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

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