Wrinkles and pigmentation and hair loss - #26936
I have pigmentation and wrinklesin my face andIhave hair fall and hair loss also hair loss patches in front side please help me from last 3 to 4 months and visible wrinkles in near under eye and forehead


Doctors’ responses
For hair fall
1) Bhringamalaki tail -ext apply massage for 10 min 2 times a day 2) Jeevamrita leha -1 tsf - after food 2 times day 3) Shudh shilajatu 250 mg+ saptamrit loha500mg+ bhringraj churna -3 gm– 2 time after food with honey and ghee
selected hair treatment for three months before you will see results. For pimples Simple Remedies 1. Prepare paste from turmeric and milk of Calotropis procera(madaar) , apply on the affected area. 2. Apply the paste prepared from turmeric & sandal wood with rose water. 3. Apply the paste of Terminalia Arjuna. 4. Make a paste of nutmeg (Jaiphal) with raw milk. Apply on pimples and black heads leave on for 20 minutes. medicine 1) Arogyavardhini rasa-500mg +gandhaka rasayana-500mg +khadira Churna-2gm +nimbadi Churna-2gm - with 20 ml of manjishtadi kwath 3 times a day after food
2) Manjishtadi Taila or Kumku-madi Taila (external) apply 2 times a day
3) Syrup- raktashodhaka-20ml after food 2 times a day with water. Diet and Lifestyle
Pathya: Fresh fruits, fresh vegetables, nutritious food, adequate sleep
Apathya: Avoid salt, sugar, tobacco, and alcohol. Overconsumption of salt and sugar increases dandruff and hairloss. Avoid large amounts of vitamin A.
Avoid strong soaps, shampoo or hair sprays. Only use mild castile soaps. Hats and wigs are apt to cause hair to fall out faster, since they limit the air to the scalp. Avoid tension, stress, worry and hurry
Pathya: Nutritious food, relaxation techniques
Apathya: Stress, tension, anxiety, awakening at night, and exposure to sunlight Surely this will help you
Hello pushpa ji, The condition of hair and skin are indicators of our overall health. Changes in hair texture, appearance, or growth rate, as well as skin’s color, texture, and presence of rashes or lesions, can reflect underlying health issues. So, internal medicine and external treatment both are needed. Treatment - 1. Neem ghanvati 1-0-1 after meal 2. Mahamanjisthadi kwath 30ml with 30 ml water twice a day after meal 3. Amalaki rasayan+ Black sesame seed powder - 1 tsp with water twice a day before meal 4. Rogan Badam oil -2-2 drops in each nostril either in the morning empty stomach or at bedtime. 5. Apply Aloe vera gel after cleaning the face with rosewater 6. Apply kumkumadi tel before bedtime
Follow these - 1. Adequate amount of water 2. Eat antioxidant rich food like amla, beans, green tea, spinach etc 3. Clean your towel and pillowcase every week 4. Avoid using makeup or some chemical product especially before sleeping. 5. Boil 1 spoon of triphla powder in 2 glasses of water,let it cool then use this for hairwash once a week. 6. Stress management -Through meditation, walking, journaling etc.
Yoga - 1. Anulom vilom 2. Sheetali 3. Sheetkari 4. Adhomukhashavasan 5. Uttanasan
Hi pushpa this is Dr Vinayak as considering your problem…no need to worry… As you are 43 menas near to menapause stage…these are common things happening in every life as life goes on… *Don’t think too much about anything… *Have proper sleep and proper diet…
Rx-use Manjistadi taila massage all over the face… gently take plane water steam properly till oli goes on from face… T.ksheerabala 101 1-0-1 after food with Luke warm water Follow this you will notice the changes
HELLO PUSHPA JI,
first of all avoid excessive pitta vardhakahar vihar like too spicy,sour and salty food ,sesame seeds etc.
And start taking these medications, FOR YOUR HAIR FALL 1.Narsimha rasayana 1tsf with lukewarm milk at bed time. 2.Trichup cap.1-0-1 3.Amalki choorna 1tsf twice in a day with Lukewarm water.
FOR YOUR SKIN *Massage your face with NALPAMARADI OIL. Thrice in a week. *Massage your face with kumkumadi tailam at bed time only.
Take care😊
And visit nearby ayurvedic physician for PRACHANNA KARMA and after that apply HASTIDANTMASI over the affected area (Bald) of your scalp.
