James P. Foshee, MD is a Board-Certified Dermatologist and Fellowship-Trained Mohs Surgeon practicing in Sun City West, Peoria, and Phoenix, Arizona.
Dr. James P. Foshee grew up in North Phoenix and received his B.S. in physiology from the University of Arizona. He earned his medical degree from Jefferson Medical College in Philadelphia, where he graduated magna cum laude and was elected to the Alpha Omega Alpha Medical Honor Society. He completed an internship at Thomas Jefferson University Hospital before returning to the University of Arizona for his dermatology residency. After residency, he received further fellowship training in Mohs Micrographic Surgery and Dermatologic Oncology, as well as lasers and cosmetic procedures at the Center for Dermatologic and Cosmetic Surgery at Washington University in St. Louis.
He is a member of the American College of Mohs Surgery, and the American Society for Dermatologic Surgery, with special clinical interests in surgical and non-surgical treatment of skin cancer, cancer reconstruction, transplant dermatology, lasers, and scar treatment.
He is an avid Arizona Wildcats fan and enjoys cooking and spending time with his wife, daughter, and two dogs.
13943 N 91st Ave
Peoria, AZ 85381
14506 W Granite Valley Dr
Sun City West, AZ 85375
Actinic Keratosis, also known as solar keratosis, is a scaly or crusty lesion on the skin that develops slowly and indicates the presence of sun damage. It is most commonly found on parts of the body frequently exposed to the sun including the bald scalp, face, ears, lips, backs of the hands or forearms, neck, and shoulders.
Actinic keratoses are considered precancerous and can develop into a type of skin cancer called squamous cell carcinoma. In fact, some 40 to 60 percent of squamous cell skin cancers begin as untreated actinic keratoses.
Because of this, your doctor should be diligent in diagnosing, treating and monitoring actinic keratosis.
Annual Skin Examinations are yearly scheduled skin exams with a dermatologist. Did you know that skin cancer is the most common form of cancer in the U.S.? In fact, it is estimated that one in five Americans will develop skin cancer in their lifetime. Sun damage to the skin is cumulative over a person’s lifetime, so the average risk of skin cancer also increases as our life expectancy gets longer.
Just as you schedule your annual physical or trip to the dentist, it is important to conduct a self-examination of your skin each month and schedule a professional annual skin examination once a year. Skin cancer is a treatable condition, but early detection is key.
Basal Cell Carcinoma, also known as basalioma or basal cell cancer, is the most common type of skin cancer and carries the least amount of risk, though it still requires attention. If caught and treated early, basal cell carcinomas are not likely to be life-threatening, but they do have the potential to cause disfigurement of the skin tissue.
Almost one million new cases of basal cell carcinoma are diagnosed each year in the U.S., and up to 30% of Caucasians may develop basal cell carcinomas in their lifetime.
Skin cancer is considered low risk when the affected cells remain clustered in a single group. Both basal cell carcinoma and squamous cell carcinoma are rarely life-threatening. Though it is unlikely to spread to other parts of your body, if left untreated, basal cell carcinoma can move into nearby bone or other tissue.
Basal cell carcinoma typically begins as a small, shiny bump on the face, although it can occur on any part of the body.
Cryotherapy, or “cryosurgery,” is a simple, non-invasive procedure in which liquid nitrogen is used to freeze and destroy growths on the surface of the skin. This is an effective treatment for precancerous skin lesions (actinic keratoses), as well as other skin conditions such as warts, skin tags and moles.
Applying liquid nitrogen to skin lesions allows dermatologists to target the damaged skin cells and destroy them at the cellular level. After freezing, the affected area may blister and scab over, and should heal within three to six weeks.
Our dermatology team uses cryosurgery to treat a wide range of conditions. It offers a number of advantages: Cryotherapy is a simple, affordable outpatient procedure, the discomfort level is minimal, and there is a low risk of infection.
Melanoma, the deadliest of skin cancers, only accounts for about 4 percent of all skin cancer cases, but causes about 79 percent of skin cancer deaths.
Melanoma is a cancer of the skin that begins in the melanocytes, which are the cells that produce the pigment melanin. It is the leading cause of cancer death in women 25 to 30 years old and the second leading cause of cancer death in women 30 to 35 years old.
In some cases, melanoma occurs in melanocytes throughout the body, even if those parts have never been exposed to the sun.
