Skin Diseases

Acne & Acne Scars

Acne (pimples) over the face and back is a condition that is more common in the age group of 15-30 years. It is a multifactorial disease. It could be due to genetic predisposition, excess sebum production, blockage of pilosebaceous units, hormonal imbalances (PCOD, etc), frictional causes, cosmetics, and various drugs like steroids. Bacterial colonization & few aggravating factors like skim milk, junk foods, sunlight, pregnancy, headband, etc.

Treatment of Acne :

The management of acne includes evaluating the underlying cause and grading acne according to its severity.

Medical Treatments Include antibiotics (oral & topical), retinoids, and hormonal therapies(OC Pills, etc).

Conservative Treatments include avoidance of junk foods (low glycemic diet), skim milk, sun protection, cosmetics, etc.

Procedural Treatments include chemical peel like salicylic acid, black peel, glycolic acid, etc, Intralesional steroids, and light & laser therapy.

Fungal Infection

Fungal infection cases have risen dramatically in recent years. It can involve the skin, hair, nails, and other deeper organs. In India, the most common type is the superficial fungal infection, involving the groins, buttocks, abdomen, face, etc. This type, medically known as tinea, presents with reddish, itchy ring-like patches on these areas. When nails are affected, they become discolored eg yellowish, thick, and have subungual debris. And delay in treatment causes it to spread to other areas as well to other family members of the affected. Treatment is individualized as per the extent, age, weight, and presence of other comorbidities.

Do’s :

Seek a qualified Dermatologist consultation at the earliest.
Keep your towels and clothing separate. (Avoid sharing)
Wear loose-fitting clothing, especially in warm humid climates or seasons.
Cotton fabric in contact with the skin.
Maintain genital hygiene. Keep the genitalia clean and dry.
Keep the nails trimmed and clean.
Follow up as advised by the Dermatologist.
Complete the course as advised by the dermatologist, even if you get better before.

Don’ts:

Don’t buy tubes/tablets on the advice of some chemist/quack. It will only add the cost of the treatment without giving you a cure. Besides your body will be exposed to unnecessary medicines and may not respond well to the correct dosages etc. in the future.
Don’t buy any cream containing steroids.
Don’t share your face towels etc.
Avoid scratching the lesions.
Avoid wearing wet clothing.
Don’t delay a Dermatologist consultation.
Don’t stop the treatment on your own.

Eczema

Eczema is a common skin condition. Various exogenous sources responsible for causing eczema are irritant chemicals, sunlight, cosmetic products, hair dye, detergents, soaps, etc. While sometimes internal factors like atopy, systemic diseases, and seborrhea could be responsible for giving rise to endogenous eczema. The most common types seen in daily clinical practice are atopic dermatitis in children and hand and foot eczemas in adults. It can be classified as an acute, subacute, and chronic disease. Initially, it presents as redness, vesicles, oozing from the lesion with itching over the lesion. Gradually, crusting and scaling increase, and then it develops thick, dry, and rough skin over the affected area. When it heals, it leaves pigmentation which lightens up gradually with time.

Treatment of eczema is sometimes difficult in long-standing cases. It is important to identify the etiological agent and treat it accordingly. Avoidance of the causative agent and generous use of emollients on daily basis can prevent the development of eczema. Various topical medicines like steroids and calcineurin inhibitors and excimer light are being used for eczema. Some severe cases may require systemic therapy.

Skin Allergy

Skin allergy is an allergic reaction to typically harmless substances such as wool, pollen, soap, or plants. These substances are called allergens. Skin allergies (also called allergic contact dermatitis) occur when your skin comes in contact with an allergen that your skin is sensitive to. Allergic skin rashes can have causes that aren’t due to underlying diseases. There is a variety of factors that can cause skin allergy including immune system disorders, medication, and injections when an allergen is responsible for triggering an immune system response then it is an allergic skin condition. Contact dermatitis most common form of skin allergy occurs when the skin reacts to something that it has touched.

Symptoms: may include

Skin rash
Skin redness
Itching

How long does it take to develop an allergy :

It depends from person to person it may take a few hours to days for a skin allergy to develop. With treatment, it takes 2-4 weeks to resolve.

Types of skin allergies :

Contact dermatitis :

Irritant contact dermatitis: Caused by chemicals, Poison Ivy (plant), insect bite.

