to get rid of an erection and stop a person from focusing on arousing thoughts. To try meditation, a person should:

  • breathe slowly and deeply
  • focus on the sound of the breath
  • try repeating a word or phrase over and over to focus the mind
  • acknowledge distracting thoughts and then imagine letting them go, refocusing on the sound of the breath

Meditation can aid relaxation and is accessible to everyone. Some people find meditation difficult when they first try it, but there are meditation classes and apps that may help.

Before relying on meditation to get rid of an erection, it is a good idea to practice it throughout the day.

3. Distraction

Distracting the mind with other thoughts can help get rid of an erection. The following may help:

  • avoiding thinking about anything arousing
  • focusing on solving a mathematical problem
  • recalling a speech or poem or solving a riddle

4. Repositioning

Changing a sitting or standing position may also help a man get rid of an erection. Doing so may help move clothing that may have been touching the penis and stimulating it.

Switching positions may also help a man hide his erection if he is in a public or uncomfortable situation.

5. Showering in cold water

Taking a cold shower is a traditional remedy for getting rid of an erection that works well for some men. However, showering is not always practical.

6. Having a warm bath

Although some men use a cold shower, others find that a warm bath helps get rid of an erection.

A warm bath can help a person relax and reduce arousal. It can also make it easier to pass urine, which may help an erection go away.

7. Gentle exercise

Some men find gentle exercise can help get rid of an erection. Jogging and using an exercise bike are simple exercises to try.

How to talk to children about erections

If a person has children, it is important that they talk openly with them about erections.

Erections are normal for young boys, but they may not know this unless their parents explain.

Understanding their bodily functions can help children’s physical and emotional development.

Boys start having erections at a young age, so it is important to give them simple words to use to explain what is happening. This helps them ask questions and discuss things openly.

It is normal for children to want to explore their own body, but it is important to explain when this is and is not appropriate. Helping children to learn ways to deal with erections that occur in public will help them avoid embarrassment.

Children and adolescents may use a distraction technique, such as counting or reciting songs or stories to help them manage unwanted or uncomfortable erections.

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When to see a doctor

Young male doctor speaking with young male patient.
A person experiencing an erection that last more than 4 hours should speak to a medical professional immediately..

Having erections several times a day is natural. However, some situations may require medical treatment.

If a man has a long-lasting erection that goes on for more than 4 hours, he should speak to a doctor immediately, as he may have a condition called priapism.

Priapism may damage the tissue in the penis. This can lead to long-term erectile dysfunction if left untreated. Painful erections may also be a sign of this condition.

Treatments for priapism include taking medication and draining the blood from the penis.

Having an erection without an orgasm can sometimes lead to a short-term condition called epididymal hypertension. This condition is informally known as “blue balls.”

Epididymal hypertension is not a serious condition, and an orgasm is not necessary every time a man gets an erection.


It is normal for a man to get erections several times a day. Some of these may be unwanted.

To get rid of an unwanted erection, a man can try waiting, distraction, meditation, repositioning, or a cold shower.

An erection that lasts for longer than 4 hours may be a priapism. If this happens, a person should speak to a doctor immediately.

A man should arrange an appointment to speak to a doctor if he notices any bothersome changes in erectile function.

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