FAQ's

The excess sebum clogs the openings to hair follicles -- especially those on the face, neck, chest, back & shoulders. Bacteria grow in these clogged follicles. These develop as ‘heads’, also known as 'comedones,'on the skin's surface. So the plugged pores of the hair follicles initially develop as non – inflammatory lesions called ‘comedones’. These are further divided into ‘black comedones’ (called blackheads) & 'white comedones’ (white heads).
Later on, further clogging, causes the follicle wall to break under the pressure of these pent up secretions. When this happens, sebum leaks into nearby tissues and forms various inflammatory lesions which are called as follows –

• Papules – Red, elevated, dome shaped slightly painful lesion less than 1cm
• Pustules – Pus filled, painful lesion that may be seen over the red papules
• Nodules – Swollen, tender, deeper lumps usually more than 1cm in size
• Cysts - Nodules associated with severe cases of acne (cystic acne) give rise to firm cyst like swellings below the skin's surface. The secretions in the cysts need to be drained & these cysts could result in scarring of the skin.

Acne is primarily caused due to hereditary & hormonal factors. However, it is known to be triggered by calorious foods that have a high glycemic index. Hence fried foods, junk food, sweets, desserts, cakes, pastries, soft drinks, chocolates & ice creams should be avoided. One should avoid alcohol consumption & smoking. Certain antibiotics, steroid medications, multivitamins & cough syrups can also accentuate acne formation.
Also one should have liberal amounts of fibrous fruits, veggies, salads & drink plenty of water.

You don’t have to completely stop wearing makeup altogether, but it would be a good idea to try switching brands. If you’re noticing breakouts along the sides of your temples & frontal hairline, hair creams or gels might be exacerbating your acne. Avoid using excessive hair oils & smearing your face with greasy, thick make up creams & sunscreen lotions. Avoid using vegetable & mineral oils to clean your make up.

Look for cosmetics and toiletries with the label “non-comedogenic,” meaning that they don’t clog pores. Using a gentle skin cleanser & light make up with a calamine lotion & a few strokes of compaq should be just fine.

About 90% of teenagers are affected by acne. It usually starts by the teenage & extends upto mid-life. Some patients might notice acne for the first time in their adulthood. Rarely, babies are born with acne and uncommonly preschool children may develop acne. Most people outgrow acne by about 35 years of age; but in women it may last until the menopause. In about 5% of women the problem of acne could persist beyond menopause.

Yes. Sun exposure can worsen acne. Many acne medications make the skin more sensitive to sunlight. Besides, sweating and humidity can cause hydration and further swelling & clogging of the ductal blockages, which can precipitate the inflammatory phase of acne.

The following factors can aggravate acne & should be avoided -

• Greasy (oily) cosmetics, namely preparations that leave your face shiny following application.
• Using exfoliating & granular scrubs / loofahs/ pumistone etc.
• Topical corticosteroid containing preparations
• Squeezing, scratching & picking of skin lesions
• High calorie food with high glycemic index
• Avoid Facials, Facial spas & clean ups

You should take professional help from a ‘Dermatologist’ - When you have inflammatory lesions ( papules, putules, nodules & cysts)
If non inflammatory acne does not respond to treatment
If you develop emotional problems as a result of your acne
When signs of overproductions of androgens are present
If you suspect new prescription medication causes your acne
If you suspect that greasy cosmetics or other topical preparations may aggravate your acne

Your dermatologist will assess your condition depending upon the type, extent, severity of acne as also your age, sex & desire of child bearing etc. before prescribing you any anti-acne prescription. Initial recommendation is usually an over the counter (OTC) or prescription topical medicine for people with mild signs of acne. Topical medicine is applied directly to the acne lesions or to the entire area of affected skin.