Allergy contact dermatitis: Caused by air-borne allergy-like Pollen, dust particles, smoke, animal dander, fungal spores, house dust, etc, or contact allergen like metals, jewelry, etc.

Skin allergy can also manifest as hives or swelling of deeper tissues. Skin allergies are not contagious and cannot be spread by touching or close contact. They can be prevented by avoiding the triggering agent.

How to evaluate a patient with skin allergy?

It can be done by doing certain routine investigations like Prick test, Patch test (which has many limitations, Its a hypersensitivity test to an allergen like it’s very cumbersome, a limited number of allergens can be tested), and blood test which is done by ELISA immunoassay. In this IgE antibodies are detected to a variety of food allergens, contact allergens, and inhalant allergens.

Warts

A small, fleshy bump on the skin or mucous membrane caused by the human papillomavirus (HPV). Warts are caused by various strains of human papillomavirus. Warts on different parts of the body are caused by various strain of the human papillomas virus.

Warts are contagious means they spread by skin-to-skin contact from one location on the body to another or from one person to another by contact. Warts are very common. Commonly it is spread by skin-to-skin contact (handshake and hugs).

Warts are usually self-diagnosable. The main symptom is fleshy painless growth on the skin common affected areas are hands, feet, and genitalia. Wart is a small growth with a rough texture that can appear anywhere on the body. The appearance of a Walt depends on its location on the body and the thickness of the skin.

Various treatment modalities are available to treat warts:

Warts can be self-healing. It usually improves over time without treatment. Medical interventions needed to remove words are:

Electrocautery: The base of the wart will be destroyed using an electric needle.
Cryosurgery: The base of what will be destroyed by deep freezing.
Laser surgery: CO2 laser ablation, this procedure utilizes an intense beam of light(laser) to burn and destroy wart tissue. This is a highly effective method in case of recurrent/recalcitrant common wart/ palmar warts/ genital warts.

Medications helpful in the treatment of warts:

Topical medication like salicylic acid and lactic acid solution, keratolytic like urea 40%, and Imiquimod 5% can be helpful.
Oral zinc and levamisole have been tried and found to be effective in some patients.
Intralesional injection of MMR and BCG vaccine in Warts shows promising results.

Corns

Corn and Callus are common skin lesions in which there is a localized area of hard and thickened skin. They are usually caused by areas where there is constant friction or pressure.

They usually occur on the palm and soles, and knuckles. The area of the soles where there is the pressure during walking especially in those who walk barefoot or in those who wear tight-fitting footwear gradually become thickened. Similarly in hands of those who are in a profession like writing or players, because of holding of the racket, the area under pressure becomes thicker.

Management of corns and calluses :

Apply keratolytic creams or lotion containing urea, lactic acid, and salicylic acid.
Pare the thickened area.
if corns and calluses are not responding to topical measures then CO2 laser ablation and electric cautery can be done.

These are highly effective in the management of corn and callus.

Herpes Zoster

It causes a painful rash that may appear as a strip of vesiculobullous lesions that does not cross the midline(unilateral). Pain can persist even after the rash is gone (This is called post Herpetic neuralgia). It typically presents with pain described as burning or stabbing, followed by a vesicular rash in the affected dermatome, Presence of symptoms/lesions depends upon the nerve which is affected. The diagnosis is usually clinically made such as dermatomal pain and eruption of grouped vesicles in the same dermatome. Confirmation can be done using the polymerase chain reaction(PCR) method. Treatment is primarily to reduce neurologic pain & viral replication using antiviral medication such as acyclovir/valaciclovir.

Antiviral therapy usually at the start of lesions (within 48 hours) effectively reduces the severity of postherpetic neuralgia. The early start of antiviral therapy is particularly important in Herpes Zoster Opthalimicus (HZO) in immunocompromised/old age.
Herpes zoster is caused by reactivation of varicella-zoster virus (VZV) that was acquired during primary varicella infection( Chickenpox or due to vaccination) and is characterized by dermatomal pain (pain limited to one side) and papular rash. The pain typically precedes the rash by several days and can persist for weeks to months after the rash resolves.

Lichen Planus

It is an inflammatory condition of the skin and mucous membranes. It is an autoimmune disease. It occurs when our immune system mistakenly attacks cells of the skin and mucous members. It is not known why this type of immune response occurs. Several contributing factors play a role in the development of lichen planus.