Take care😊
If you have any doubt,feel free to ask…
Neemghan vati Kaishore guggulu- 1 tab twice daily after food with lukewarm water Amlaki rasayana- 1 tsp with warm water at night Apply coffee powder with Alovera gel + pinch of alum powder + vit E capsule + rice flour + curd make paste and apply over face weekly twice
Hello Pushpa I can understand your concern regarding pigmentation wrinkles and hairfall but dont worry we are here to help ypu out😊
✅AYURVEDIC PLAN OF TREATMENT
✅INTERNAL MEDICATION 1 Manjisthadi ks tab 2-0-2 after breakfast and dinner 2 sarivasavam 30ml-0-30ml after breakfast and dinner 3 Groo 1-0-1 after food 4 Jeevamrutham 1 tsp at bed time follwed by warm water
✅ EXTETNAL CARE FOR HAIR AND SKIN
➡️FACE 👉Kumkumadi Tailam (for external face massage) Apply 3–5 drops at night, massage gently Reduces pigmentation, fine lines, improves glow 👉Weekly Ubtan Pack: Mix sandalwood powder + turmeric + rose water apply 15 min, wash with lukewarm water 👉Aloe vera gel at morning (moisturises & calms skin) 👉Avoid chemical-based creams or any bleaching agents
➡️HAIR 👉Nilibhringadi Tailam External scalp massage 2–3 times a week Stops hair loss, promotes regrowth in patches 👉Hair pack once a week Hibiscus flower paste + fenugreek seed paste + curd apply 20 min, wash with mild herbal shampoo
✅ DIET MODIFICATION ✅Include Cow ghee (1–2 tsp a day) Fresh fruits pomegranate, papaya, black grapes Soaked almonds (5 daily) and 2 walnuts Moong dal, green leafy vegetables Herbal teas (Tulsi, Brahmi, Rose)
❌Avoid Excess tea/coffee Spicy, fried, and very sour foods White sugar, processed snacks Late-night sleeping
✅LIFESTYLE MODIFICATION 👉Morning Drink warm water with ½ tsp turmeric & honey (detox & skin glow) 5 min Anulom Vilom pranayama (improves oxygen flow to skin & hair roots)
👉Night Gentle Kumkumadi Tailam massage on face Foot massage with sesame oil improves sleep & slows skin aging
Wish you a good hair and skin 😊
Warm Regards Dr Snehal Vidhate
Kaishore guggulu 2 tab twice daily, after meals Amalaki Rasayan 1 tsp with warm milk twice daily, before meals Bhringaraj Asava 20 ml with 20 ml water twice daily, after meals Kumkumadi tailam / Nalpamaradi Tilam 2-3 drops, gentle massage on the face Neelibhringadi tailam-for scalp massage
HELLO PUSHPA,
YOU ARE EXPERIENCING- CHRONIC PIGMENTATION, DULL AND SENSITIVE SKIN, WRINKLES AND PROGRESSIVE HAIRLOSS WITH NO REGROWTH-ALL WITHOUT UNDERLYING CHRONIC ILLNESS.