There are several OTC topical medicines used for mild acne. Each works a little differently. OTC topical medicines are quite effective in treating early mild acne when used regularly; however, it may take up to 8 weeks before you see noticeable improvement. Following are the most common ones:

Benzoyl peroxide - destroys P. acnes, and reduces oil production
Resorcinol - can help break down blackheads and whiteheads.
Salicylic acid - helps break down blackheads and whiteheads.
Sulfur - helps break down blackheads and whiteheads.
Antibiotics - help stop or slow the growth of bacteria and reduce inflammation
Vitamin A derivatives (retinoids) - unplug existing comedones, allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. These drugs contain a different form of vitamin A. Some examples are tretinoin, adapalene, and tazarotene.

Topical OTC medicines are available in many forms, such as gels, lotions, creams, soaps, or pads. In some people, OTC acne medicines may cause side effects such as skin irritation, burning, or redness, which often get better or go away with continued use of the medicine. If you experience severe or prolonged side effects, you should report them to your doctor.

However a course of antibiotics may be prescribed to treat inflammatory lesions. The course of antibiotics may go upto a few weeks.

No acne can never be completely cured, but it can be treated successfully. Till you are genetically prone to get acne & fall in the susceptible age group of getting them, you may keep getting episodes of break out on & off, depending of various triggers. However if the requisite DO’s & DON’T’S (as mentioned above) are followed correctly, then it is quite possible to maintain healthy skin & prevent/minimize recurrences of acne.

Depending on their extent & severity, acne marks are treated by various forms of depigmenting creams. However the stubborn ones are tackled with very safe & effective office procedures called chemical peels & skin polishing.
Chemical peels – In this procedure, a medicated solution ( naturally derived & processed peeling agent containing glycolic acid, salicylic acid etc.) is gently applied on the skin (under professional supervision) to reduce acne, pigmentation & cause skin rejuvenation
Skin Polishing ( Microdermabrasion) – In this procedure the very superficial layers of skin are gently exfoliated in a very controlled way using a machine called microdermabrader. It peels of the uppermost layers of skin, thus exposing the young, plump rejuvenated skin cells to the surface thereby decreasing pigmentation marks & increases skin glow.

Superficial acne scars partially respond to topical medications like vitamin A creams etc.; however deep acne scars warrant more aggressive treatment options like –

• Chemical peels (CROSS – Chemical reconstruction of surgical scars)
• Laser skin resurfacing using Fractional CO2 laser – Fractionated (broken down) laser beams are used to cause neo-collagenesis ( formation of new collagen tissue) & uplift the scars with meticulous precision
• Microneedling using Dermaroller & Dermapen to cause neo-collagenesis & neo-vascularization & decerease the scar depth
• Dermal filler using fat & hyaluronic acid fillers to uplift the depressed scars
• Skin surgery like scar excision surgery etc.

Eczema, also known as dermatitis or skin allergy, denotes a general term for a group of conditions that cause the skin to become inflamed, red, dry, cracked and itchy. Fluid filled lesions (vesicles & blisters) may occasionally develop. About 25 – 30% of patients are affected by some form of eczema in their lifetime. Over a period of time, the affected skin becomes dark in colour with a thick texture & increased skin markings. In some cases, a rash might develop in one area & gradually progress to involve the large areas of the body. The word eczema is usually used specifically to talk about ‘atopic dermatitis’ the most common type of eczema.

The exact cause of eczema is unknown, however a genetic predisposition is known in a sizeable number of patients, eczema is commonly found in families with a history of skin eczemas, allergic cold & cough & asthma. Eczema is thought to be associated with an overactive response by the body's immune system to an irritant / allergen. It is this response that causes the signs & symptoms of eczema. Anxiety and stress are common triggers that cause eczemas to flare up.