Potential causes include :

Viral infection
Allergy
Stress
Genetics

sometimes in association with other autoimmune disorders. It does not spread by skin-to-skin contact. Some variety of lichen planus can be serious and painful. Itchy purplish skin-colored lesions, which are plane topped can appear on the skin. Bumps may appear in clusters or lines. These lesions tend to develop and spread over the body over several weeks or a few months. Lichen planus can also involve the mucous membrane of the mouth and genital area where it forms lacy white patches sometimes with painful ulcers. Less commonly lichen planus also involves Nails and scalp.

Causes and risk factors:

Its cause is unknown, but it can occur to anyone at any age. There are certain contributory factors like family history of lichen planus, having a viable disease like Hepatitis-C, and exposure to certain antibiotics, Gold, Arsenic, Dyes, and Iodide compounds. Diagnosis can easily be made by clinically a dermatologist. In case of doubt, a Skin Biopsy can be performed.

Treatment :

Mild cases usually take weeks to months with or without treatment. Medications helpful in lichen planus are as follows:
Corticosteroids can be given topical, oral, or given as Intralesional injection.
The main aim is to reduce inflammation and itching.
Immune modulator like Tacrolimus, Vitamin-D, Vitamin-E can be beneficial.
NBUVB light therapy, Excimer 308 mm has shown excellent results in the treatment and prevention of recurrences.

Xanthelasma

Xanthelasma is a white or yellowish lesion that is present on the eyelids. The upper eyelids are more commonly involved than the lower eyelid. Though the lesions are asymptomatic and do not disturb the patient physically, they can cause cosmetic disfigurement. They are caused by the deposition of cholesterol under the skin. Your treating dermatologist will ask you to get your lipid profile done to avoid the reoccurrence of xanthelasma because of hyperlipidemia.

Treatment of xanthelasma: A variety of modalities are available to treat xanthelasma.

Trichloroacetic acid can be applied to the lesions.
CO2 laser – The lesions of xanthelasma can be very effectively treated by CO2 laser ablation.
Electrocautery and Surgical excision: Both are also effective in treating xanthelasma.

Rosacea

A condition that causes redness and often small red pus-filled bumps on the face. The main symptoms of acne rosacea are facial redness with small red bumps and small visible blood vessels. It is very common in India and worldwide.

What is the main cause of triggers of Rosacea?

The main triggers of rosacea are sunlight heat, stress, alcohol, spicy food, and hair sprays are the factors which cause rosacea.

Early signs & symptoms of rosacea:-

Facial redness: Rosacea usually causes a persistent redness in the central part of the face with swollen red bumps. This also develops pimples on the face that resemble acne.

The exact cause of this is still unknown and there is no cure. The best way to treat rosacea is symptomatic which will minimize its symptoms. One will experience symptoms for weeks or months at a tune, the symptoms will go away and then return.

What are the types of rosacea?

Erythematotelangiectatic rosacea: characterized by persistent redness face.
Papulopustular rosacea: Characterized by pimples/pus-like lesions on the Central part of the face.
Phymatos rosacea: Advanced stage in which patient develops fibrosis like large bulbous red nose(rhinophyma).
Ocular rosacea: Involvement of eye in the rosacea dryness or puffy eyes.

Treatment of Rosacea:-

Treatment depends upon the severity of Rosacea. Various antibodies or anti-acne medication can control and reduce symptoms if left untreated it tends to worsen over time.
Home remedies, self-care, and sun protection by applying sunblock moisturizer hydrates and protect skin from damage. Artificial tears moisten eyes to provide soothing relief.

Medications :

Oral antibiotics like doxycycline, and Minocycline are effective.
Topical antibiotics such as azithromycin, clindamycin, and metronidazole.
Vitamin-A derivatives by unplugging blocked hair follicles prevent new lesions to develop.
Topical azelaic acid and topical acne medication are also effective.
Brimonidine gel is effective in reducing flushing and redness.

Scabies

Scabies is a highly itchy skin conditions caused by a tiny mite (Sarcoptes scabiei). It is highly contagious and spreads rapidly in family and contacts. It is very common in hostels where many people are together (because of sharing belongings and washing clothes together).

The major symptom is itching which is worse at night. The most common sites of itching are between the fingers, armpits, inside of wrists, breast, abdomen, thighs, genital area( scrotum & penis in males must be explained for modules), and buttocks.

