Skin Question Answer Page

Dr.Hanish Babu's Dermatology Q&A Page

DR.HANISH BABU,MD, CONSULTANT DERMATOLOGIST, CITY MEDICAL CENTRE, AJMAN, UAE

This Page is for YOU! Please do send in your queries about skin disorders. If you do not wish your name be included on the page, do feel free to request for the same.When the answer to your query is posted you will be informed through E mail. You may then visit this page and go through the answer.

Important: Before you send in Your Query , please go through the Q&A posted and make sure your query is not already dealt with. Thank You.

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Q7: AJS,Cananda: Vitiligo:Can this be cured?

Dr.Hanish: Vitiligo is an acquired,usually progressive, loss of pigmentation of obscure cause clinically manifesting as circumscribed white patches on different parts of the body

Vitiligo probably has its origin from latin words'vitelius', meaning vale(pale pink flesh of calf as it resembles the white patches of a spotted calf) or 'vitium',meaning blemish.

Coming to treatment proper, Presently, there is no universally effective medical or surgical modality for vitiligo cure; however, there are a number of active therapeutic approaches that are known to be effective and can provide satisfactory repigmentation in a good number of patients

However, there are certain pointers to poor response to treatment and prognosis of the disease:(1)Early childhood and old age,(2)Patches on the so called resistant sites like fingers,toes,palms, soles,lips,genitalia (collectively known as acrofacial) and skin over joints of extremities,(3)Greater percentage of white hairs on lesions portends poor prognosis,(4) Patches in areas prone to constant friction and contact with chemical bleaches,(5)Individuals with a tendency for emotional lability & high levels of stress,(6)Associated systemic diseases like Diabetes,Autoimmune thyroiditis etc,(7) A hereditory predisposition

Q6: SKJ(@hotmail.com): I am a doctor.I'm suffering from psoriasis for last 8 years and I've tried many medicines and treatments but didn't find anyone effective.Is there any cure available? If yes,please send me its details.I'll be grateful to you if You could help me get rid out of my psoriasis.

Dr.T.Gopinathan: Psoriasis :The treatment for psoriasis may be broadly classified as TOPICAL THERAPIES and SYSTEMIC TREATMENT. Topical medication includes use of corticosteroids of different potencies,Ointments containing tar, salicylic acid etc.which inhibits enzymes that contribute to psoriasis and helps prevent cell proliferation.Tar is often used with ultraviolet B[UVB] phototherapy.Vitamin D3 analogues like Calcipotriene has antiinflammatory properties and is safe and effective,but rather costly in the Indian set up.Topical Retinoids which are Vitamin A derivatives are available abroad which are useful for some forms of psoriasis. Different modalities of drug delivery into the skin are often used , such as use of occlusive tapes along with steroid ointments applied to small areas of the body only.Systemic treatment for psoriasis will depend upon whether there is associated arthritis[psoriatic arthropathy] and for severe incapacitating cases that do not respond to topical or less potent therapies.Generally speaking the primary oral drugs for severe psoriasis are methotrexate and oral retinoids.These drugs are potentially toxic and should be taken under close supervision of a dermatologist. Immunosuppresent drugs like cyclosporine and others have limited use only and not generally or widely used.Phototherapy treatment for difficult cases are ultraviolet B[UVB] or ultraviolet A[UVA]. UVB treatment can be used alone[selecive phototherapy] or along with topical tar or anthralin under supervision.The use of ultraviolet A[UVA] radiation in combination with systemic use of photosensitising drugs like Psoralens is known as PUVA treatment. A number of drugs can worsen psoriasis including antimalarial drug chloroquine, beta blockers and ACE inhibitors used for hypertension, progesterone, lithium,indomethacin etc.

Thus it becomes clear that we have several options for controlling this chronic skin condition although one cannot assure a "cure" with a specific drug.There are periods of remissions , sometimes prologed remissions, and ofcourse relapses.I would recommend a positive attitude for the patient as well as the dermatologist who treats patients with psoriasis.I would strongly suggest to the person who has send this query to consult the local skin specialist and not undertake any of the lines of treatment or drugs mentioned above on his own volition.

For Do's and Don't's of PsoriasisClick Here

Q5: NS, Mumbai, India: I am facing photoprotection problem,I cannot go in the direct sunlight, all my skin becomes red,and also swollen, Presently my doctor has given the medicine of GLAXOCHILE,TUBE (BECLODIPE),but seems to be of no use, Can you suggest me some right kind of medicine, I don't mind getting it from Emirates. Hope you will do the needful!

Dr.Hanish: Solar Urticaria seems to be your problem. Solar Urticaria is a rare disease presenting with development of erythema and wheals within a few minutes of exposure to sunlight.
All the treatment options listed below are available in Mumbai.

Q4: R M D(@skynet.be): I have a boyfriend who has urticaria. He has urticaria for over two years now! We been to a lot of specialists, but no one could help us! We hope that you can give us helpful information!

Dr.T.Gopinathan: Chronic Urticaria or Hives is always a problem with respect to diagnosis of the exact cause as well as the most effective treatment. In all cases of chronic urticaria one should have a thorough general medical examination and look for any focus of infection in the E.N.T, dental and other areas.Any underlying disease has to be treated or controlled. A good history taking often reveals some clue about the cause of the urticaria, for eg.food allergy, dust, mites etc. Infact there are so many causes that it will not be possible to enumerate them all here.Unfortunately, even after a thorough examination, allergy tests, other investigations as indicated one cannot find the exact cause in each and every case.In such cases one has to give symptomatic treatment with antihistamines.The newer antihistamines like Fexofenadine are nonsedating, selective peripheral histamine H1 receptor antagonist and quite effective in controlling the symptoms. In the case under consideration the details of the patient are not given and, therefore, one cannot give more specific advise.

