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

Why does my mother have white patches on her legs?

Q. My 64 years old mother is having skin discoloration in her fore legs, without any itching. The doctor asked her to apply Placentrex gel after bath and take two Kodna tabs daily. However, the doctor asked her to stop taking the medicines due to her age. The problem has re-appeared afterwards. She is patient of angina pectoris for a decade and has been taking medicines for the same. Are the white patches on her legs due to some allergy to the medicines or any other infection? Or is it because of some deficiency?

A. Hypopigmented patches over the legs can be seen in a number of conditions. These are sometimes seen when an inflammatory condition of the skin subsides. Hypopigmented patches, which also have impaired sensations, are encountered in leprosy. Completely depigmented patches which are milky white are seen in leukoderma / Vitiligo, guttate hypomelanosis and lichen sclerosis et atrophicus. In children one also has to consider some congenital disorders. Treatment for leprosy should not be refused. For others one may or may not take treatment.

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

How can I get rid of itchy red rashes in the pubic area?

Q. I am a 48 years old female. I shaved my pubic hair 5 months back and developed small red and itchy bumps in the pubic area, within an hour of shaving. A few days later, the bumps turned into big knots, they kept recurring on the pubic area and have now left big red rashes there. It itches a lot and worsens with scratching. What can this be?

A. The possible consequences of shaving of pubic hair are itching, razor burns, nicks, cuts, bumps, blisters/pimples, genital infections, ingrown hair and folliculitis- an infection in the hair follicle usually caused by the bacteria, staphylococcus (staph) or a fungus. A common cause of folliculitis is recently shaved hairs re-growing out of the follicle and curling back around to irritate the skin.

What you currently have is probably Folliculitis, for which a topical over-the-counter antibiotic will work, such as sisomycin, or mupirocin. If you have already any of the above problems, there are general treatment procedures to help.

Itching/irritation: Apply 1 percent hydrocortisone two or three times per day. Avoid shaving for two months.

Razor burn: Use aloe vera to soothe sensitive skin and help alleviate the pain.

Bumps: Take a warm bath, and see your doctor if the bumps don't clear up after one week.

Blisters/pimples: As long as they're not painful and don't bother you, there's no problem. Keep them clean and dry, and do not pick them.

Ingrown hair: Do not pick at them as this could cause infection. To prevent ingrown hairs, shave downward with the angle of the hair, or clip hairs instead of shaving. Also, some creams can help exfoliate the skin and relieve ingrown hairs. Check with your doctor about these topical treatments.

Please remember that these treatments are simply recommendations and are not a diagnosis of any condition. If the symptoms don't clear up, I strongly recommend you consult your doctor.

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

What is the cause for spots on various parts of my body?

Q. I have small pimples on my penis. These are increasing in number. I can also see hair coming out of these boils / pimples. There is no pain or itching. Also, there are small spots under my gums and on the upper side of my lips. What is my problem?

A. What you have is a condition called Fordyce spots.

Fordyce spots are small (1-5 mm), slightly elevated yellowish or white papules or spots that can appear on the glans or shaft of the penis, labia of the female, inside of the cheeks and on the lips. Fordyce spots are a variant of sebaceous glands (the glands that normally produce sebum and are usually found within hair follicles). Fordyce spots are sebaceous glands without hair follicles. They are present in 80-95% of adults. They are probably present at birth but become bigger and more visible from about puberty onwards. They may occur as a solitary lesion or more frequently in crops of about 50-100.

Fordyce spots cause anxiety but they are completely harmless whether on the lips or on the genitals. They are not a sexually transmitted disease and they are not infectious.

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

What causes scleroderma?

Q. My 21 years old son has been diagnosed with scleroderma. Why did he develop this disease? On doctor’s prescription, he is taking Trental (400 mg) for blood circulation three times a day, Azoran (50 mg) one tablet at night and Glacex one tablet for joint pain. Do these medicines have side effects? For how long does he need to take these medicines?

A. Unfortunately, the real cause of scleroderma (systemic sclerosis) has not been found out yet. Hence, the treatment is mainly symptomatic i.e. dealing with symptoms for as long as it is necessary. Hence, it is not possible to put a time frame. Trental (pentoxiphylline) is actually indicated in peripheral vascular diseases to increase blood supply. Azoran (azathioprine) is immunosuppressant and is normally meant for prevention of rejection of transplanted organs (such as kidneys) but is also given in other disorders where there is possibility of immunological problem. Like most other medicines, both do have side effects but one has to weigh the benefits against side effects.

