Premature Graying of Hair

The hair get there color from the melanin pigment. Normal graying of hair occurs due to aging in late thirties and varies according to the race and ethnicity. If the hair starts graying before age of 25 years, it is called as premature graying or canities or achromotrichia.

The exact cause of premature graying has not yet been identified, however the studies conducted so far have found many potential causes. These causes are;

•        The genetics play an important role in premature graying. The genetic predisposition may lead to early destruction of melanocytes required to pigment hair. If your parents had their hair gray early, you might get too. 

• Certain environmental factors like UV radiations, pollution may also cause damage to hair and cause premature graying in genetically susceptible individuals.

•  Emotional stress

•    Hypothyroidism

•   Deficiency of many vital vitamins and minerals has been found in patients with canities. Some of them are iron, copper, Vitamin D3, Vitamin B12 and protein deficiency.

• Smoking and alcohol consumption have been found to be responsible.

•  Administration of certain drugs and chronic illness can lead to premature graying.

The treatment for premature graying depends on identifying the cause if any and correcting it. Your dermatologist would help you identify it and would advice you treatment accordingly. 

Repigmenting the hair is difficult however with treatment the progression can be slowed.

 

Jock itch (दाद)

This is a type of skin infection that affects many. It is called by many names like jock itch, ringworm, दाद (in hindi) and many more. The desire to itch is uncontrollable and can often be embarrassing in public places. This easily manageable disease has become a menace nowadays due to widespread misconception and ignorance about its cause and treatment. So let’s understand what exactly is it and how to manage it.

What is it?

It is exactly a fungal infection caused by a superficial fungus. This dermatophyte infection is called as Tinea. It can affect any site on skin and can also involve hair and nails. On skin it can infect areas like face, beard, arms, legs, trunk, etc, i.e., literally everywhere. Most commonly it is seen in areas which are warm and moist, like, groins, armpits and in females additionally in there breast folds. 

A warm and humid atmosphere favors its development, thus it is more commonly seen in summers or rainy season. However nowadays due to its changing nature it is present round the year. In people with diabetes, HIV infection, or taking immunosuppressive drugs, the chances of getting infected increases and also it spreads rapidly. This infection can spread from one person to another if they share towels, clothes, handkerchiefs, etc.

As far as how it happens in a person is concerned, there is no specific reason for it. It is an infection and you can get it from some other person, or if you wear tight fitting clothes or shoes for long time, if you work in some hot and humid environment or if you stay at a place which has such atmosphere you can get infected. Your eating habits however have no role in it.

Once it happens, it presents as a ring like infection which spreads on the periphery and involves larger areas. It starts as a small reddish area on skin and then spreads. It is extremely itchy, and itching can also lead to formations of boils in the area.   

What to Do?

If you get ringworm, consult a dermatologist, follow the instructions and take proper treatment.

 The main reasons for this infection not getting treated properly or spreading over larger areas are;

1.  Self treatment: 

NEVER apply any cream or ointment on the ringworm without a consultation of a certified dermatologist. This is the most common blunder patients do. They go to a drug store, get an over the counter available cream and start using it. Or they consult someone who is not a qualified dermatologist and get wrong creams and apply them. Also some people apply topical irritants like lotions which are very ZALIM or have dithranol in them.

So what are these creams and what is wrong in them?

These creams/ointments contain a mixture of drugs. The worst ingredient is steroids, like, clobetasol, betamethasone, flucinolone, triamcinolone, etc. These creams when applied give a quick relief. Your infection seems to disappear within a week. But no, it has not treated anything, it has just hidden it. As you stop applying the cream, the infection gets worse, is redder, itchier and spreads rapidly. Also these creams harm your skin. They make the skin thin and you can get very bad stretch marks in these areas. 

Additionally they make the infection more difficult to treat. If you consult a dermatologist and have been applying such cream before, as you start the treatment the infection flares up and you feel that medication is not working. 

NEVER APPLY SUCH CREAMS. 