There are broadly 2 types of eczema, Endogenous (due to internal causes) & Exogenous (due to external causes). The following are the types of:

Endogenous Eczemas

• Atopic Eczema
• Seborrhoeic Dermatitis
• Pompholyx (Dyshidrotic Eczema)
• Nummular / Discoid Eczema
• Stasis Dermatitis ( Venous Eczema)
• Xerotic Dermatitis (Eczema Craquele’/ Dry skin dermatitis))

Exogenous Eczemas

• Allergic Contact Dermatitis
• Irritant Contact Dermatitis
• Photo dermatitis (due to sunlight)
• infection)

It depends on the type of eczema and its response to treatment. Most contact dermatitis heal within two to three weeks with proper treatment. Most stasis dermatitis lasts for years. About half of children with atopic eczema still have the problem as adults. Irritant eczemas & allergic contact dermatitis get better on avoidance of the trigger/allergen. Sun protection plays the key role in photodermatitis. Infective eczema clears up once the offending infection is taken care of. Frequent application of thick moisturizers is imperative in the treatment of xerotic dermatitis.

No. Eczema & infections are different entities. However eczematous skin is more prone to develop superadded fungal & bacterial infections due to a compromised skin barrier function.

Some common foods that may trigger an eczema flare-up and that should be removed from a diet include the following :
Fruits - Citrus fruits, Strawberries, pineapple , banana
Nuts – Peanuts, groundnuts, cashewnuts, treenuts etc.
Artificial colors & preservatives, Chinese food, papad, pickles, cow milk products Eggs, gluten or wheat, soy, spices (such as vanilla, cloves, and cinnamon) tomatoes
Seafood – Shellfish, Jellyfish, prawns, lobsters & crabs

Eczema is not a contagious skin condition. Eczema does not spread from person to person. However, it can spread to various parts of the body (for example, the face, cheeks, and chin (of infants with atopic dermatitis) and involvement of the skin folds (neck, wrist, knees, and elbows of adults). Exposed areas of arms & neck are usually involved in photodermatitis. Scratching the skin can make eczema worse.

There is no permanent cure for eczema. Treatment for the various types of eczemas aim to heal the affected skin and prevent flare-ups of symptoms. Doctors suggest a plan of treatment based on the type of eczema & the individual's age, symptoms, and current state of health. For some people, eczemas do get suppressed, by themselves over time.

Basic principles to treat eczema aim at eliminating the cause of eczema & also improve the barrier function of the skin. Quite often topical corticosteroid creams play a key role in relieving the symptoms. Rarely, strong systemic medicines may be prescribed by the treating dermatologist, depending upon the patients’ age, associated factors, type of eczema & severity of the disease. General measures are as follows –

• Have bath with lukewarm or tap water. Avoid hot water bath.
• Use gentle cleansers. Avoid strong soaps, detergents chemicals etc.
• Moisturize the affected areas of skin multiple times a day.
• Wear loose soft cotton covered clothing. Avoid tight fitting clothes
• Avoid sun exposure & other irritant allergens (if any)
• Avoid itching, scratching or vigorously rubbing the affected areas of eczema
• Use ice packs for soothing effect
• Learn & practise the art of ‘stress management.’

Losing some amount of hair routinely during shampooing, combing etc is called ‘hairfall’. Hairfall is due to lack of specific nutrients in the diet. This can be controlled & is usually a reversible condition with the right medications (proteins, vitamins & biopeptide lotions etc.).
However, ‘hairloss’ implies ‘baldness’ or loss of density & thinning of hair in a particular pattern hence it is also called as ‘patterned hair loss’. Hairloss is not due to any dietary deficiencies. It is due to effect of hormones seen in genetically susceptible individuals with a family history of balding. In hairloss, the scalp becomes visible, due to the thinned out overlying hair cover.
Males - Starts with a receding hairline at the temples, followed by loss of hair on the crown area in males.
Females – It is apparent as thinning of hair & widening of the hair partition in the frontal & crown area in females.

 Everyone of us lose some amount hair every day. The average human scalp has approximately 100,000 hair follicles, most of which are producing hair at any moment in time. Losing 0.05 – 0.1% of hair per day is normal. Also during certain seasons (May & December) the hairfall may increase, this is called “seasonal hairfall”. Usually one feels that the hairfall seems to be more after shampooing; however shampooing & conditioning only loosen up the hair which were almost ready to be shed anyway.