Answered by
Dr. Chandra M. Gulhati
Editor,
MIMS,
New Delhi

How can white patches be treated?

Q. I am a 28 years old man who developed white patches on both the legs. I have got the white patch first on the left leg during some fungal infection and itching, then it became bigger and after that it has started expanding to another 3-4 places, where there was no fungal infection but some itching was there. Please note that my two cousins are also having these patches on there complete body and when they applied the treatment, they got opposite results from medicines. Please suggest me a suitable treatment.

A. White patches are seen in a number of conditions. Maybe you have vitiligo. However this needs to be confirmed by a dermatologist. Vitiligo can occur at any age, is non-infectious, and does not affect the physical health of the person. It is purely a cosmetic problem, which can cause serious psychological and emotional problems. In some individuals it spreads for a short time and then may remain quiescent for a long time before activating again. How many times this will happen cannot be predicted. In some it spreads very rapidly and may cover large areas. Treatment response is variable. Few people may not respond at all while some may show a very slow and partial response. Psoralens form the mainstay of the treatment. Other drugs include steroids, immunomodulators, immunosuppressives, extract from placenta, etc. Lack of response may mean either the dose is inadequate or another medicine is required. Actual combination of drugs and their dosage will vary from person to person.

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

Is there a permanent cure for sebaceous cysts?

Q. I am a 32 years old man having sebaceous glands from many years. Can they be cured permanently?

A. Each hair follicle has a sebaceous gland, which produces sebum (the oil of the skin). These cannot be removed. It seems you have got the name wrong for some disorder. Probably you are referring to sebaceous cyst. There is no medicine to cure it. However it can be removed surgically and should be done before it gets infected otherwise the results may not be good.

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

How do I deal with hyperpigmentation?

Q. I am a 47 years old lady suffering from hyper pigmentation on my forehead, both the arms, back of my neck, and the area below my knees since the last 15 years. I also suffer from eczema on my feet. My doctor has prescribed me Evion capsules 400 mg daily, Omnacoril tablet once a day, and asked me to avoid sun exposure. But the fact is that I don’t go out in the sun at all and also use Melalite cream on the pigmented areas but there is only a very slight improvement . My doc says it is a hormonal problem and thus cannot be treated by medicines. Please help me with your kind opinion. Also I am a strict vegetarian and thus cannot take Evion capsule as it is made up of gelatin (which is an animal product), could you please suggest me some other alternative for vitamin E tablet?

A. It appears that you are suffering from Melasma (also called Chloasma, or Mask of Pregnancy ) which generally appears during pregnancy, disappears in due course in most patients but persists in others for months and years. It is more common among patients of thyroid disease. Unfortunately except avoiding sun light (so that it does not become worse), there is no known, proven efficacious drug treatment. Creams containing tretinoin, kojic acid and azelaic acid have been shown to improve the condition to varying extents. Occasionally, chemical peels or topical steroid creams are found to be useful in reducing the pigment. In severe cases, laser treatments can be used to remove the dark pigment. However where the pigment is deep into dermis (in some cases it is in epidermis only), the effect is not satisfactory. It is not due to deficiency of vitamin E. In any case daily requirement of vitamin E is less than 15 mg which is available from normal diet while commercial supplements such as Evion contain 100 mg or more. Excessive intake can lead to side effects. Omnacortil is a steroid and is not proven to be efficacious in melasma when taken by mouth. It may cause serious adverse effects including weight gain, high blood pressure diabetes etc. It is good that you have discontinued antipsychotics.

Answered by
Dr. Chandra M. Gulhati
Editor,
MIMS,
New Delhi

How to take care of severe hair loss?

Q. I am suffering from severe hair fall. I have lost 20-30% of my hair. I don't want to lose my hair further. My skin is dry and after using Mintop it is becoming even drier and I am losing more hair than earlier. Will you suggest continuing this or should I start any other medication?

A. Hair loss occurs in a number of different conditions. Andorgenetic alopecia (common baldness) can begin as early as 17 or 18 years of age, when the male hormone begins to be formed in significant amounts. Minoxidil lotion is effective in this kind of baldness as it counters the effect of the male hormone at the level of the roots of hair. Therefore it will be obvious to you that Minoxidil has practically no role in other forms of baldness. Now what is good for you will depend upon the disorder you have.