Mohs surgery offers the highest cure rates for all non-melanoma skin cancers. For certain cases of the most common types of skin cancer — squamous cell carcinoma and basal cell carcinoma — the cure rate can be as high as 99 percent.
Mohs surgery is a highly specialized surgical technique used to treat non-melanoma skin cancers in which the surgeon removes all of the visible cancer, plus a small margin of the surrounding healthy tissue and examines it to ensure that all cancer cells have been removed at the time of surgery.
During Mohs micrographic surgery — named after Dr. Frederic Mohs, who first performed it in the 1930s — cancer is removed from the skin layer by layer until all cancerous cells have been removed. This type of surgery is most commonly used for cancers that have a high risk of re-occurrence. This technique allows for complete removal of the skin cancer while minimizing the removal of surrounding healthy skin.
A rare and aggressive form of skin cancer, sebaceous carcinoma is sometimes referred to as sebaceous gland carcinoma, sebaceous gland adenocarcinoma or meibomian gland carcinoma.
Sebaceous carcinoma can develop in any sebaceous glands, which lubricate the skin, but it most often begins on or around the eyelids. If it is found and treated early, treatment is often successful. However, if sebaceous carcinoma spreads, it can be deadly.
Because sebaceous carcinoma can appear to be a benign growth such as a stye, diagnosis is often delayed, which increases the risk of death. If you notice a growth on your eyelid, it’s important to make an appointment with your dermatologist. The sooner sebaceous carcinoma is diagnosed and treated, the better the outcome.
Seborrheic keratosis is one of the most common noncancerous skin growths found in older adults. It most commonly appears as a brown, black or light tan growth on the face, chest, shoulders or back. Although they are not cancerous, they can look like skin cancer.
Skin cancer is the most common form of cancer in the U.S. with more than 3.5 million cases diagnosed each year.
Skin cancer is the result of uncontrolled growth of abnormal skin cells that takes place when skin cells suffer DNA damage and then mutate, causing them to multiply rapidly and form malignant (cancerous) tumors. Most skin cancers develop on the visible outer layer of the skin (the epidermis), particularly on sun-exposed areas such as the face, head, hands, arms and legs. They are usually easy to detect with a skin examination, which increases the chances of early diagnosis.
There are different types of skin cancer, each named for the type of skin cell from which they originate. The most common type of skin cancer is basal cell carcinoma. Almost one million new cases of basal cell carcinoma are diagnosed each year in the U.S. Most skin cancers fall into one of three categories:
There are often warning signs that cancer is developing. The most common are pre-cancerous lesions called actinic keratoses that often develop on sun-exposed areas. These tumors replace normal surrounding tissue and generally do not spread to other areas.
Skin cancer is considered low risk when the affected cells remain clustered in a single group. Both basal cell carcinoma and squamous cell carcinoma are rarely life-threatening.
Skin cancer is considered a high risk when cells have invaded surrounding tissues. The third most common skin cancer, malignant melanoma, can be life-threatening if not diagnosed and treated early.
If skin cancer is detected before it has spread to surrounding tissues, the chances of a complete recovery and cure are excellent. High-risk forms of cancer like melanoma require more aggressive treatments.
Squamous Cell Carcinoma is a common form of skin cancer that develops in the squamous cells that make up the outer layer of the skin. Although it is usually not life-threatening, it can be aggressive in some cases.
If left untreated, squamous cell carcinoma can grow large or spread to other parts of your body, causing serious complications.
Acanthosis Nigricans is a condition that causes the skin to become discolored in the creases and folds of your body. This dark colored skin sometimes becomes thickened and often shows up in the armpits, groin and the folds of the neck.
Acne is a dermatological condition caused by inflammation and mild infection in clogged pores. If not properly treated, acne can cause emotional distress, low self-esteem, and depression. In severe cases, it can even lead to permanent scarring.
While not a serious physical health threat, acne is an embarrassing skin problem that can be life-altering for many patients. Though it is most common among teenagers, acne can affect anyone, regardless of age or gender, and can be mild, moderate or severe.
Alopecia Areata, also known as spot baldness, is a type of hair loss in which your immune system attacks hair follicles. This leads to areas of baldness on the scalp and body. In severe cases, a person with alopecia may even lose the hair of their eyebrows and eyelashes.