ACCORDING TO AYURVVEDA- 1)SKIN ISSUE(,DULLNESS,HYPERPIGMENTATION,WRINKLES) DOSHA INVOLVEMENT- -PITTA AGGRAVVATION-, INFLAMMATION(PIMPLES), WRINKLES ,HEAT IN T-ZONE. -VATA INVOLVEMENT- , DULLNESS -RAKTA DUSTI(VITIATED BLOOD)- CAUSES ONGOING WRINKLES AND DISCOLORATION -AMA(TOXINS)- SKIN DOESNT ACCEPT PRODUCTS LEADS TO SENSITIVITY AND DARKNESS
2)HAIRFALL TURNING INTO HAIR LOSS(NO NEW HAIR GROWTH) -VATA PITTA AGGRAVATION AFFECTS HAIR ROOTS,AND WEAKENS REGENERATION -ASTHI DHATU KSHAYA(WEAK BONE/HAIR TISSUE)FROM IMPROPER NUTRITION OR STRESS -POOR DIGESTION RESULTS IN MALNOURISHED RASA AND RAKTA NOT SUPPORTING HAIR GROWTH
WRINKLES, HYPERPIGMENTATION PROBLEM- PITTA+RAKTA+KAPHA=HEAT+TOXINS+BLOCKED CHANNELS
HAIRLOSS-VATA-PITTA+ASTHI DHATU- HAIR ROOT DRYING WEAKENED NUTRITION FOLLICLE DAMAGE, NO REGROWTH
#TREAMENT GOAL-MONTH WISE
MONTH 1- SKIN=REDUCE HYPERPIGMENTATION, WRINKLES HAIR=STOP HAIR FALL, INTERNAL= TOXIN REMOVAL,IMPROVE BOWEL HEALTH
MONTH 2- SKIN=FADE MARKS,BRIGTHEN TONE, HAIR- IMPROVE TEXTURE,INTERNAL=LIVER AND BLOOD DETOX
MONTH 3- SKIN=GLOW, LESS HYPERPIGMENTATION , HAIR= INITIATE REGROWTH-NOURISH RAKTA+ASTHI DHATU
MONTH 4 TO 6- SKKIN= LONG TERM IMMUNITY OF SKIN, HAIR=STRENGTHEN ROOTS, FULLER ROWTH, REJUVINATION PHASE
SO THIS TREATMENT IS FOR 6 MONTHS
MORNING(EMPTY STOMACH) 1)MAHATIKTAKA GHRITA- 1 TSP WITH WARM MILK/WATER=SKIN AND BLOOD DETOX, IMPROVES LIVER
2)TRIKATU CHURNA- 1/2 TSP WITH HONEY-ENHANCE DIGESTIVE FIRE, REDUCES TOXIN ACCUMULATION
3)WARM WATER WITH LEMON-1 GLASS=OPENS CHANNELS,REDUCES FACIAL OIL AND TOXINS
#AFTER BREAKFAST 1)CAP GANDHAK RASAYANA-1 CAP=FIGHTS HYPERPIGMENTATION ,PURIFIES BLOOD
2)MANJISTHA GHANVATI- 1 TAB=RAKTA PURIFIER, REDUCES PIGMENTATION
3)SAPTAMRIT LAUHA- 1 TAB = SUPPORTS HAIR REGROWTH,IMPROVES SKIN TONE REDUCE WRINKLES
4)SARIVADYASAVA-15ML+15ML WARM WATER=IMPROVES SKIN METABOLISM,REDUCES PITTA
#AFTER LUNCH 1)CAP.KESH KING PLUS/KESH RAKSHA- 1 CAP=STIMULATES NEW HAIR GROWTH
2)ASTHIPOSHAK RASAYANA/NARASIMHA RASAYANA- 1 TAB=STRENGTHEN BONES AND HAIR
#AFTER DINNER 1)AROGYAVARDHINI VATI-1 TAB=LIVER CLEANSING,DETOX SKIN AND BLOOD
2)TRIPHALA CHURNA- 1 TSP WITH WARM WATER=GUT CLEANSING,REGULATE SKIN METABOLISM
#EXTERNAL THERAPIES FOR SKIN
*CLEANSER(DAILY ) MIX MULTANI MITTI+NEEM POWDER+SANDALWOOD->PASTE WITH ROSE WATER
*NIGHT SERUM DAILY 2-3 DROPS OF KUMKUMADI TAILA+1 TSP ALOE VERA GEL->.APPLY GENTLY, LEAVE OVERNIGHT
*FACE STEAM-2TIMES/WEEK BOIL NEEM+TULSI+ROSE PETALS-USE STEAM FOR 10 MIN TO REDUCE WRINKLES
FOR HAIR- *OIL(3 TIMES/WEEK NIGHT) BHRINGARAJ TAILA+NEELIBRINGADI TAILA+BHRAMI TAILA WARM MIX-APPLY 20 MINS BEFORE SLEEP
HAIR WASH(2TIMES/WEEK) SOAKED REETHA+AMLA+SIKAKAI POWDER DECOCTION-OR HERBAL SADHEV/SOULTREE BRRAND SHAMPOO