2.  Improper treatment:  

The next mistake patients often do is not taking treatment for adequate duration. They do the right thing by consulting a dermatologist, but they stop treatment after taking it for 15 to 20 days. It is because they get relieved of the infection and they think now its treated and there is no need to further continue the treatment. But it is not so. The fungus takes a longer time to get completely treated. From looking at the skin it might feel treated but it is still present in layers of skin and when there are no antifungal drugs to control it, it grows again.

So it is generally advised to take treatment for at least 6 to 8 weeks.

When you visit your dermatologist he would prescribe you proper antifungal treatment which would help you get rid of this infection.

Recurrence

The main problem with fungal infection is recurrence.  Even after taking adequate treatment of 6 to 8 weeks from a dermatologist, you may see after 6 months to 1 year that the infection recurs. Well it is the nature of the disease. When the fungus gets favorable conditions like warmth and humidity it starts to grow again. However if you are careful and follow the DO’s given below it might not recur. If it does recur, take adequate treatment again.

DO's

1. Always consult a certified dermatologist and take adequate treatment.

2. The topical antifungal needs to be applied on the entire affected are plus two centimeters outside on the normal skin.

3. Take bath after activities which result in excessive sweating and pat yourself dry carefully after taking bath.

4. Towels, undergarments, napkins, handkerchiefs should be washed in hot water, sundried, ironed and then worn. Dry them inside out.

5. Change your socks regularly. 

6. Avoid wearing tight undergarments. In males, boxer shorts are preferably to the conventional V shaped underwear. Cotton loose clothing is preferred. 

7. Avoid jeans/jeggings/leggings and other tight clothing.

8. It is important that all contacts including the family members and people having similar conditions in the work place are treated correctly and completely for the fungal infections. If your contacts are left untreated, you may contact the infection again.   

DONT's

1. Never do self treatment.

2. Never apply steroid creams.

3. Avoid sharing towels, clothes, etc. with infected persons. 

Dandruff

This is an issue that troubles many. You try many remedies but it never seems to go. It gets under control but then again flares up. So what exactly is dandruff?

Dandruff is an early stage of a skin problem known as Seborrheic dermatitis (SD). Seborrheic dermatitis presents as redness of involved skin with greasy-looking scales and is said to occur because of a fungus named Malassezia furfur or due to its yeast form, Pityrosporum ovale. 

This fungus is normally also present on our body, but in this condition its amount is increased and also the body response to it is aggravated. It is mainly present in areas with abundance of sebaceous glands, like; scalp, face, chest, back, behind the ears and in flexural areas.

Most commonly it is seen over scalp.  The area involved is brownish in color and is covered with greasy scales. These scales are what come as white flakes in our nails when we scratch the scalp. The area involved can increase to extend over the whole scalp and even beyond the frontal hairline. The important thing to remember is that dandruff if causes hair loss, it is reversible as there is no damage to scalp skin. Also, there can be small boils on scalp which often pain when we touch them.

Seborrheic dermatitis can also be seen on face. Here it is seen to involve eyebrows, eyelid margins, around opening of nose, moustache, beard and behind the ears. These areas have redness and some scaling. This redness and scaling can also be seen on chest, upper back, shoulders, axillary region and in groin area.

Don not get too carried away by the above description. It is not a very serious problem and is easily manageable. However the only problem with dandruff is recurrence. It is a manageable issue but cure is difficult.

It is only because in these patients the body is more responsive to the responsible fungus than others, and since this fungus is normally found on skin of even healthy people it cannot be wiped out completely. When you take treatment it reduces the number of the organisms, with clearing of the condition, but recolonization occurs on stopping the treatment.

So What to do?

If you have a problem of recurrent dandruff, use the antidandruff shampoo regularly to keep the amount of fungus under control. If it gets aggravated and you get above mentioned symptoms, consult your dermatologist for proper treatment.

To conclude, do not worry if you have recurrent dandruff. It is normal for you like some people have acne and some don’t. Consult your dermatologist for proper treatment.

Common Blunders done to Skin

 Everybody wants a clear skin. A single spot on skin is not tolerable to few. They try everything to get rid of them, and then is when blunders are done. In an effort to try and make our skin glowing and spotless we end up applying things which have no evidence backing them, and eventually damage our skin. Sometimes such damage is irreversible. You end up with a blemish which is more worse than what you already had. It has been said that, " It is good to make mistakes, but it is better to learn from other people's mistakes". So here is a list of common mistakes made so that you learn from them.