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

Why does my scar pain on touching it?

Q. I am a 28 years old male. Last year I was operated for Hernia on the right side. For the last 15 days, I am experiencing severe pain on the scar tissue (the operation cut). My abdomen also pains when I touch the scar. What can this be due to?

A. Your skin has become a little sensitive. This is an aberrant behaviour of scar tissue, and it is probably best to tolerate this for a few months. If you have no benefit, consult a skin specialist. Skin specialists often have some creams that can help.

The only other treatment, I think, is surgical excision of the scar, but this will not give guaranteed results. Therefore, overall you should tolerate this discomfort for a few more months.

Answered by
Dr. Suneet Sood
Consultant Surgeon,
Metro Multispecialty Hospital,
NOIDA, UP

What are the side-effects of hair transplantation?

Q. I am a 22 years old male suffering from seborrhoeic dermatitis on my scalp. Whenever I try to remove flakes from my hair, a bunch of hair comes out along with it. I apply mintop lotion 5% daily twice a day and take finpecia daily to control my hair fall. I want to go for hair transplantation. How can seborrheic dermatitis adversely affect the transplanted hair? What other side effects can hair transplantation have?

A. Scaling of the scalp could be due to seborrhoeic dermatitis or even psoriasis. Hair transplantation can be done but scalp skin should ideally be normal or near normal. Following can be the side effects of finasteride, however, they are often minor:

- impotence (inability to have or maintain an erection)

- decreased libido (interest in sex)

Some side effects can be serious like changes in the breasts such as lumps, pain, or nipple discharge. If you experience any of these symptoms, call your doctor immediately.

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

Are there any special foods to be taken by a leprosy patient?

Q. I am suffering from leprosy. I am talking the medicines as suggested by my doctor. I want to know what types of food should be taken and avoided?

A. There is no special food for leprosy patients. Take a good balanced diet. Take your medicines regularly and in the proper dose. Also go to the doctor for regular check up.

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

What is the reason behind painful blisters on my lips?

Q. I always find small blisters on my lips. There are random small painful swelling on my lips area too. What is this?

A. In herpes labialis tiny blisters in groups appear on the lips and adjacent areas. The affected area may be slightly swollen. This condition recurs from time to time. You could be suffering from this condition. However, this is a self limiting disorder and the attack normally resolves in about a week, unless the body resistance is very low or if it gets secondarily infected or complicated.

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

What are the latest advancements in vitiligo treatment?

Q. What are the latest advancements in vitiligo treatment?

A. The basic principles and the medicines are the same. To my mind there is nothing new in the last 1-2 years. The various modalities of treatment include psoralins, exposure to UV rays (sunlight, artificial lamps or lasers), extracts from placenta, growth factors, immunomodulators (levamisole, tacrolimus) and immunosuppressives. Surgery can be helpful for some recalcitrant cases.

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

Why do I get red rashes and itchy bumps after shaving armpits?

Q. I am a 21 years old boy. Every time I shave my armpits, I get red rashes and itchy bumps there. The itching increases when I sweat. What is causing all this and how can this be treated?

A. You have a problem each time you shave and not otherwise. If your observation is correct then the cause and effect relationship is obvious. You could be having contact dermatitis to the material used for shaving or friction dermatitis. Clinical examination when you develop the problem should be able to differentiate between the two. Change the shaving material. If it does not solve your problem then consult your dermatologist.

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

Should I go for UV rays therapy for treating psoriasis?

Q. I am a 33 years old Indian, living in Chicago right now. I am suffering from Psoraisis since long. My Indian doctor prescribed me Neotrexate. But, the doctors here in Chicago are asking me to stop that and to go for UV rays treatment instead. What shall I do?

A. Psoriasis is a chronic disease, characterised by exacerbations and remissions. Therefore, one will like to induce remission by minimal medication and preferably by a medicines which have a good safety profile. UV therapy is much safer than methotrexate. I will advise methotrexate only if other modalities like topical ointments, UV therapy etc., either fail to produce the desired result or the patient finds them unacceptable for some reason or the other.

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

Why does my mother get rashes and cuts on her skin?

Q. My mother often gets rashes and the cuts on her feet and hands. This causes lot of itching and sometimes blood oozes out. Is she suffering from some serious ailment?

