Patient Education

Patient Education


PIMPLES (ACNE)

  • It is the block of sebaceous gland, which leads to accumulation of sebum and secondary infection with bacteria leading to pimples.
  • Common sites involved are face, neck, chest, shoulders and back.
  • It starts after puberty and may continue up to 40 years of age.
  • Anybody can be affected with equal male to female ratio.
  • It can be mild, moderate, or severe depending on various factors that include hormonal, genetic and environmental factors.
  • It can be associated with hair loss, obesity, and unwanted hair growth over upper lip, chin and side-locks in females.
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  • It can also be associated with seborrhoea and hidradenitis suppurativa, a recurrent bacterial infection in underarms and gluteal region.
  • Few pimples are expected, but moderate to severe pimples should be evaluated. Severe pimples may cause depression and social isolation.
  • Diet containing sweets and dairy products have a minor role in aggravating pimples. Certain occupation involving use of oils, greece and petroleum products can also aggravate pimples.
  • Treatment of pimples is a continuous process and varies for different grades of pimples.
  • It is treated to clear pimples faster and to prevent complications such as scarring and pigmentation. Early treatment resolves pimples faster and prevents scarring. Delay in treatment leads to more complications with settled scars and poor response to available treatments. Scars within a year respond well to combination treatment.
  • Topical gels are the mainstay of treatment. Any anti-acne gel should be started with short contact that is half an hour application to the affected area and washing it off for 3 days and gradually increase to 1 hr for next 3 days and long contact which is overnight application. Gel should be applied to dry face after cleansing with mild cleanser as prescribed. You can go to sleep after half an hour so that the gel dries quickly and does not cause burning of eyes. Apply a thin film over the pimples and pimple prone area regularly as advised. In spite of following these, if you have any side-effects, kindly report to the doctor instead of calling.
  • Certain oral medications given should be taken as prescribed and follow-up is essential to up or down-regulate the dose and to monitor with lab investigations. Any anti-acne treatment will take 4 to 6 weeks to show results. Procedures such as Salipeel ds and Microdermabrasion will reduce pimples faster and prevent further occurrence of pimples.
  • Wash your face 2 to 3 times per day. Avoid self medication and products given without content name. It may contain topical steroids which might reduce pimples initially, but long term use causes side-effects such as flare-up of severe acne, skin atrophy, unwanted hair growth, itching, redness, small blood vessels on skin and sun sensitivity. No home remedies involving too much rubbing, picking and squeezing of pimples. Avoid too many cosmetic creams which may flare up acne.

HAIR CARE

  • Normal hair loss is about 50 to 100 hairs per day. These hairs are shed every day and regrow.
  • Every day shampooing and coconut oil application does not cause hair loss. If there is thinning of hairs on scalp and recession of hair line, it requires evaluation and treatment.
  • The most common cause is androgenetic alopecia or common baldness. In males, it leads to male pattern baldness, that is frontal hair line recession and vertex baldness. In females, it leads to diffuse thinning more on the vertex area.
  • Other causes of reversible hair loss include nutritional factors such as anaemia (low Hb due to iron deficiency, vitamin B12 and folic acid deficiency), malnutrition, dandruff, vitamin deficiency, stress, pregnancy and lactation, post surgery and hospitalization, prolonged fever such as typhoid, malaria, dengue and others can lead to reversible hair loss. Hormonal disorders such as polycystic ovary, thyroid disorders, drug induced, mechanical factors such as hair dryers, straightening, curling, colouring and traction of hairs.
  • Treatment should be started early to prevent further progression and to induce re-growth of hairs. Depending on the extent of baldness, treatments vary. Combination of treatment works better along with home hair care as prescribed.
  • Home hair care includes application of prescribed lotions to scalp, which usually dries within 10 minutes and use of prescribed shampoos to prevent hair loss and dandruff. No need of hair washes daily for females. The lotion should be applied after bath. Take care that the lotion does not dribble on to the face. The response starts after 2 to 3 months and peaks at about 6 to 8 months. Maintenance is required with smaller dose for prolonged period.
  • It can be combined with hair growth laser, injection mesotherapy with hair growth factors, and hair transplantation.

