Do I have steroid induced acne?

Q. For the last 20 years I have been getting a seasonal facial skin allergy, which was treated by local steroid creams. I am now 42 years old, hypothyroid (controlled) and for the last 6 months have a persistent rash, which looks like small mosquito bites. I have been prescribed steroid creams and on stoppage I develop acne all over the face. I have also been prescribed Elidel as my condition was diagnosed as steroid induced acne but didn’t help much. Now I have been told to take oral steroids and am very worried whether or not I should go for it. Please advice.

A. You have a condition called Rosacea. Please read below for further information and knowledge. Rosacea is a common but little-known disorder of the facial skin. In fact, while rosacea is becoming increasingly widespread as the populous baby boom generation enters the most susceptible ages, a survey found that many have no knowledge of this condition, including how to recognize it and what to do about it.

Because of its red-faced, acne-like effects on personal appearance, it can cause significant psychological, social and occupational problems if left untreated. While the cause of rosacea is unknown and there is no cure, today medical help is available that can control the signs and symptoms of this potentially life-disruptive disorder. Any one of the following warning signs is a signal to see a dermatologist or other knowledgeable physician for diagnosis and appropriate treatment before the signs and symptoms become increasingly severe:

- Redness on the cheeks, nose, chin or forehead.

- Small visible blood vessels on the face.

- Bumps or pimples on the face.

- Watery or irritated eyes.

Because the signs and symptoms of rosacea vary from one patient to another, treatment must be tailored by a physician for each individual case. Various oral and topical medications may be prescribed to treat the bumps, pimples and redness often associated with the disorder. Dermatologists usually prescribe initial treatment with oral antibiotics and topical therapy to bring the condition under immediate control, followed by long-term use of the topical therapy alone to maintain remission.

When appropriate, treatments with lasers, intense pulsed light sources or other medical and surgical devices may be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose. Rosacea affecting the eyes may be treated with oral antibiotics and other therapy.

Skin Care

Patients should check with their physicians to ensure their skin-care routine is compatible with their rosacea. A gentle skin-care routine can also help control rosacea. Patients are advised to clean their face with a mild and non-abrasive cleanser, then rinse with lukewarm water and blot the face dry with a thick cotton towel. Never pull, tug or use a rough washcloth.

Patients may apply non-irritating skin-care products as needed, and are advised to protect the skin from sun exposure using a sunscreen with an SPF of 15 or higher.

Cosmetics may be used to conceal the effects of rosacea. Green makeup or green-tinted foundations can be used to counter redness. This can be followed by a skin-tone foundation with natural yellow tones, avoiding those with pink or orange hues.

Lifestyle Management

In addition to medical treatment, rosacea sufferers can improve their chances of maintaining remission by identifying and avoiding lifestyle and environmental factors that trigger rosacea flare-ups or aggravate their individual conditions.

Kindly consult your dermatologist for further help.

Answered by
Prof. Jayakar Thomas
Senior Consultant Dermatologist
Kanchi Kamakoti Childs Trust Hospital
Chennai

Why do I get pimples on my face after I shave?

Q. I am 19 years old and my problem is that whenever I shave (once in two weeks) I get pimples on my face. Earlier, when I had not started shaving I used to get pimples on just my forehead.

A. If you develop pustules over the beard region, after the shave, then they are unlikely to be pimples. In all probability, it is folliculitis due to bacterial infection.

Another condition which is brought about by shaving is pseudofolliculitis. This occurs in those who have curly hair growing in different directions. Shaving with electric razor may help. Otherwise the only way out is to keep a beard and trim it.

Answered by
Dr. Kamlender Singh
Senior Consultant, Dermatology and Venereology,
Sir Ganga Ram Hospital,
New Delhi

How do I get rid of the dark patch on my chin?

Q. I have a dark patch on my chin. It starts to fade away, but as soon as I shave that part, it becomes very dark. What is the treatment?

A. Please try to change your shaving cream /gel /foam. Avoid sun exposure. Use a good sunscreen (SPF>15). Use a Kojic acid cream with mometasone cream at bedtime for the dark spot.

Answered by
Dr. Rishi Parashar
Consultant Dermatologist,
Sir Ganga Ram Hospital,
New Delhi

What is the correct way to shave the underarms?

Q. My daughter is 11 years old and shaves her armpits. Her armpits have become extremely itchy and appear to be swollen a bit. She says the fabric seams on her shirt rubs against her armpits causing irritation. What kind of treatment is there for this? It doesn't appear to be an infection and is more like an irritation.

A. Yes, it does sound like an inflammation. Shaving is one of the most efficient ways to remove hair from the underarms. Whether you use an electric shaver, or a razor, it should be done a few times a week, to keep the stubble from returning.

Here are some useful steps:

-Take a shower or bath to soften the hair and skin.