SCALP MASK(1 TIME/WEEK) AMLA POWDER+BHRAMI POWDER+CURD-> APPLY LEAVE 20 MINS
DIET- FOODS TO INCLUDE *VEGETABLES-LAUKI,TINDA,CARROT,BEETROOT,CORIANDER,SPINACH (BOILED NO RAW SALAD STRCTLY) *FRUITS- AMLA, POMEGRANATE,PAPAYA,BLACK RAISINS(SOAKED) *GRAINS- RICE,OLD WHEAT, GREEN MONG KHICHDI *SPICES-HALDI,JEERA,AJWAIN,CORAINDER SEEDS *DAIRY- WARM MILK WITH TURMERIC, ASHWAGANDHA(NO CURD AT NIGHT) *FATS- COW GHEE, COLD PRESSED COCONUT OIL FOR COOKING(BEST FOR HAIR) *FLUIDS- CUMIN-CORIANDER-FENNEL WATER, KOKUM SARBAT,AMLA JUICE
AVOID STRICTLY *FRIED/GREASY- CHIPS,SAMOSA,PRATHA WITH TOO MUCH OIL *SOUR- VINEGAR,FERMENTED PICKLES, CURD(ESPECIALLY NIGHT) *SPICY-RED CHILLI,GREEN CHILLI(BAD FOR SKIN AS WELL AS HAIR) *SUGAR- WHITE SUGAR,SOFT DRINKS,CHOCOLATE *MILK+FRUIT- BANANA SHAKE, MILK WITH CITRUS *INCOMPATIBLE FOODS- FISH+MILK, SALT+MILK, CURD+HOT FOOD(PARATHA WITH CURD) *LATE MEALS- EATING AFTER 8:30 PM *DRY SNACKS- BREADS,RUSKS, BISCUITS-CAUSE DRYNESS AND HIAR BREAKAGE
#LIFESTYLE TO BE FOLLOWED 6:00 AM- WAKE UP,TONGUE SCRAPING,WARM WATER SIP 6:30AM- 5 MIN OIL PULLING WITH SESAME OIL(1 TSP OIL HOLD IN MOUTH FOR 5 MIN THEN SPIT) 7:00AM- PRANAYAM+YOGA-20 MIN 7:30 AM- BATH AND HERBAL DRINKS 8:30 AM- BREAKFAST 12:30 PM- LUNCH(FOCUS ON COOKED VEGETABLES+GHEE) 4:00PM- HERBAL TEA OR SOAKED RAISIN 7 6:00 PM- LIGHT WALK OR STRETCHING 7:30 PM- DINNER(LIGHT KHICHDI OR VEG SOUP ETC) 9:30 PM- WARM MILK AND TRIPHALA 10:00 PM- SLEEP(STRICTLY BEFORE 10:30PM)
#YOGA AND PRANAYAM
ASANA-15 MIN DAILY -SARVANGASANA-STIMULATES THYROID FOR HAIR -UTTANASANA- INCREASES SCALP BLOOD FLOW -PAWANMUKTASANA- DIGESTION BOOST -VAJRASANA AFTER MEALS-IMPROVES NUTRIENT ABSORPTION
PRANAYAM-10-15 MIN DAILY -ANULOM VILOM- BALANCES VATA-PITTA -SHEETALI- COOLS SKIN AND LIVER -BHRAMARI- CALMS STRESS AND IMPROVES SLEEP
#EMOTIONAL + STRESS SUPPORT -PRACTICE EARLY RISING+SUNLIGHT EXPOSURE-15 MIN DAILY -JOURNAL 3 THINGS DAILY- WHAT MADE ME SMILE/FEEL CALM -AVOID SCREENS 1 HOUR BEFORE BED -GENTLE SELF MASSAGE WITH WAR SESAME OIL-2 TIMES/WEEK
FOR MIGRAINE -SHIRASHULADI VATI= 2 TABS WHEN SEVERE HEADACHE
DO FOLLOE CONSISTENTLY 100% RESULT YOU WILL GET FOR SURE
HOPE THIS MIGHT BE HELPFUL
THANK YOU
DR.MAITRI ACHARYA
Start with Amla juice 10ml+ aloevera juice 10ml twice daily after food with water Apply kumkumadi oil on face at night before bedtime Apply aloevera gel on face during the day. If going out apply Sunscreen SPF 50+ during the day use umbrella or wear hat. Light massage on scalp twice weekly with Brahmi amla oil twice weekly keep overnight and wash in the morning with mild herbal shampoo. Avoid processed spicy fried street foods Include seasonal fruits and seasonal vegetables+ dryfruits in your diet.