Scabies may occur even after two months of coming in contact with the patient of scabies. It is an infestation and not an infection.

The most common lesions that can be seen are papular, nodular or scratch marks caused by intense itching.

Family history must be taken while evaluating a patient with scabies and all family members must be treated simultaneously to prevent a recurrence.

Management of Scabies :

Treatment of the contacts is a must to prevent a recurrence.
Proper hygiene should be maintained.
All the clothes must be washed properly and ironed especially inside out.
Consult a dermatologist for proper treatment.

Seborrheic

Also Known as Senile warts. A benign skin condition that appears as a waxy brown, black, or tan growth. It is one of the most common non-cancerous skin growth in older adults. It is frequently seen as multiple growths on the face, upper back, hands, chest, and shoulder, with advancing age it increases in number. It has a waxy, scaly & slightly elevated appearance.

Although benign, in some cases causes irritation & cosmetic concern to the person.

Treatment :

Consists of interventions like

Light electrofulguration : by doing light elctrofulguration. It can be removed without scar and the chances of recurrence are less.

CO2 laser ablation: highly effective in removing seborrheic keratosis without any residual mark.

Cryosurgery: using liquid nitrogen can be done for the treatment of DPN.

Curettage: the scrapping of the skin followed by light electrofulguration or CO2 laser ablation to prevent a recurrence.

Urticaria Treatment

Itchy evanescent wheels, surrounded by a red halo or flare and sometimes also associated with stinging, burning, or prickling sensations are characteristic features of urticaria. Angioedema i.e. subcutaneous swellings around the eyes, and lips may accompany the wheals. Mostly, wheals disappear within 24 hours but new lesions keep appearing for a few days.
- Various factors like food allergy, drugs, infections, vaccines, parasites, physical stimuli like heat, cold, and vibration, and emotional stimuli can cause urticaria. It can be autoimmune or idiopathic also. Acute urticaria resolves within 6 weeks while lesions in chronic urticaria are recurrent beyond 6 weeks.
- Management:- Urticaria is a treatable disease. Avoiding the stimulus if known can itself prevent the recurrence. H1 Antihistamines are the mainstay of treatment. Soothing agents like calamine and menthol can be used topically for local discomfort. Oral antibiotics, steroids, ASST therapy, and various immunosuppressive drugs are used depending on the etiology causing the disease.

Keloid

Few skin injuries heal by overgrowth of tissue. This overgrowth of tissue can lead to Keloid formation. Keloids can form after any trauma to the skin like burns, earlobe piercing, acne lesions, and secondary infections. Some people are generally prone to develop Keloids. Imbalance in collagen production & degradation is also responsible for Keloid formation.

Mostly, they are asymptomatic but sometimes they can give rise to pain, Itching, and burning sensation. They can be a continuous source of embarrassment especially if it is on uncovered areas. They are commonly seen over the shoulders, chest & earlobes. They are not cancerous & grow very slowly.

Treatments

Intralesional injections are an effective and safe modality. They are used repeatedly at an interval of 2-3 weeks till it regresses.
Cryotherapy, Excision along with intralesional injection are other modalities with good responses.
In compression therapy, silicone gel sheets are add-ones to present recurrence.

Psoriasis

Psoriasis is an autoimmune disease seen in all age groups and males as well as females. It presents as salmon pink thick scaly hyperkeratotic plaques and is seen on any body part including the scalp, nails, joints as well as genitals. The plaques in psoriasis are mostly not itchy, but sometimes itching or pain can be seen. The most common type of psoriasis is chronic plaque psoriasis.

The course and progression of the disease are unpredictable. Various factors are supposed to be responsible for causing this disease

Genetics like HLA Cw6. HLA B27
Drugs like β-blockers, lithium, antimalarials et
Infections like streptococcus
Stress

It is important to differentiate psoriasis from seborrheic dermatitis, eczema, pityriasis rosea, lichen planus, and many others. A skin biopsy may be required.

There are many treatment options for Psoriasis. Most commonly used are either topical agents like potent steroids, calcineurin inhibitors, topical keratolytic and vitamin D analogs, or systemic agents like methotrexate and cyclosporine. NB-UVB is also effective esp in cases where either it’s difficult to give medicines or the patient is not willing to take medicines. Newer therapies like biological agents and JAK-STAT inhibitors have further increased the cure rates in Psoriasis.