Q3: Dr.E.Krishna Varier,Calicut,India: What is the latest treatment for Icthyosis Vulgaris?

Dr.Hanish: Icthyosis Vulgaris may sound a little exotic to nonmedicos. I f you will excuse me Doctor, I would like to put down a few words about the disease for them.Icthyosis derives its name from the word'icthys' meaning fish and refers to the fish scale like appearance of skin seen in patients with this disease.Icthyosis Vulgaris belongs to a group of hereditory disorders involving faulty cell renewal and maturation of epidermal cell layers, thus compromising the barrier function of skin.Fine,light scales involve primarily the extensor aspects of the extremities and trunk. Flexural surfaces are spared, but palms and soles show diffuse thickening. The disease usually manifests after the first 3 months of life.

Coming to treatment proper,hydration of the skin and removal of scales are the major goals of therapy. This is achieved by using proper combination of emollients and water. New Compounds and new delivery systems(like liposomes) for treating dry skin are already on the way or under development. Dr.Peter Eliyas and his associates in San Francisco brought out their Glylorin which has exhibited surfactant, antimicrobial, antiinflammatory, and antiproliferative properties.Short term treatment with calcipotriol ointment(50 micrograms/g)used in amounts upto 100g/week is moderately efficacious, well tolerated, and safe in adult patients with various icthyoses.Evening primrose seed oil, a rich source of essential fatty acids, was found to have beneficial effects in icthyosis vulgaris. Topical tretinoin and topical 13-cis retinoic acid in lower concentrations, judiciousely used along with emollients,are useful in certain cases.Lactate 12% lotion was found to be more effective than petrolatum based cream in the treatment of icthyosis.Alpha Hydroxyacids(glycolic and lactic acid) exfoliate dead skin cells and moisturize the skin and are safe at concentrations of 10% or less.Other agents used to moisturize the skin are urea,propylene glycol, ammonium lactate,liquid paraffin etc, in addition to the good old vaseline.The patient should be encouraged to use the emollient-hydration programme that is most satisfactory for his conditions.Systemic therapy with retinoids is reserved for severe types of icthyosis refractory to conventional therapy.

Q2:Mr.J,USA: I am asking for my daughter. She is 18 years old now. She had chicken pox 2 years ago. It was very severe. It left a lot of scars on her face and on her neck. We thought the scars will go away, but it still remain. Can you please tell me any kind of medicines that will get rid of the scars?

Dr.Hanish: Chickenpox rarely leaves any permanent scars unless the sores become badly infected with impetigo or your child repeatedly picks off the scabs. However, normal chickenpox can leave temporary marks on the skin that take 6 to 12 months to fade. It is unfortunate that in this age of effective ANTIVIRAL therapies, we should get disfigured for a potentially preventable disease. There are effective vaccines against chicken pox and oral antiviral drugs like acyclovir significantly shortens the duration and magnitude of the disease,accelerates healing and reduces the number of skin lesions and reduces the chances of scarring in healthy youns individuals. Pitted facial scars caused by chickenpox poorly respond to topically applied medication like retinoic acid,alphahydroxyacids etc.A cosmetologist or dermatologist could give your daughter a graded facial peeling with glycolic acid if the scars are superficial. However, the alternatives for deep scars are:dermabrasion(potentially hazardous),punchgrafting,scar revision and laser therapy. Pulsed Er:YAG laser skin resurfacing is an effective and safe treatment for pitted facial scars.

Q1:Ms.S, Perth, Australia: Can you please give me suggestion for my problems. I've got a surgery scar on my knees. Is there any medicine that can heal it? Could you please give me the reference based on the medicine available in Australia particularly Perth this year ?THANKS.

Dr.Hanish: Keloids (Gr. for'claw like') and hypertrophic scars are overgrowths of scar tissue within the dermis of the skin, the former growing beyond the confinement of the original wound, the latter remaining within its boundaries. In the normal course of wound healing, an equilibrium occurs between the syntheitic and degradative phases of collagen metabolism. In certain predisposed individuals,however,this equilibrium is lost, and a greater mass of collagen results in the formation of a keloid or a hypertrophic scar.Keloids and hypertrophic scars need to be treated because of the cosmetic and symptomatic discomfort. No mode of therapy is universally successful and recurrence rates after simple excision is higher. Successful treatment include cryotherapy, intralesional steroids and laser treatment. My favourite line of treatment consists of first treating the hypertrophic scar or keloid with liquid nitrogen cryotherapy and after thawing injecting steroid intralesionally.This is followed 2-3 weeks later by daily, direct application of Silastic Gel Sheet(SGS) to the healed wound for 1-2 months. This line of therapy gives excellent results. You may also try Cica-Care(manufactured by Smith-Nephew), a self adhesive silicone gel sheet which is efective in both old and new scars. The treatment will have to be continued for 2-4 months.

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DISCLAIMER: The answers given on these pages are only a guideline and based on good faith. The information on these pages can be subject to interpretation and can become irrelevant in special situations.Treatment of skin diseases require exhaustive history taking,skin examination and relevant investigations. Therefore, information should never be a substitute for an open and trusting doctor-patient relationship. Always consult your doctor before trying out any treatment or advice.The authors will not be responsible for any treatment carried out by the patients themselves without consulting their respective Dermatologists in person. The author is also not responsible for the veracity of the advertisements appearing on this page.The patients should take professional advice before trying out any medication/therapy.