Cold sores, which are also called fever blisters, are groups of blisters that appear on the lip and around the mouth. The blisters may break open and leak a clear fluid and then scab over. They may take up to two weeks to heal. They are caused by the herpes (HSV) virus.
Cysts are pockets of tissue (sacs) that may become filled with pus, fluids, skin cells, and even air.
They are fairly common on the skin and can appear anywhere on the body. Cysts may feel like a pea under the surface of the skin, but without removal, they can grow significantly larger over time. In most cases, cysts are not painful, and they grow slowly. There are different types of cysts as we’ll discuss in the next section, and the vast majority of these skin growths are benign (not cancerous). Not all cysts will require treatment, but it is vitally important to have any lump under the skin evaluated and diagnosed by a board-certified dermatologist because some soft tissue malignancies (growths that are cancerous) can present like a cyst. Before recommending removal or other cyst treatments, your dermatologist will examine the growth to determine whether it is likely to cause you pain, become infected, or otherwise lead to skin health issues.
Dandruff is a condition of the scalp which causes flaking and itching of the skin. It is more common in people with the skin conditions seborrheic dermatitis, psoriasis and eczema, and also can be a reaction to hair or skin products.
Eczema, also sometimes referred to as dermatitis, is a common condition characterized by a certain type of inflammation in the skin. There are many different types of eczema and symptoms can range from mild itching and redness to severe blistering and cracked skin. Whether you’re newly diagnosed with eczema or you’ve struggled with this chronic skin condition for years, you know that finding a treatment that works for you isn’t just important – it’s essential. Without proper and effective interventions, people with eczema can experience significant discomfort, itching, and inflammation.
At U.S. Dermatology Partners, our knowledgeable dermatologists partner with their patients to develop and maintain an effective eczema maintenance plan and provide advanced treatments for serious flareups. Learn more on this page or contact U.S. Dermatology Partners to get started working with us today.
Hidradenitis suppurativa is rare skin condition in which small, painful lumps develop under the skin, usually in areas where the skin rubs together (armpits, groin, between the buttocks, under the breasts, etc.) or in areas near hair follicles where many oil and sweat glands are present. Sometimes, the lumps may break open and smell, or they may create tunnels under the skin.
It can continue for many years, may worsen over time and can have serious effects on your daily life and emotional well-being, particularly during outbreaks.
Hyperhidrosis, often referred to as excessive sweating, occurs when people experience disproportionate and/or unnecessary sweat production. While sweating is a natural function of the body’s systems to keep itself cool and maintain the best temperature, sweating too much or sweating that is not necessary to cool the body can create many difficulties that impact your overall health and wellbeing. Generalized hyperhidrosis may affect the whole body. Others have localized cases of excessive sweating that impact only certain areas. Specifically, there are three main types of localized hyperhidrosis: axillary (impacting the underarms), palmar (impacting the palms), and plantar (impacting the feet). If you experience general or localized excessive sweating at least once per week, you should talk to a dermatologist about a treatment plan.
A lipoma is a common, non-cancerous, soft tissue growth just below the skin made up of fat cells. Though most lipomas are not a cause for concern, if the growth becomes too large, it may become painful.
Melasma is a fairly common skin condition that creates the appearance of brown to gray-brown patches of skin, usually on the face. It can also occur on the neck and forearms and is the result of the body producing too much melanin, that natural substance that colors our hair, skin, and eyes.
If you’re dealing with dark spots or patches on your skin from the chronic condition melasma, the U.S. Dermatology Partners team can help you to improve the appearance of these spots and minimize the risk for future flare-ups of the condition. Read the page below to learn more or reach out to the U.S. Dermatology Partners location nearest you for more information.
Atypical moles, also known as dysplastic nevi, are unusual-looking benign (noncancerous) moles.
A dysplastic mole is one that, when viewed on a cellular level, has features unlike those of a healthy, benign mole. A benign mole will have a regular pattern of coloration and pigment, even borders, symmetry, and a tan or pink color. Dysplastic moles can be asymmetric, have indistinct borders, or contain multiple colors or very dark pigment.
Dysplastic moles are often spotted as the “ugly duckling” on a patient’s skin. Any departure from the typical mole a person’s skin makes may be dysplastic. They can appear anywhere on the body, but in most cases are found on the back, chest, buttocks, breasts, or scalp.