ALOPECIA AREATA

  • It presents as smooth sudden localised hair loss over scalp, beard, moustache and eyebrows.
  • It commonly occurs in 20 to 40 yrs age group with equal male to female ratio.
  • Exact cause is not known. Various factors like autoimmune and stress are implicated.
  • Complete regrowth of hair occurs in most patients with treatment.
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XEROSIS (DRY SKIN)

  • Dry skin can be from childhood and has genetic influence. It can be localised limited to legs or generalised. It can be congenital or acquired. Acquired causes include winter season, drug induced, hormonal disorders like thyroid disorders and diabetes mellitus, renal failure etc.
  • Treatment is a continuous process by application of prescribed moisturising lotion daily. A moisturising lotion should be kept in the bathroom and has to be applied immediately after bath and pat drying. Use of moisturising soaps, limiting the bath time, lukewarm water and avoiding harsh soaps helps to counter dry skin.
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PHOTODERMATITIS (SUNLIGHT ALLERGY)

  • Red, hypo or hyper pigmented skin rashes associated with itching over sun exposed areas such as face, neck and hands.
  • It is due to allergy to ultraviolet rays of sun and has varied presentation from sunburn to sun tanning.
  • It has also chronic effects such as chronic sunlight allergy and photoageing.
  • Many people deny sunlight exposure as they are always inside the office. Minimal sunlight exposure is enough like open doors and windows, while driving, walk during lunch hour to produce sunlight induced effects.
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  • Treatment is by using photo-protective clothing and sunscreens. Photo-protective clothing means proper covering of skin by full shirt, leather gloves for hands while driving, broad rimmed hat such as used by cricketers, good sun glasses and always carry and use an umbrella.
  • Apply the prescribed sunscreen lotion liberally every 3 to 4 hours. A more practical way is to apply sunscreen in the morning and afternoon.  Sunscreen should be applied 15 to 20 minutes before going out to sunlight. Quantity should be one teaspoon for face and neck and one each for both forearms. Apply sunscreen even if you are indoors and in all seasons. Apply a thin coat of talcum powder or foundation powder for enhancing the sunscreen effect and to reduce oiliness. In water sports like swimming apply water resistant sunscreens every half an hour.

ATOPIC DERMATITIS (CHILDHOOD SKIN ALLERGY)

It is skin allergy of childhood which occurs at about 3 months of age and lasts up to 8 to 10 yrs of age. In infants, it usually presents as extreme dryness, redness and scaling associated with itching over cheeks and extensor aspect of body. In children over 2 yrs of age, it commonly affects flexural areas. Parents may have allergic disorders like asthma, runny nose with sneezing or skin allergy. It gradually reduces in severity as age progresses.

Treatment is aimed at continuous use of prescribed moisturisers and mild soaps. Itching is controlled by anti-allergy syrups or tabs as prescribed. Regular follow-up with your doctor is essential to control flare-ups and to prevent recurrence.

Precautions:

  • Avoid contact with woollen and synthetic clothes and prefer cotton clothes.(teddy bear, carpets, dust and pets)
  • Avoid prolonged bathing which tends to wash out protective oils from skin. Bathe with lukewarm water.
  • Certain foods like ice cream, eggs, seafood, aerated drinks and packed food.
  • Avoid vigorous exercise which tends to sweating. Take bath immediately after sweating.
  • It aggravates during winter season.
  • Clip nails to avoid scratching and secondary infection.


CONTACT ALLERGY

  • It can be irritant contact dermatitis or allergic contact dermatitis.
  • Irritant contact dermatitis presents instantly within half an hour to 1 to 2 days after application. It is delayed in allergic contact dermatitis.
  • Common agents are hair dye, bindi, nickel in artificial jewellery, gold, perfumes, soaps, detergents, leather, rubber, perfumes, deodorants, greece, oils, plants like parthenium, pollens in the air, cosmetic creams, ayurvedic and homeopathic products. Allergy can happen anytime after the first use or continuous use of the product for a long time.
  • Treatment is to avoid contact with offending agent. Change occupation or environment. Wear protective gloves for hand allergy.
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URTICARIA (HIVES)

