These include estrogens, thereby including drugs for hormone replacement therapy or the combined oral contraceptive pill, as well as non-steroidal anti-inflammatory drugs and beta-blockers.Premenstrual water retention, causing bloating and breast tenderness, is common. Mechanism
Six factors can contribute to the formation of edema:
increased hydrostatic pressure;
reduced colloidal or oncotic pressure within blood vessels;
increased tissue colloidal or  oncotic pressure;
increased blood vessel wall permeability (such as inflammation);
obstruction of fluid clearance in the lymphatic system;
changes in the water-retaining properties of the tissues themselves. Raised hydrostatic pressure often reflects retention of water and sodium by the kidneys.Generation of interstitial fluid is regulated by the forces of the Starling equation. Hydrostatic pressure within blood vessels tends to cause water to filter out into the tissue. This leads to a difference in protein concentration between blood plasma and tissue. As a result, the colloidal or oncotic pressure of the higher level of protein in the plasma tends to draw water back into the blood vessels from the tissue. Starlings equation states that the rate of leakage of fluid is determined by the difference between the two forces and also by the permeability of the vessel wall to water, which determines the rate of flow for a given force imbalance. Most water leakage occurs in capillaries or post capillary venules, which have a semi-permeable membrane wall that allows water to pass more freely than protein. (The protein is said to be reflected and the efficiency of reflection is given by a reflection constant of up to 1.)
Prurigo pigmentosa is a rare skin condition of unknown cause, characterized by the sudden onset of erythematous papules that leave a reticulated hyperpigmentation when they heal. : 57  The condition has been associated with a strict ketogenic diet in case reports in the medical literature. It was first reported by Masaharu Nagashima in 1978. Research has shown that it may be caused by gut bacteria dysbiosis as a result of ketosis. See also
Pruritus
Skin lesion
Masaharu Nagashima

References


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