Photodynamic Therapy, often referred to simply as PDT, is a medical treatment that uses photosensitizing agents and light exposure to treat a range of conditions, including skin cancers, acne, and actinic keratosis (“pre-cancers”). You can learn more about photodynamic therapy on this page, and the U.S. Dermatology Partners team would love to hear from you if you’re interested in scheduling a consultation to discuss photodynamic therapy. Simply use our online request form to schedule a consultation visit at the U.S. Dermatology Partners office closest to you.
Psoriasis is a chronic autoimmune inflammatory condition that causes patches of skin to become red, inflamed, and bumpy. This disease affects more than 8 million people in the U.S.
Psoriasis occurs when the immune system mistakes skin cells for a virus or other infection and responds by producing more skin cell growth. This can be triggered by stress, anxiety, injuries to the skin, infections and hormonal changes.
Rosacea is a fairly common skin condition that causes redness in your face. In some cases, it may also produce small, red, pus-filled bumps. Typically these signs and symptoms may flare up for a period of weeks to months and then diminish for a while.
Rosacea may sometimes be mistaken for acne, an allergic reaction or other skin problems. It is believed to be caused by a combination of hereditary and environmental factors.
Learn more: 4 Types of Rosacea
Sebaceous hyperplasia is a benign bump on the skin that forms as a result of over-productive oil glands. When oil glands are damaged, they can become enlarged and clogged, leading to this condition. It is primarily a cosmetic concern rather than a medical problem.
Shingles, also known as herpes zoster, is a painful skin rash that occurs when the virus that causes chickenpox reactivates.
Typically, shingles appears on a small area on one side of the face or body. The rash is often painful because it travels up nerve roots (which supply sensation to your skin) to the area of skin supplied by those specific nerve roots.
Skin tags are small, soft skin growths that can occur anywhere on the body but are most common on the eyelids, neck, armpits, groin folds and under the breasts. They are harmless but they can be annoying, particularly if they are in an area where they are rubbed on by clothing. They may be flesh-colored, pink or may darken.
The sun can age and burn your skin, and it can also cause damage on the cellular level, leading to skin cancer. The good news is, the U.S. Dermatology Partners team can help you formulate a plan to prevent sun damage and repair the effects of the sun’s UV rays so that you can go out and enjoy a sunny day. Learn more on this page or contact U.S. Dermatology Partners to schedule an appointment with us.
Individuals who are prone to sunburn are thought to be genetically predisposed to skin cancer. Risk is also increased when exposure to UV rays is excessive. Sunscreen helps prevent the damaging effects of ultraviolet radiation, including skin aging and skin cancer like melanoma and squamous cell carcinoma.
Sunscreens are rated and labeled with a sun protection factor (SPF) that measures the fraction of sunburn-producing UV rays that reach the skin. The higher the SPF, the greater the protection.
Vitiligo is an autoimmune disease in which white patches of skin appear on different areas of the body. This happens when melanocytes, the cells that make pigment in the skin, are destroyed. In addition to the skin, it can affect the mucous membranes of the mouth and nose as well as the eyes. Its cause is not known.
Warts are benign, non-cancerous growths that appear on the skin as the result of a virus called human papillomavirus, or HPV. They are contagious and are spread by contact – either with the wart or something that touched the wart. Cut or damaged skin is more vulnerable to warts.
Related: How to Identify a Wart
Botox, the commercial brand name for botulinum toxin (BTX), is an injectable cosmetic dermatology treatment that reduces the appearance of fine lines and wrinkles on the face.
Unlike injectable wrinkle fillers, which work by filling a crease in your skin with another substance, Botox actually relaxes targeted muscles to reduce the look of lines in the face. This results in smoother skin with a more youthful appearance.
Each Botox injection relaxes key facial areas by temporarily paralyzing specific muscles. This temporarily removes wrinkles and improves the look of laugh and frown lines, skin bands on the neck, crow’s feet, forehead creases and more.
Although it was originally developed to treat eye muscle disorders, Botox has become popular cosmetically and this is now its primary use. In fact, Botox injections are now the most common cosmetic treatment in the U.S., with 6.3 million procedures done in 2013. Because Botox inhibits the release of certain neurotransmitters, it is also sometimes used to treat chronic migraines.