1. Topical Steroids:

This is the biggest problem we dermatologists are facing nowadays. Use of steroid creams in everything, be it acne or pigmentation or even jock itch. Steroids when applied always give a false sense of relief.  

Scenario 1

If you apply it on face for pigmentation you would feel your skin become very clear and free from pigmentation. But after some time you start getting facial hairs and find that your  skin has become sensitive. When you try to stop applying it, you realize you can not. The moment you stop it you get rashes on your face, there is itching and you are unable to tolerate sunlight. If you apply that cream again all the symptoms are gone. This condition is called as Topical Steroid Dependent Face.

Scenario 2

Steroids are commonly falsely applied on face for acne too. But when applied they give rise to increase in number of your acne. Also the acne arising because of steroid use are resistant to treatment too.

Scenario 3

Another common condition where steroids are applied is jock itch. We avoid consulting a specialist and get a cream from chemist or a non specialist doctor. Steroids damage you skin very badly. It leads to thinning of your skin and you can get very severe stretch marks. Also you are initially falsely relieved of your itch, but it is only worsening the problem. The moment you stop applying it the itch flares.

So steroids give a false sense of relief of symptoms but in the background they are making you dependent on them. They are damaging your skin. Its all just because we go to chemist directly for treatment or consult a non dermatologist for skin problems. The steroids most commonly used are combination creams of betamethasone, clobetasol, mometasone, etc. 

2. Local Irritants

Another blunder which is commonly done is application of topical irritants to get rid of skin diseases. Most common is application of "CHUNA" for removal of moles, warts, etc. They give you a very bad scar and even can cause a keloid formation. You apply it once to remove something but instead you give yourself a permanent blemish. Such scars are very difficult to treat and they never go completely.

Another thing is application of some topical irritant lotions. One of them is very famous and used commonly but it is very "ZALIM"😀. It is very commonly used in jock itch. It cures nothing and just burns your skin. It can leave very bad pigmentation or scar if the burn is too intense or deep.

Nowadays the markets are flooded with many creams claiming to make you fair and lovely or fair and handsome. We are lured by such commercials and end up applying them on our face thinking that we would get a better glowing skin. But these products can damage your skin and make your skin sensitive.

These all things happen just because of the laziness in consulting a skin specialist. Like you always buy a flower from a florist and a cake from a baker and never vice versa, always consult a dermatologist for your skin problems and no one else. Never apply anything on your face until it has some scientifically backed proof of the result it claims to give you. Never apply anything just because you read it over internet, saw it on television or was advised by anyone. Its your skin you are experimenting such things and if you do some irreversible damage it would leave a permanent blemish. Even if you unknowingly do it consult a dermatologist before its too late.

Allergy

This is a word that has now falsely become synonymous to all skin diseases. Any patient who comes to consult when asked about the complaint would simply say I have an allergy, even if they have an acne on their face. And by allergy they mean due to some food, clothes, medicine, etc. But is it true? Are all skin diseases allergy to something? The answer is NO.

So what is allergy?

So let us not go into the science of it and understand simply. The allergy in question, i.e., due to some food or any other allergen is a very specific type of allergy and causes a few specific diseases, like, urticaria, angioedema, urticarial vasculitis, etc.
All skin diseases are not allergy. Skin diseases are caused by a plethora of reasons and this type of allergy has a role only in very few of them. This misconception has been spread because of the profit people are gaining by doing allergy tests even when not needed. The person being tested is just duped of money and the only person being benefitted is the person doing the test.

Urticaria/Angioedema

Let us understand about the very specific disease this type of allergy causes and how. Urticaria is a very common problem and 20% population encounter it once in their life. It presents as itching and where we itch the area becomes red and slightly swollen. It goes away by itself after some time and may happen at another place. It may happen few times a day.

This happens because we have developed allergy to something, called allergen. The allergens  vary from patient to patient. Whenever we come in contact to this allergen, our body releases a substance called histamine that causes itching, redness and swelling.  Some people may develop swelling due to it like on lips, under the eyes, etc., called as angioedema.