A. From the scanty description, it appears that your mother probably has subacute to chronic eczema.

Eczemas are inflammations of the skin due to allergic reaction of the body to a foreign substance. Symptomatic relief is given till the culprit is found and eliminated or till it resolves spontaneously on its own.

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

What is the reason for small pimples on shoulders and back?

Q. I am a 30-year-old male from UAE. I have small pimples on the side shoulders, side of my body and back, which keep appearing and disappearing. What is the cause and how can I over-come this issue?

A. At your age, it is likely that it may be truncal acne, miliaria (prickly heat), or drug induced acne-form eruption (due to drugs for asthma). Unless, you consult a dermatologist, your diagnosis cannot be made. Treatment depends on the diagnosis i.e., the problem you have.

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

Can a general surgeon perform skin grafting?

Q. My 12.5 years old son got hurt in the right leg below the ankle just above the heel. His leg was pierced. However, no stitches were given to him and advised to remove the dead tissues. But now he has been advised to under-go skin grafting. A general surgeon is going to perform skin grafting on my son's leg. 1) Can a general surgeon perform skin grafting operation? 2) After the operation can any lumps be formed on the skin ? 3) Can you guide me regarding the pre and post operation phases?

A. The answers to your questions are:

A. yes, a general surgeon can do a grafting, but I think plastic surgeons do it better

B. I don't think any lumps will form

C. There is very little special pre and post operative advice that you require. Your surgeon will tell you all. The surgeon may want some antibiotics started before surgery, and may want to restrict activity after the operation. However, take relevant advice from him.

Answered by
Dr. Suneet Sood
Consultant Surgeon,
Metro Multispecialty Hospital,
NOIDA, UP

What is the best treatment for recurrent acne?

Q. I am 32 years old female. I am getting pimples on my cheeks and they are painful to touch. I wash my face with face wash twice daily. I consulted a dermatologist last month and was given doxylag 100 mg tablet one daily for two weeks, benzoyl peroxide gel and differin gel. Within two weeks of using these medicines my condition was totally cured. In between I applied benzoyl gel 2-3 times and I was fine. But since two days I started getting pimples. Please help.

A. Acne vulgaris (in common language pimples) is a self-limiting disease. The aim of the treatment is to minimize and if possible prevent permanent scarring of face. It takes time for the results to appear. With conventional treatment, it may take as long as 6 months for 60 to 80% improvement. Once the optimum control is achieved, the medicines are gradually tapered till the maintenance therapy is reached. This is continued till the tendency lasts. The patient is periodically followed up to see if the results are as desired and also to see if there are any side effects. In either case the medicine or the dosage may have to be changed. In the vast majority of patients acne subsides by mid twenties. However in recent years, cases are being encountered who have started acne after the age of 25 years. In females who do not respond to treatment or who start later in life, one would like to rule out any underlying hormonal abnormality and other disorders, which may resemble pimples, etc.

Therefore do not panic. Continue treatment as advised by your doctor. In acne, two weeks is a very short time to judge response. I am sure your dermatologist will take appropriate measures in case response is not as expected.

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

Can I get rid of the red spot on my penis?

Q. I am a 37 years old male and have found a red spot on my penis but there is no pain and irritation on the affected area. The red spot appeared after 20-25 days when I returned from Bangkok. I had oral sex with an unknown girl who also gave me a massage. For few days, nothing was there on my penis. I have applied Lobate - GM but it hasn't helped much. How do I treat this red spot?

A. Red spots over the glans penis suggest that you have some kind of inflammation. In a broad sense, one can say you have balanitis. This could be due to fungus candida or due to irritants, etc. These can then get secondarily infected by bacteria. Mouth harbours various kinds of organisms and depending upon the hygiene of the person, some of these can be nasty. Besides, a person could have rinsed the mouth with medicines/chemicals, which are then transferred on to the glans (during oral sex with or without ejaculation) and then cause irritant balanitis. In some individuals, damage to the delicate skin can also be caused by the digestive enzymes present in the saliva. Therefore such activities can never be always free of unwanted eventualities. I suggest that you consult your Dermatologist.

Why do I have boils on my face?

Q. I am a 56 years old man and have got several boils on the face. What is the cure?

A. Boils on face may be nodulocystic acne, furuncles, or sweat gland abscess. Unless exact cause is known, treatment can not be planned.

Why does my husband's skin get cut?