HELLO PUSHPA,
You are experiencing facial pigmentation, visible wrinkles (under-eye and forehead), hair thinning, hair loss, and patches of hair loss at the front. These changes over the last 3–4 months are commonly linked to aging, hormonal fluctuations, stress, and possible nutritional deficiencies. Migraine and chronic stress can also aggravate hair fall and skin changes. Pigmentation and wrinkles often develop due to reduced collagen, sun exposure, and oxidative stress. Hair fall patches indicate localized scalp imbalance, possibly aggravated by stress, hormonal shifts, or scalp dryness. With targeted Ayurvedic care, nutrition, and external therapies, skin elasticity can improve, pigmentation can reduce, and hair regrowth can be supported, though results take a few months. Lifestyle, diet, and gentle care play a crucial role alongside medicines.
Before starting treatment, please provide:
Appetite and digestion Bowel and urine pattern Sleep quality Daily hair and skin care routine
START WITH,
Ama Pachana (first 3 days): Trikatu churna ½ tsp with warm water before meals Warm water with jeera 1 tsp in the morning
Internal Medicines (from day 4 onwards):
Arogyavardhini Vati 1 tab twice daily after meals Yashtimadhu Churna ½ tsp with warm milk at night Brahmi Churna ½ tsp with warm water or milk in the morning Ashwagandha Churna ½ tsp with milk at night
External Therapy:
Face massage with Kumkumadi Taila daily at night Hair oil massage with Bhringraj Taila 2–3 times a week, leave for 30–60 minutes Avoid harsh chemicals on hair and face
Diet & Food Nature:
Prefer: Fresh fruits, vegetables, nuts (almonds, walnuts), whole grains, milk, ghee, and proteins like lentils and seeds
Avoid: Fried, processed, and overly sugary foods, excessive caffeine, and deep-fried snacks Drink warm water throughout the day
Lifestyle & Care:
Protect face from direct sun; use hats or scarves outdoors Maintain stress control: meditation, pranayama, light exercise Sleep 7–8 hours to support hair and skin regeneration
Investigations & Follow-up:
Blood tests for thyroid, iron, vitamin B12, vitamin D, and hormone profile to rule out deficiencies
Follow-up after 20–25 days to monitor improvement in hair density, skin glow, and reduction in pigmentation
Warm regards :
Early intervention can slow down hair loss, improve scalp health, reduce pigmentation, and enhance skin elasticity
Consistency in medicines, external therapies, and diet is key Gradual results are expected; follow-uP is important to modify therapy if needed.
DR.KARTHIKA
HELLO PUSHPA,
ROOT CAUSE ACCORDING TO AYURVEDA
-HAIRFALL AND THINNIG= primarily linked with vata-pitta imbalance, poor nourishment to asthi dhatu and weak rasa rakta dhatu -Skin wrinkles and pigmentation= due to rakta dushti, pitta aggravation, and subtle toxins
1) INTERNAL MEDICATIONS
FOR HAIR DENSTITY AND FALL REDUCTION
-BRINGARAJASAVA= 15 ml with water after meals twice daily =nourishes hair roots and improves liver function
-KESHYA RASAYANA= 1 tsp morning empty stomach = hair specific rasayana for density
-NARASIMHA RASAYANA= 1 tsp with warm milk evening =builds tissues and strengthens hair
-GUDUCHI SATVA= 250 mg after breakfast with water =immuno modulator and detoxifier, help with rakta Suddhi
B) FOR SKIN
-RAKTAMOKSHAK VATI(UNJHA BRAND)= 1 tab after lunch =purifies blood, reduces pigmentation
-KUMKUMADI LEHYAM= 1 tsp at bedtime =enhances skin glow from within
-SARIVADYASAVA= 15 ml with water after dinner =acts on skin rakta and pitta dosha
2) EXTERNAL APPLICATION (HAIR + FACE)
FOR HAIR -NEELIBRINGADI TAILA =massage thrice weekly leave overnight
-BRAHMI-AMLA HAIR PACK -mix brahmi powder + amla powder + Aloe vera + 2 tbsp yogurt =apply on scalp and hair, leave for 45 mins then wash with mild shikakai
FOR FACE=SCAR AND GLOW
-KUMKUMADI TAILA= nightly massage 5 drops Into face and underage
-Mix massor dal powder + sandalwood + mulethi + raw milk or rose water =apply for 20 mins , gently scrub and wash
DIET ENHANCERS your current diet sounds good, but these tweaks will enhance your results
-include black sesame seeds-1 tsp daily -add soaked almonds 5 + 1 date in morning - drink triphala water at night (1 tsp triphala soaked overnight in warm water) - weekly detox day-light khichdi + warm water + herbal. teas
PANCHAKARMA(optional but highly beneficial) -takradhara -nasya with anutaila -raktamokshana-leech therapy
LIFESTYLE AND YOGA -sleep by 10 pm-crucial for hormonal balance and skin repair -hair specific yoga= sarvangasana, shashankasana, matsyasana -avoid hot water for head wash
THANK YOU
DR. HEMANSHU MEHTA
Wrinkles, pigmentation, and hair loss can indeed be of concern. In Ayurveda, these issues often arise from an imbalance in the doshas, predominantly a vata and pitta imbalance. Low agni (digestive fire) and weakened sapta dhatus (particularly the rasa and rakta dhatus) may contribute to these symptoms.