These allergens can be anything, like; Drugs or medicines, additives used in food products, some food items, any infection or infestation, some inhalable substances(like plants, chemicals), etc.

Then some people develop urticaria in response to physical stimulus, like, pressure, vibration, temperature. Some people complain of itching in winters when they do some physical activity or go out in sun, called cholinergic urticaria. Some people develop it after contact with water, like bathing, called Aquagenic urticaria. Urticaria is also found associated with other diseases like thyroid, etc.

So as you can see that anything can cause this allergic urticaria and thus to pin point a cause is very difficult.

So what to do?

You can yourself try to find out what is triggering urticaria. Give a thought whether the urticaria is taking place at a particular place like home only or at workplace, whether it is taking place at a particular time of day, if so take a note of activities you are doing at that time and try to figure out if you can relate to something like food or surrounding plants, etc. Some people have this is a particular season, if so than some plant around you might be triggering it.

You can also maintain a diary and when you get urticaria note down all things you came in contact with that you can remember like food, drugs, any plants or place, etc. Every time you get urticaria keep noting and try to find out if there is anything common among all the episodes. Like this also you may be able to find out a cause.
If you can find something out try to avoid it and it will relieve your disease, but if not consult a dermatologist and he can help you.

There are many safe and effective medicines available which can be safely used over a long term. But remember your prescribing doctor should be a qualified dermatologist and not a self declared skin specialist or quack.

Allergy test

In allergy test your serum is tested against many possible allergens to try and find out what you are allergic to. It is a costly test and not always beneficial. So always go for this test when advised by a dermatologist only and not voluntarily or on advice of anyone else as you might get the test done and not need it.

 
Thus to conclude, all skin diseases are not allergy. Do not get tested unnecessarily for this test. If you have urticaria try to find out a cause. If not, consult a dermatologist.

Facial Pigmentation

India is a country where beauty is measured by skin color. A fair looking person is considered more beautiful. However it is not true. The beauty of a person is measured by their values and their nature. Still every person wants to look good. All the patients always want a glow on their face and an even skin tone. So what are the various types of dark pigmentation seen on face? I have tried to compile a few for you, which are as follows;

1. There are some natural variations in pigmentation in every individual known as pigmentary demarcation lines (PDL). On face they can be seen from angle of mouth to chin or between malar prominence and temple.

2. According to race the skin color of an individual can vary. The color of an individual is formed by his basic skin tone and some additional pigmentation due to sun exposure. This basic skin tone is genetically determined.

 3. Due to sunburn and tanning.

4. Pregnancy can cause pigmentation, especially on face ( called chloasma), neck and anogenital region. It can also cause darkening of the nipples. This pigmentation usually fades after delivery but sometimes can persist for months-to-years.

5. Just before menstruation some females show hyperpigmentation.

6. Depending upon the various social, cultural, religious and personal practices pigmentation can occur at few sites due to friction.

7. A very common pigmentation frequently seen is periorbital melanosis, i.e. darkening around the eyes. Many causes have been suggested for it however conclusively nothing has been confirmed. The various causes reported are genetic, excess weight loss, endocrine disturbances ((hyperthyroidism), physiological (occurring at puberty), stress, eye strain, etc.

8. Another very common type of facial pigmentation is melasma. It mainly occurs on the sun exposed areas, like; forehead, cheeks, temples and upper lip. Here again many causes have been suggested for it however conclusively nothing has been confirmed. Sun exposure however is the most agreed upon aggravating factor for this type of pigmentation. Hormonal factors have also been suggested due to its association with oral contraceptives, pregnancy and endocrine dysfunction. It can be genetic also. Nowadays with rampant use of cosmetics and no quality control, the toxic and harmful ingredients present in these can also cause hyperpigmentation. The hyperpigmentation due to such cosmetics is darker and responds to treatment poorly.

What to do?

As I always say NEVER do self treatment. There are many steroid creams available in market which is handed over to patients either over the counter by chemists or by unqualified self proclaimed skin specialists. They give you a false impression of relief initially but eventually cause damage to your skin. it can lead to thinning of your skin, steroid dependence and facial hairs. Always consult a dermatologist for your skin problems.