Q. My 34 years old husband feels too much of pain after sex and sometimes the skin also gets cut. Is there any problem?

A. It appears he has phimosis. In this condition the opening of the prepuce is tight. On erection, the diameter of penis increases. As a result of this, during coitus, prepuce cannot slide back easily. When forced there is pain and the prepuce cracks at the margin. This may be since childhood or may result from repeated inflammation. Many a times conservative treatment helps. In others surgery may be required. Consult your Dermatologist.

Why does my sister have burning sensation on her neck?

Q. My sister and mother both have pigmentation/dark marks on their arms and neck for the last 4-5 years. They feel burning sensation in summers and hot weather. They have not consulted any doctor till now. My sister is using aloe vera gel on these marks and there is a slight improvement. Please suggest.

A. If both your mother and sister have burning sensation in the affected areas, then it cannot be simple tanning of the skin. There is some element of a reaction in the skin. It could be photosensitivity leading to both pigmentation and burning. It is likely to be more in summers because (1) the intensity of light in summer is more, and (2) they should shed off as many clothes as is possible to escape heat and hence expose greater areas for longer periods to the light (to act on skin). Once it is established that they have photodermatitis or photomelanosis, then the photosensitizer should be looked for and if possible eliminated. Else one will have to take photoprotective measures.

Is my hair falling due to stress?

Q. I am suffering from a lot of hair fall since last 3 years. I got married in March 2005 and in May 2005 my younger sister passed away and since then my hair started falling. In November 2005, my father-in-law passed away and we had a lot of unhappiness and quarrels in our family and then too my hair fall increased. I got pregnant in June 2006 and during pregnancy the hair fall stopped and they again started falling after delivery. Is it related to stress?

A. The hair growth is cyclical. It grows for some time (anagen phase), and then it dies (catagen phase) and remains in resting phase (telogen phase). The telogen hair comes off with very little traction, e.g, while combing and scrubbing. On the scalp, after a resting phase of 3 months, the dead hair is shed off (if not lost earlier by traction) and a new hair regrows. If all the hair were in the same phase, then at the end of a cycle all hair will be lost and the person will become bald. Subsequently all hair would grow slowly at the same rate and would be of same length. But this is not what happens; the growth of hair is asynchronous. Thus at a given time, one hair may be 1 month old, another 1 year old, another 16 month old and so on. This results in presence of hair over the scalp all the time; but there is continuous loss of about 100 hairs per day. In some individuals, in periods of stress (physical or mental), a large number of hair die prematurely. These are then shed off (in numbers greater than normal) leading to sparse scalp hair. This is called Telogen Effluvium and you seem to have a tendency for it. All these lost hair will come back spontaneously once the stress is over. You may be having some additional problem. Clinical examination maybe along with few investigations will settle the issue.

Why is my skin dry and rough?

Q. I am a 24 years old male having very sensitive skin. I have an acne problem on my back and chest from the past 6 years, which has reduced considerably. The skin on my face, especially above my lips and on the chin and some areas on my cheeks, peels off quite often, a severe form of dryness. I went to a skin specialist and he said I have rosacea. He prescribed Microdox-dt and Clinmiskin, but I found that Clinmiskin did not help much and the skin on my cheeks became rough and reddish, so I used Clindac-A, which was prescribed earlier and that helped. But, if I do not apply it, the skin becomes reddish and rough again, with the severe peeling around my mouth. I have also found that my skin becomes more reddish during the winter season. My nose is very oily. I have tried Cetaphil moisturising cream and a cleansing lotion also. Please advise.

A. Red skin in patches with a dry surface suggests that there is an element of dermatitis. This may be due to a reaction to medicines, allergy to cosmetics, allergy to chemicals in the environment, photodermatitis. Rosacea is usually more common in females and occurs after 35/40 years of age, but can occur at an early age.

What is biofibre hair implantation?

Q. What is bio fibre hair implantation? Can you tell me the name of the clinic doing this? What are the advantages and disadvantages of it? Is it advisable to go in for it? What is the cost of it?

A. Bio-fibre is an artificial fibre which is used to replace hair in an individual who is bald and has poor donor area. It is usually used only in limited cases where there is no donor hair, and is an alternative to Hair Transplant in these cases. Because artificial fibre is used, there is always the chance of infection, rejection and other problems, and this needs care for your entire life. Since the grafts are placed in the scalp and are exposed to dust, dirt, heat and the environment, the possibility of infection is always high. You can look up the Internet and see the website of Bio fibre to get more information.