For addressing pigmentation and wrinkles, consider using a paste made from sandalwood powder and rose water, applying it to your face for 15-20 minutes before rinsing with lukewarm water. Practicing this a few times a week can balance pitta and promote skin health. Additionally, incorporate a natural oil massage using sesame or almond oil to nourish the skin and maintain moisture, focusing on areas prone to wrinkles.
Hair loss patches and general hair fall can also benefit from specific Ayurvedic practices. A daily scalp massage with bhringraj oil or coconut oil revitalizes hair follicles and reduces vata imbalance. Consider consuming amla (Indian gooseberry) regularly – either as fresh fruit or juice, enriches hair with vitamin C, promoting growth.
Pay attention to your diet by including foods that are cooling and nourishing – like cucumbers, ghee, almonds, and milk – this aids in maintaining balance in the body. Drink plenty of water, and avoid excessively spicy, processed foods that may aggravate pitta and contribute to hair and skin problems.
Ensure you’re managing stress, as emotional well-being has a pronounced effect on hair and skin health. Practices like meditation or pranayama can help balance your nervous system.
If symptoms persist despite these interventions, it would be wise to consult a healthcare professional or an Ayurvedic practitioner for a personalized plan, ensuring no underlying conditions.
For pigmentation and wrinkles, Ayurveda emphasizes the balance of doshas, especially concerning the Vata dosha, which increases with age and can lead to wrinkles and dryness. For pigmentation, Pitta imbalance is often involved. To tackle these an begin with diet, which is integral to enhancing skin health. Incorporate more cooling, Pitta-pacifying foods, such as coconut water, aloe vera juice, and sweet fruits like pomegranates and grapes. Avoid spicy, oily, and sour foods as they can aggravate Pitta further. Drinking amla juice daily can help reduce pigmentation, given its rich vitamin C content chosen for promoting glow.
For wrinkles, applying a paste of sandalwood and rose water to the affected areas can be beneficial. It soothes the skin and provides moisture. Consider facial massage with warm sesame oil or almond oil to moisturize and tone the skin. Regularly practice abhyanga (self-massage) with these oils, taking special care around the eyes, which are delicate.
For hair fall and loss, the focus shifts to enhancing scalp health and balancing internal nutrition. Begin with regular oil massage using bhringraj oil or coconut oil, which strengthens the roots and promotes growth. Brahmi oil also works wonders for calming the scalp and nourishing hair follicles. Massaging the scalp in gentle, circular motions increases blood flow, nurturing the hair roots.
Herbal supplements such as Triphala can help detoxify the system and have long-term benefits for skin and hair. Mix 1 teaspoon of Triphala powder in lukewarm water and consume it during night time before sleeping. This supports digestion and elimination, impacting skin, and scalp health positively.
Reduce stress with daily practices of yoga or pranayama, essential for balancing doshas and reducing hair loss triggered by stress or anxiety. Savasana and Pranayama, with equal practice of alternate nostril breathing, stabilizes mental health.
Not to overlook, ensure adequate sleep—sleeping early keeps Vata dosha in check, curbing wrinkle formation and ensuring the body repairs itself naturally. Kindly note, if hair loss continues to worsen, consult with healthcare professionals for detailed evaluation and to rule out other underlying conditions.

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