When it comes to dermatological treatments that will help people reclaim a youthful glow, create an even skin tone, and minimize the appearance of scars, chemical peels offer a conservative solution that addresses all of these concerns. Chemical peels are versatile treatments that help to improve the health and appearance of the skin, and just about every patient could benefit from the procedure. If you’re interested in learning more, continue reading below or get in touch with a U.S. Dermatology Partners location near you to schedule your visit.
Dermaplaning is a safe and effective physical exfoliation procedure that triggers cell regeneration and allows products to better penetrate the skin. Dermaplaning is considered excellent for ridding the face of excess fine hairs which can often accumulate dirt and oil.
Dermal Fillers (also known as facial injections, as well as many brand names) include a variety of products that are injected into the skin to replace lost volume, enhance lips, reduce wrinkles and rejuvenate the skin overall.
There are many brand-name facial injections available including Juvederm, Restylane, and Sculptra. These injections use fillers such as collagen, hyaluronic acid, and calcium hydroxyapatite and can be helpful in combating early signs of aging.
Dysport is a prescription injection used for the temporary improvement in severe frown lines between the eyebrows. As the muscles relax and prevent contractions, wrinkles in and around the brow and frown area will disappear.
Dysport, also known as Reloxin, is made from a neurotoxin produced by the bacterium Clostridium botulinum; it is the same neurotoxin used in BOTOX Cosmetic.
Fractional RF with Pixel8 is an innovative non-surgical way to achieve skin tightening and smoothening through the precise delivery of radiofrequency (RF) energy. By adjusting the amount of energy, depth, and areas of treatment, Fractional RF can be customized to improve the appearance of the skin by reducing skin laxity, fine lines, wrinkles, pore size, rough or pebbly texture (“solar elastosis”), stretch marks (“striae”), and scars, including surgical scars and acne scars.
Jeuveau (pronounced Jū vō) is a new way of tackling frown lines between the eyebrows that tell the stories of your years of smiling, squinting, concentrating, and yes, even frowning. The story of our lives may be written on our faces in the form of fine lines and wrinkles, but it doesn’t have to stay that way thanks to Jeuveau. If you’re ready to look and feel your very best, it’s time to sit down for a consultation with one of our knowledgeable dermatology professionals. Our teams are dedicated to offering the latest and most effective treatment options for any dermatological need to ensure your skin’s health and vitality for life.
Juvederm is a group of injectable dermal filler gels made from hyaluronic acid and used to correct for moderate to severe facial wrinkles and folds or to provide contour. Different types of Juvederm are:
Keloids are raised, red scars created by excessive healing of skin wounds, such as burns, cuts and acne. They are the result of an overproduction of collagen as the skin tries to repair itself. Keloids also can occur after piercings, tattoos or surgery and often times are itchy and painful. They can grow for years and sometimes show up three months or longer after the injury occurred.
Keratosis pilaris is a common skin condition characterized by small, hard bumps that may make your skin feel like sandpaper. Most often they appear on your upper arms, thighs and buttocks, and sometimes are accompanied by redness or swelling. In some cases they may appear on your face.
It is caused by a buildup of keratin, a protein that protects skin from infections. When a buildup forms, it blocks the opening of a hair follicle and creates the bumps, but doctors don’t know what triggers the buildup.
Kybella is an injected treatment that targets fat stores below the chin (double chin). It is one of the best available, non-surgical treatments for double chin, and the knowledgeable dermatologists at U.S. Dermatology Partners are proud to offer this minimally invasive cosmetic dermatology option for our patients who are interested in improving the appearance of their jaw and facial structure without undergoing unnecessarily invasive surgical interventions. If you’re interested in learning more about Kybella, please take a few moments to fill out our appointment request form to schedule a consultation. One of our team members at the office nearest you will be in touch to discuss the details of your visit.
Laser rosacea therapy is a way to treat a rosacea complexion. One of the most common and effective treatments is the pulsed dye laser (PDL), which targets visible blood vessels and can reduce redness and flushing by destroying the lining of the inflamed blood vessels.
Laser skin resurfacing is a treatment used to reduce facial wrinkles and skin conditions including acne, scars, warts, enlarged glands on the nose and more.
The process vaporizes the upper layers of skin, which creates a wound that encourages the body to produce new collagen. The collagen and elastic fibers tighten as they heal, and the tightened skin eliminates wrinkles as it pulls together.