I would recommend a hair transplantation (HT) in case you have donor hair, for it is a safer and permanent solution with no side-effects. Here is some information about HT, which is done at our clinic by the Follicular Unit Technique. The hair which are transplanted in the bald area

are permanent, do not fall, grow like normal hair and subsequently need hair cuts. You can apply oil or shampoo on them and comb them to your desired style. The operation is done on an out patient basis and the patient goes home immediately after the operation. It takes 4 to 6 hours for one session where approximately 500 plugs (i.e. 2000 hairs) are transplanted.

The charges for my team for transplanting 500 plugs is Rs. 25,000/-(@ Rs. 50/- per plug) plus Nursing Home charges (Rs. 5000/-to 10,000/-) for using the O.T., instruments and medicines. For large areas of baldness, we have transplanted upto 1200 plugs in a sitting in 6 to 7 hours. There are no side effects of hair transplantation. You can see photos of hair transplantation before and after surgery on my website www.cosmeticsurgery-india.com.

Background: The Clinical and Translational Science Awards Consortium

After years of confusion and neglect, translational research is now becoming institutionalized.

Citing the barriers between the lab and clinic, along with the difficulties and complexities of conducting clinical research, the NIH set up a major program to advance clinical and translational research. The Clinical and Translational Science Awards consortium, or CTSA consortium, was launched in October 2006. Its aims are no less than to “catalyze the development of a new discipline of clinical and translational science.”

The CTSA consortium consists of major academic health institutions, like the Mayo Clinic or John Hopkins University, who are given large grants by the NIH. The grants are used to develop centers for translational and clinical research. These centers set up graduate programs and advance research in a variety of ways, including developing partnerships with industry and other private and public institutions. By 2012, 60 institutions will be “linked together to energize the discipline of clinical and translational science.” The NIH is not skimping on this initiative, as it plans on funding the completed program to the tune of $500 million per year.

Although “translational research” is a varied term, the CTSA will mostly focus on research that is relevant to industry. According to an article by Steven H. Woolf in the Journal of the American Medical Association (JAMA), two major areas have been defined, called T1 and T2. T1 is more applicable to industry, as it involves “the transfer of new understandings of disease mechanisms gained in the laboratory into the development of new methods for diagnosis, therapy, and prevention and their first testing in humans.” T2 involves “the translation of results from clinical studies into everyday clinical practice and health decision making.” The CTSA program seems to mainly focus on T1.

Although the CTSA program is young, there have already been examples that show how partnering with CTSA researchers can benefit pharmaceutical companies. One is the Yale Clinical trial network, which should streamline and improve the clinical trials process for the companies that are part of it. Among other goals, the network will remove barriers to clinical trials and promote trial participation. There is also at least one example of a cross licensing agreement between a CTSA funded researcher and industry. Dr. Daniel Rader, at the University of Pennsylvania, took advantage of his university’s CTSA to develop an MTP inhibitor that was very effective in treating a rare disease called familial hypercholesterolemia. Seeing the potential of lower doses of the drug to treat patients at risk of heart disease, Aegerion Pharmaceuticals is developing the drug for this purpose.

CTSA consortium grants work as individualized cooperative agreements between the NIH and the grantee. This means that each CTSA institution will be organized differently. Individual CTSA’s will have varying degrees of openness to participants from industry. However, the ones that are very open to industry participation present extensive opportunities. One example of an industry-friendly CTSA is the Institute of Clinical and Translational Sciences (ICTS) in St. Louis. According to their website, individuals from companies that collaborate with an ICTS-affiliated academic researcher can register for ICTS membership. Benefits of membership include access to research facilities, access to consulting services, and increased potential for further collaboration with ICTS-affiliated academic researchers.

Further information, including a list of all current CTSA institutions, is available at www.ctsaweb.org.

Roche and Genentech’s mating dance

Roche has floated an offer to acquire Genentech, a move which has raised a flurry of questions about the sustainability of the big Pharma business model, Genentech’s future independence, and the value of Genentech. It it worth noting, however, that Roche already bought (and sold) Genentech. Using an excerpt from Building Biotechnology to illustrate, Roche pocketed several billion dollars the last time it bought and sold Genentech over a six-week period in 1999:

So, the question must be asked: Despite Roche’s announced plans to include Genentech as an independent research entity, is this transaction simply based on a weak U.S. dollar and an undervalued Genentech? Might they just flip Genentech again?