-Use a moisturising shaving gel or lotion or foam.

-Raise one arm overhead; apply shaving medium.

-Keep the arm raised high, so that the skin is taut. Since underarm hair grows in many directions, its best to shave up, down and side to side all the while looking at what you are doing in the mirror.

-Shave only where there is really visible underarm hair. You don't want to shave further down and get that hair prickly, too. You will just have to keep shaving that area also the next time, which is a pain. Don't shave more hair than necessary.

-If you shave in every direction your armpits will be smoother.

-Rinse razor after each stroke, to remove foam and cut hair strands.

-Rinse underarm to remove all foam.

-Repeat with other armpit.

Also,

- Wait half an hour before using deodorant after shaving your underarms. The chemicals in deodorants and antiperspirants can sting the skin, especially in a sensitive area as the underarm.

-Though it sometimes means daily maintenance, shaving is the easiest way to remove underarm hair.

-Use an electric razor in place of a regular soap and water razor for daily or quick touch ups especially if you are going to wear a sleeveless dress. This will make sure that your underarm skin is clean and smooth and void of any unsightly hairs.

-Underarm hair grows in different directions and in hard to reach areas so it is helpful to pull the skin slightly to make it taut to eliminate natural underarm creases and folds.

Answered by
Prof. Jayakar Thomas
Senior Consultant Dermatologist
Kanchi Kamakoti Childs Trust Hospital
Chennai

Why do I have black spots on my lower lip?

Q. I am a 28 years old male with 2 dark black spots on my lower lip, one in middle and the other on the left side. Earlier I thought that it’s dry skin but if I rub it off now, my lips starts bleeding. I am a non-smoker. What can be the cause and treatment of this problem?

A. Usually, black spots over the lips are due to lentigines or result from some inflammation. In the former the spots are small and round. The post inflammatory hyper pigmentation can be of different shapes and sizes depending upon the primary disorder that caused it. One of the commonly encountered problems causing the latter variety is Fixed Drug Eruption. In this condition, reaction occurs at the same place each time the person takes the same medicine to which he/she is allergic. Thereafter the patch becomes darker than what it was. The culprit medicine has to be identified and then avoided. The drug in question may vary from individual to individual.

Answered by
Dr. Kamlender Singh
Senior Consultant, Dermatology and Venereology,
Sir Ganga Ram Hospital,
New Delhi

Can scalp psoriasis affect other body parts?

Q. I am a 30 years old male suffering from mild scalp psoriasis. It looks more like dandruff than psoriasis. Are there any chances of psoriasis getting shifted to my body? Further, I am planning to go for a liposuction to solve my problem of gynaecomastia (fatty Chest). Will my problem of psoriasis get aggravated after liposuction?

A. Psoriasis can remain localised to an area for a long time and then spread to other areas. When this will happen, cannot be predicted. It usually starts over the scalp, but may begin elsewhere.

The condition from which psoriasis of the scalp has to be differentiated is dandruff (seborrhoeic capitis). Sometimes, the patches of seborrhoeic dermatitis over the body may resemble those of psoriasis. When it is not clinically possible to differentiate between them, some use the name sebopsoriasis to describe the disorder.

Psoriatics do undergo surgery when necessary. However, most of the time there is no adverse complication. Therefore, your surgery should not aggravate your condition, but it cannot be predicted with any certainty. Stress is known to trigger psoriasis in some and surgery is a stressful event.

Answered by
Dr. Kamlender Singh
Senior Consultant, Dermatology and Venereology,
Sir Ganga Ram Hospital,
New Delhi

Why is the skin around my mouth darker?

Q. I am 26 years old and have a skin pigmentation problem. The skin around my mouth is slightly dark and hence gives an unpleasant look to my face. I have shown myself to various doctors and they all suggested different creams to apply. However, my problem is not yet resolved. I have this problem since 4-5 years now. The skin becomes more dark and prominent especially when I get to sleep less. The external creams that I have used so far are Ban a Tan, Melacare and now using Demelan and additionally I have been advised to take Vitamin Tablets. It all started when once I mistakenly applied a hair removal cream on my upper lip to remove hair. I have now given up and want one last solution to this so that this is permanently cured. I am very confused. Please help me out. This problem is causing me embarrassment.

A. Perioral pigmentation could be due to hair removal creams, cosmetic creams (especially anti-wrinkle) or even fluorinated toothpaste. To find out a cause, a detailed work up is required. If you are using them avoid them and apply Aziderm cream (20%) cream in the morning and Demelan cream at night. Take Cap. Evion 400 mg daily. Generally, if you avoid precipitating factors, your problem can be solved.

Answered by
Dr. D.M. Thappa
Associate Professor and Head, Department of Dermatology and STD,
JIPMER,
Pondicherri