Ingrowing Toe Nails

An Ingrown toenail also known as onychocryptosis is a painful condition, most commonly seen in the great toenail. It happens when the sides or corners of toenails grow into the skin on the side.

Factors responsible for ingrown toenail :

Excessive cutting/trimming of nails on sides.
Fungal infection of the nail.
Wearing tight shoes & high heels for long hours.
An injury is like a sports injury/accident.
It commonly leads to painful, swollen nail folds, sometimes pus & Oozing can also be there.

Treatment:

It is prevented by avoiding excessive cutting of nails & wearing open shoes.
Antibiotics & then surgical removal of the affected side of the nail plate is a good treatment.

Molluscum Contagiosum

Molluscum Contagiosum is a viral infection that causes benign, raised lesions or growth on the skin.

The growths are white, pink, or skin-colored. They are smooth and firm with central dimpling. They Can occur on any part of the body.

They are contagious, i.e., they can spread from person to person by touching or sharing personal

Belongings: –

Avoid sexual contact with your partner if you have lesions on or hear genitalia

Treatment includes interventions like:-

Needle Extraction and curettage.
Currettage followed by light electrofulguration
CO₂ laser ablation
Cryotherapy using liquid Nitrogen

Tinea

Tinea is one of the most common superficial fungal infections. It is commonly seen on the lower abdomen, back, thighs, groin area, and buttocks in adults. While in children, the most common site to get involved is hair. The lesions in tinea are typically erythematous, round, circular, and scaly and hence the name ringworm.

Various other diseases which can resemble tinea are nummular eczema, psoriasis, seborrheic dermatitis, and pityriasis rosea. In the current era of antibiotic resistance, it has become very difficult to treat tinea. Also, patients presenting with the intake of wrong medicines like steroids and various over-the-counter preparations, present with an extensive disease that is even more difficult to treat. Antifungals form the ideal modality of treatment. Dose, duration, and type of antifungal depend on the age, an area involved, and other comorbidities. A long duration of treatment with good compliance as well as taking care of the source and maintaining adequate hygiene is very important.

Ear Lobe Repair

Ear lobe piercing is a common cultural practice seen in India. Complete or partial tears are commonly seen…

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Mole

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Melasma

Melasma is also referred to as blemishes by common people.
It is a skin condition characterized by brownish spots or pigmentation on the face.
Usually involves cheeks, nose & forehead
It can occur in both males & females but is more common in females.

Predisposing Factors

Sunlight ( UV exposure)
Pregnancy
Drugs – Birth control pills (Oral Contraceptive Pills )
Antiepileptics
Retinoids
Stress
Thyroid disorder
LED Lights
Perfumes & Scented Cosmetics

Don’ts

Avoid sun exposure
Do not sit prolonged in front of laptops & televisions (Led Lights)
Don’t use over the counter products as they may contain steroids which may further worsen the condition

Pityriasis Versicolor

Pityriasis Versicolor or Tinea Versicolor is a fungal infection that causes hypopigmented (mostly) or sometimes hyperpigmented patches on the skin. The most common sites involved are the chest, upper back, shoulder, upper arm, and face. The lesions are usually asymptomatic.

The predisposing factor or who are at more risk of developing pityriasis Versicolor :

Those living in warm, moist areas are more likely to develop the condition.
Those who sweat profusely.
Teenagers are more commonly affected.
Those with weakened immune systems.
This disease is not contagious. It does not spread from person to person.

Treatment of Pityriasis Versicolor :

To avoid a warm and moist environment.
Avoid wearing tight-fitted clothes. Use cotton loosely fitted clothes.
Topical antifungals.
Oral antifungals.
Antifungals soaps.

Some people have apprehensive that it is vitiligo, but it can be made clear using a wood lamp examination.

Razor Bumps

Razor bumps are inflammation of the skin around the hair
It is also old as pseudofolliculitis
It can occur post shaving, waxing, threading, and plucking of hair

The symptoms can be

Pain
Small red bumps
Pus filled lumps, pustules
Itching, redness
Pigmentation
It usually affects the face, axilla, pubic area

Measures to follow to avoid razor bumps:-

Hydrate your skin before shaving
Use sharp razor
Don’t shave in the directions opposite to that of the hair
Moisturize the skin after a shave
If you have razor bumps, then avoid shaving for 3-4 weeks
Avoid pulling skin while shaving