  • It occurs as elevated red swelling associated with itching all over the body. In severe cases swelling of lips and eyelids occur.
  • It can be acute or chronic. Acute is short lived while chronic for more than 6 months. Hives lasts from half an hour to 1 day.
  • Causes of hives include drugs, food, insect bite, hot, cold, pressure and hidden infections like sinus problem, dental caries and white discharge.
  • Treatment include elimination of the cause if found. Anti-allergy tabs as prescribed can be taken for long time without much side-effect. Appropriate lab investigations are necessary to find out the allergen. In spite of extensive lab investigations, in 50% of cases the allergen cannot be detected. Keep the prescribed tabs with you always and can be taken whenever it comes with the consent of your doctor.
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PSORIASIS

  • It is localised or generalised itchy well demarcated, raised, red, scaling patches of skin associated with itching preferring the extensor areas.
  • Common sites of involvement include extensor aspect of trunk and limbs, elbows, knees, palms, soles and scalp. Other areas include nails and flexural areas in obese.
  • Exact cause is not known. Various factors have been implicated such as autoimmune, genetic and environmental factors.
  • The disease is more common in men than in women. In general, the younger age of onset, the worse the outlook as far as the severity, frequency and persistence of disease is concerned.
  • Psoriasis is a lifelong disorder subject to unpredictable remissions and relapses. It can be associated with joint pains. Aggravating factors are stress, alcohol, infection, smoking, winter season and certain drugs.
  • Treatment is aimed at control and long term maintenance by continuous use of moisturizing creams.
  • Avoid alcohol and smoking. De-stress yourself with yoga, exercise and meditation.
  • Topical application as advised forms the mainstay of treatment. Other modalities include oral medications and phototherapy. Follow-up with your doctor is essential for rotation therapy of available treatments, prevention of exacerbation and maintenance of remission.
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INFECTIONS


Infections of skin could be fungal, bacterial and viral infections.

Fungal infections (Ring worm)

  • It presents as red itchy rash with central clearing and peripheral spreading.
  • It is common in hot and humid climate, excessive sweating and in diabetics. Common sites are regions of occlusion such as thigh folds, buttocks, under arms, waist, under breasts and abdomen. Other sites include inter-toe, nail and scalp.
  • Treatment is aimed at promoting dryness of the area and avoid frequent wetting. Avoid frequent wetting and prolonged wearing of shoes. Pat dry properly soon after bath and don’t use wet clothes.
  • Avoid self medication, apply creams and take oral medications as prescribed.
  • Apply the prescribed cream 2 cms extra to the normal surrounding skin and continue treatment for another 2 weeks following clearance of the lesion.
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Bacterial infections (Boils)

  • It presents as red painful swelling with discharge of pus anywhere in the body. It can occur due to break in the skin barrier due to scratching and injury. Recurrent boils are due to poor skin hygiene, low immunity and anaemia.
  • Treatment includes draining the pus out and taking the prescribed medicines for proper duration as advised. Recurrence can be prevented by maintenance of skin hygiene by using prescribed soaps and elimination of carrier state of microbes by follow-up with the doctor.

Viral infections

It commonly occurs in immunosuppressed individuals. Various viruses cause different skin diseases. The common ones are herpes labialis, herpes genitalis, chicken pox, herpes zoster, warts and molluscum contagiosum.

Warts

  • Common warts present in varied forms like nodular, papular, cauliflower-like and flat topped painless lesions present anywhere in the skin including palms and soles.
  • Get yourself treated when one or two warts are there, to prevent spread and faster healing.
  • Electrocautery or burning the tissue is the treatment of choice. In beard region, it spreads by shaving and minor trauma.
  • It can recur in few after treatment.
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Herpes labialis (cold sore)

  • It presents as grouped pin head sized fluid filled lesions associated with redness and itching over upper lip and rarely lower lip.
  • It can be recurrent and is usually associated with fever and cold.
  • Avoid kissing during active lesions and take the prescribed medication to avoid recurrence and faster clearing.
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Chicken pox

  • It is a common childhood ailment and presents as red fluid filled lesions associated with itching and crust formation.
  • It starts with fever, myalgia and back ache in some.
  • It can spread from person to person with incubation period of 2 to 3 wks.
  • It resolves in one week.
  • Isolation is needed during the active stage by using separate towels, soaps and bedspread. Take the prescribed medications at the earliest sign to avoid complications such as scarring and pigmentation.

Herpes Zoster (shingles)


  • It presents as grouped fluid filled lesions on a red base associated with pain and burning sensation over the involved nerve root seen in adults.
  • It is the reactivation of chicken pox virus remaining dormant in the nerve root after a chicken pox infection.
  • Treatment should be started at the earliest possible to prevent complications such as post herpetic pain and scarring.
  • Isolation is required to prevent spread of infection. In elderly, complications are more frequent.