Laser treatments work by using specific wavelengths of light to interact with tissue, which can positively affect pigment, blood vessels, hair follicles and moisture in the skin. The result is improved skin tone and texture, as well as the tightening of loose skin.
Lasers can also be tuned to very specific frequencies to perform different tasks and can even be used in surgery to allow doctors to work on a very precise area with less pain, swelling and scarring than traditional surgery.
Cosmetically, lasers can be used for skin resurfacing and to treat such things as acne, wrinkles, rosacea and more.
Laser vein reduction uses light focused on a specific area to break up broken blood vessels. This allows them to be absorbed back into the body. It is most often used for eliminating spider veins.
ProFractional therapy uses a laser to create small, microspherical holes in the surface of your skin to “aerate” or thicken your tissue and stimulate natural collagen growth. It is similar to the Fraxel treatment and is used for treating lines and wrinkles, loose skin, scars and depleted collagen.
At U.S. Dermatology Partners, our board-certified dermatologists utilize a range of treatment options to help our clients achieve healthier, more beautiful skin. Among these are dermal fillers, a great option to improve the appearance of fine lines, wrinkles, and sagging skin. There are many different dermal fillers available, and each has its own, unique advantages. RADIESSE dermal filler injections from U.S. Dermatology Partners are an innovative treatment option. Due to the long-lasting results, RADIESSE has quickly become one of the most popular filler options available. You can learn more on this page, and don’t hesitate to call the U.S. Dermatology Partners team near your home or office to schedule a cosmetic dermatology consultation. Book your appointment today to find the best cosmetic dermatology treatment for you and your skin.
RADIESSE is an injectable dermal filler used to plump the skin. When age or scarring causes fine lines, wrinkles, or sagging, RADIESSE dermal fillers can be injected below the skin to restore volume and smooth, youthful fullness. Each type of dermal filler is uniquely formulated to address specific concerns. RADIESSE’s formula uses a water-based gel with calcium-based microspheres to recreate lost volume, with non-toxic and non-allergenic ingredients. Because the components of RADIESSE’s formula are very similar to naturally-occurring minerals, people are much less likely to experience an allergic response. Over time, the body absorbs the filler material, but unlike traditional dermal fillers that need to be immediately readministered to maintain the desired results after they’re absorbed, RADIESSE dermal filler treatment is also designed to spark the production of your body’s natural collagen, meaning you’ll retain your improved appearance for even longer before you need retreatment.
While most people select RADIESSE for use improving the appearance of the face, specifically the skin around the nose and mouth, it is also used to restore volume on the backs of hands, and it can sometimes be administered as an alternative to implant surgery in the nose, cheeks, or chin.
Restylane is an injectable dermal filler gel made from hyaluronic acid to produce volume and fullness in the skin. This reduces the appearance of wrinkles and can also create fullness in the lips.
We all want healthy, beautiful skin. But scars, a natural part of the healing process, leave a lasting mark and cause some people to struggle with the negative impact on the appearance of their skin and in some cases, limitations in function or other concerns. If you’re unhappy with the appearance, texture, or health of your skin after an injury, surgery, or other damage that leads to scarring, the U.S. Dermatology Partners team can offer treatment to improve the appearance of scarring.
Sclerotherapy is an outpatient procedure performed by a board-certified dermatologist. It is used to treat varicose and spider veins in the legs. Sclerotherapy involves injecting a solution directly into the vein. The solution irritates the lining of the blood vessel, causing it to close when compression is applied.
Sculptra is an FDA-approved synthetic injectable used to correct shallow to deep facial wrinkles and folds. It is also a collagen stimulator that helps revitalize your body’s own collagen production.
Spider veins are blood vessels that are visibly enlarged and can be seen on the face as well as other areas of the body, most commonly the legs. They may also be called broken blood vessels or thread veins, and appear as hairline marks that can be red, bluish or purple. They most often appear on the nose, chin or cheeks.
Broken blood vessels occur when the skin has been damaged. They are often caused by falls or accidents that caused bruising, or by scrubbing the face too vigorously. However, spider veins also can be caused by such factors as aging, pregnancy, estrogen replacement therapy, sun damage and rosacea. In the legs, they may be caused or worsened by standing or sitting for long periods of time, obesity and constipation.