Since now you are aware of the types and causes of pigmentation (mentioned above), try and find out if you can relate something to your pigmentation. Avoid that cause. Also important is prevention of sun exposure. Apply sunscreen whenever you are out in sun, cover as much body as you can with some clothing and carry an umbrella or use a hat. Apply sunscreen on face and all remaining exposed parts.

 There are plenty of treatment options available for pigmentation. There are topical and oral drugs, lasers, dermarollers, mesotherapy, fillers, etc. What treatment is required for you would be judged by your dermatologist and would depend on the type, intensity and location of your pigmentation.

However, pigmentation is a difficult problem to treat. It is because when you take treatment it gets light but the moment you stop treatment it starts recurring. So it is advised to take appropriate treatment and do not stop it suddenly. Your dermatologist would suggest you some cream or any other modality of treatment which would help you maintain a less pigmentation and also the medication would have no long term adverse effect on your skin.

 

DOs

1. Prevent sun exposure.
2. Eat balanced diet.
3. Include some relaxing workout or activity in your schedule.  
4. Consult a dermatologist.

DONTs

1. NEVER do self medication.
2. Avoid applying steroid creams.

 

 

Acne

Acne is the last thing a person wants on face.  Eruption of even a single pimple is enough to make the days gloomy. They try everything to get rid of them, like grandma remedies, home remedies, friend remedies, social media remedies or other propaganda advertisement remedies. They stop eating many things and go on some strict diet to reduce them. So what is acne and is it so complicated.

Well No!! Acne is not a thing that should trouble you so much. 

Acne happen due to presence of sebaceous glands on our face which get blocked and accumulate sebum. The condition usually starts in adolescence(10-12 years) and frequently resolves by the mid-twenties (25-27 years). Few people get acne later in life, i.e., after 25 years age or in their thirties or forties.

Various causes found responsible for acne are genetic susceptibility (presence of acne in family), hormonal imbalance (androgen hormone mainly responsible), polycystic ovarian disease in females,  hot and humid climate or emotional stress. 

Food has been blamed a lot for acne, like, oily food, junk food and even mangoes or pickels. The list is endless. But do they really produce acne. If we go for scientific studies no role of diet has been established in acne. However, some studies have reported that excess consumption of dairy products and high-glycemic load carbohydrate diet can cause acne, but then the amount we eat in our regular daily diet is not so much to produce acne.  

What to do?

The most important thing is to not take stress. Consult a qualified dermatologist. An early and regular treatment would help keep your face free of acne and thus would prevent any chances of developing scars and pigmentation. The treatment might be long and you might get few acne while on treatment too but after some time they stop coming. However, they can recur eventually. Whenever they do take treatment, never think that there no use of treatment as pimples keep on recurring. It is the nature of acne. You have to fight it and take treatment to prevent scarring and pigmentation.

There are many treatment options available for acne and they are quite effective too. Nowadays we have chemical peels and lasers too to treat it. What treatment is required for you would be judged by your dermatologist.

 
NEVER do self treatment. There are many steroid creams available in market which are handed over to acne patients either over the counter by chemists or by unqualified self proclaimed skin specialists. They give you a false impression of relief initially but eventually cause formation of very bad acne outburst. Always consult a dermatologist for your skin problems. 

Management of Scars and pigmentation

Pigmentation due to acne can be managed very efficiently by topical medications. Now chemical peels and lasers are available too. 

Scars  are a difficult job to manage. They do not go away easily. However there are many treatment options available for it. They start from topical medication, dermarollers and lasers and if they do not work can even be surgically managed. It depends on type of scar and severity of scarring.

But do not let your acne go to the stage of pigmentation and scarring. Take regular treatment and keep control on it. Follow advice of your dermatologist.

DO's

1. Take a balanced diet.

2. Avoid foods with high glycemic index, like; sugar and sugary foods, sugary soft drinks, white bread, white rice etc.

3. Follow advice of your dermatologist.

4.  Wash your face two to three times a day.

DONT's

1. Never do self treatment

2. Do not follow any remedy or treatment which is not backed by scientific evidence.

3. Dont scratch and press your pimples.

Hair Loss

Hair loss is such an important issue that even a movie was made about it. Almost everyone at some point in their life face this problem. A daily loss of 50- 100 hairs is considered normal. It is a part of normal hair cycle. The disturbance of this normal hair cycle is what that leads to hair loss.