Molluscum contagiosum

  • It is a virus infection which presents as painless pearly white umbilicated lesions over the skin anywhere in the body.
  • It commonly presents in children.
  • In immunosuppressed individuals, it can occur in adults and spreads by shaving and minor trauma. It is sexually transmitted, if it is present in genital region.
  • Treatment is removal of lesions by needling or radiocautery after using topical anaesthesia.
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Herpes genitalis

It is similar to herpes labialis, which presents in genital region and is sexually transmitted. It can be recurrent and sexual abstinence is advised during active lesions. Take the prescribed medications for faster clearance and to prevent recurrence. It is a mild self limiting disorder with not many complications.

SCABIES

  • It presents as severe itching usually in the night associated with skin lesions over hands, foot, underarms, abdomen and genital areas.
  • It spreads from person to person. Treatment should be done for all the family members. Bedspread and other clothes should be washed and dried.
  • Apply the prescribed medication properly. It takes 2 to 3 weeks to clear.

VITILIGO

  • It presents as milky white patches on skin due to focal failure of pigmentation caused by destruction of pigment producing cells. It can occur at any age.
  • It occurs in 1 to 2% of population. Exact cause is not known. It does not have definite pattern of inheritance and is non-infectious.
  • Treatment is done for cosmetic reasons and social stigma regarding the disease. There are no major complications due to the disease.
  • Treatment is long term and may take months to years. The course of the disease is unpredictable.
  • It can be localised to 1 or 2 patches and responds well to treatment. In few, it has a relapsing and remitting course. Treatment modalities include phototherapy and surgical for stable disease.

DPN&SKIN TAGS

  • It is painless small outgrowths of skin mainly over face, neck and chest.
  • It can occur in other areas also.
  • Treatment is done for cosmetic reasons and does not cause any harm.
  • Radiocautery is the mainstay of treatment. It completely clears without much scarring.
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CORN AND CALLUSES


It is localised thickening of plantar skin of foot due to constant pressure over the area by use of tight and improper footwear. Treatment is surgical excision. Prevention is by using soft footwear and shoes with soft padding.

MELASMA

  • It is a butterfly shaped hyperpigmentation of face.
  • It can be superficial or deep. Exact cause is not known. Many factors are implicated such as hormonal changes in pregnancy, sunlight, smoking etc.
  • Treatment is aimed at clearance of lesion by topical creams and chemical peeling. Proper follow-up is required for maintenance creams as it is a long term disorder.
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FISSURE FOOT

  • It is a common disorder characterized by pain and fissuring of foot.
  • It increases during winter season. If it is very extensive, it could be plantar psoriasis which needs different treatment modalities.
  • Treatment is done by application of the prescribed cream in the morning continuously and night ointment for short period till lesion is cleared.
  • The night ointment is applied after immersing the foot in lukewarm salt water for 5 minutes.
  • The foot is then pat dried and covered with a plastic cover, and wear socks over it to prevent soiling of clothes and better penetration of ointment.
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KERATOSIS PILARIS

  • It is a genetic disorder and runs in families.
  • It can be mild and presents as multiple small pin head sized lesion with nut-meg crater localised to arms or it can be generalised spreading over back, shoulders, chest and buttocks.
  • Treatment is lifelong application of prescribed topical medications.

LICHEN PLANUS

  • It presents as severe itching associated with eruption of red to purple skin lesions.
  • It is common in middle aged and exact cause is not known.
  • Various factors implicated are autoimmune, dental filling, viral hepatitis etc.
  • It usually lasts for 1 to 2 years with remissions and exacerbations and completely clears in most of them leaving behind hyperpigmented patches.
  • It does not spread from person to person.
  • It can affect skin, scalp, nail and oral mucosa. Treatment is aimed at controlling itching by medications.
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AMYLOIDOSIS


It presents as hyperpigmented patch over back, neck, arms, forearms and legs associated with mild itching. It occurs due to deposition of substance called amyloid in the skin. It can be due to constant friction of the skin by using stone or scrub while bathing. It is a disease of middle aged. Treatment is aimed at controlling itching and reduction of pigmentation by various treatment modalities.