Causes of Hair loss

A person can see a sudden hair loss after high fever, surgical trauma, sudden starvation or some heavy bleeding.  The causes for the more commonly observed chronic type of hair loss in both males and females can be; emotional stress, thyroid disorders, profound iron deficiency anemia, dieting or improper diet (like; low protein diet, daily junk food, etc.) or some chronic illness. Then there is a patterned hair loss which is seen in both males and females and is due to a genetic presence of hair loss in the family. It can be both paternal and maternal. In many cases the hair loss can be idiopathic, i.e., without any specific cause.

What to do about it?

Evaluate your diet 

 
Take a look at your diet. See what you are eating. Your diet should be balanced so that you get all the nutrients properly. Also your diet should be rich in protein as they are necessary for your hair growth.

 Take Expert advice

In India there are many experts who always have a remedy for everything, although they might never have tried it themselves. The remaining damage is done by the social media, television and print media advertisement propaganda of innumerable products which claim to grow your hair.

Never believe in any remedy which is not backed by a scientific evidence and experience. Always consult a qualified dermatologist with a MD degree in dermatology. This thing about degree has been mentioned because there are many people who claim to be a dermatologist but have no degree. They just are quacks and have no knowledge of anything. So always ask your doctor if he is a qualified dermatologist before consulting.

Your dermatologist can help you find out any other cause of hair loss. He may ask for some investigations if required. Taking care of these causes can help reduce your hair loss.  As mentioned sometimes there might not be any identifiable cause.

 Treatment

The treatment would depend on the cause of hair loss. The response to treatment is slow in hair loss and it may take up to 6 to 8 weeks to show any visible benefit. There are many medications available for treatment of hair loss but always follow the advice of a dermatologist and take them. Nowadays many procedures, like; dermaroller, PRP, mesotherapy, light therapy and hair transplantation are available as a treatment.  The treatment of every patient is different and it would be evaluated by your dermatologist as to what is needed by you.

Thus to conclude, to prevent hair loss take a balanced diet, include some relaxing workout or activity in your schedule and take an advice of an expert.

A Healthy Skin

A healthy skin is a desire of everyone and a mystery for most. To have a healthy skin you do not have to climb a mountain. The things required can be easily set in your routine. 

So what is exactly a healthy skin?

From a dermatologist's point of view a healthy skin would be a good hydrated skin with no skin disease.

How to get it ?

Well its quite simple. Just follow the following steps and you would get it.

1. Moisturize your skin thoroughly. Appling a moisturizer liberally on whole skin, twice a day would be sufficient. In the morning do it just after you take a bath and at night before you are off to bed. The moisturizer does not have to be some specific one. You can use any good moisturizer which suites you. Apply it on your hands too after you wash your hands. In current COVID era moisturize your hands often.

2. Apply sunscreen whenever you are out in sun. Cover as much body as you can with some clothing and carry an umbrella or use a hat. Apply sunscreen on face and all remaining exposed parts. The effects of ageing are mostly due to sun exposure and by taking proper care you can reduce it.

3. Take a balanced diet. A balanced diet with all essential nutrients is very necessary for a healthy skin. 

4. Do not apply anything on your skin without consultation of your dermatologist. Many people unknowingly damage their skin by applying some medication they get either over the counter from the medical stores or on advice of someone. These creams which claim to provide so called glowing skin have steroids in them. When you apply them they tend to give you a fair skin but it also is damaging your skin very badly. When you apply it over time, your skin becomes dependent on it and when you try to stop applying it, the skin becomes red, itchy with some eruptions. The skin also becomes thin and it can lead to facial hairs too. NEVER APPLY THEM. 

 To conclude, I would say that you can have a healthy skin but you can not have a skin fairer then your natural skin color. Do not try to look fairer, try to look beautiful with a " Winsome Skin". Always consult a dermatologist for you skin problems and not with just anyone.