Yes. Many health conditions, including thyroid disease, malnutrition, iron deficiency anaemia (less haemoglobin) & vitamin D deficiency, can cause hairfall. However most often, thyroid blood tests and other blood tests of people who have ordinary hair loss are usually normal. It is important to exclude underlying causes with sudden or severe hair fall.

There are certain circumstances that ‘shock the system’ thus changing the hair growth rhythm. The most common ones are as follows-
A) Internal diseases as mentioned above.
B) Nutritional changes - Fasting, crash dieting (to lose weight)
C) Hormonal changes - After pregnancy & during lactation (feeding), puberty & menopause
D) Food fads (diet deficient in proteins, vitamins, calcium & iron)
E) Medical illness ( Typhoid, Malaria, Dengue etc) & after surgery
F) Psychological & emotional stress ( death, divorce etc.)

Hair follicles on the scalp do not continuously keep producing hair. Hair follicles undergo a repetitive sequence of growth and rest called the "hair cycle." They cycle through the following 3 phases as follows -
Growth stage ( ANAGEN PHASE) that can last 2 to 10 years, then
Regress to a resting stage (TELOGEN PHASE) for up to two months before starting to grow a new hair fiber again.
Shedding stage (CATAGEN PHASE) that lasts for upto 2 weeks

• At any time on a healthy human scalp, about 80% to 90% of the hair follicles are growing hair i.e. hair are in the anagen phase. Duration of this phase decides the length of hair (the longer the anagen phase the longer the length of hair)
• That leaves up to 10% to 20% percent of scalp hair follicles in a resting state called telogen, when they don't produce any hair fiber till the beginning of next anagen phase. During this three-month period, the hair root shrivels up into a small white "club," then the hair falls out.
• The rest 1 – 2% are in the catagen phase (shedding phase). This is the regressive phase in which the follicular activity declines.

legumes, pulses, curd, dals) iron (green leafy veggies), Calcium (banana, milk, ragi, nachni) vitamins & minerals (amla, seasonal fruits & colored veggies) & plenty of water.

– Use a mild shampoo to gently clean the scalp & hair during hairwash for 3-4 mins. One should shampoo their hair atleast 3-4 times a week. After shampooing, use a conditioner, by gently massaging it through the length of the hair for 2 - 3 mins. Following it, apply a stay on hair serum through the hair strands to detangle them & prevent breakage. Always comb the hair with a broad comb (never use a brush) when the hair are relatively dry. Wet hair are more prone to breakage.

– Ideally it is not safe & advisable to repeatedly treat your hair with various cosmetic & physical modalities in a parlour. One should avoid the following hair treatments –

• Hair straightening & Hair rebonding (they weaken the hair shafts & damage the outer layer of hair, called cuticle, thus making the hair prone for hairfall)
• Blow drying & Hot air ironing ( it dries up the hair & makes them rough & frizzy; also at times they could cause hair burns & hence increase breakage)
• Hair cosmetics (these could cause allergic reactions on the scalp)

– Keratin , Cystiene, bio-oils & hair spa imply application of certain nutrition rich serums & pastes on the scalp. Applying any such so called hair cosmetic to the hair has no proven benefit. Infact physical heat treatments of the hair after applying these products can furher damage the hair. However, it is ok to simply apply (NO IRONING after that) these products once or twice a year as a feel good factor.

Oiling the hair has no role to play in hair growth. It is a myth, that applying oil will strenghthen one’s hair. If that was the case, no Indian would ever be bald. Theoretically, oil is a fat & hair is a protein; there is absolutely no way that applying a fat on the scalp could help stimulate the growth of proteins in it. Infact oil is called ‘a poor man’s conditioner’, as it temporarily softens & detangles the hair. However one may use few drops of any mineral oil (virgin coconut, mustard etc) during the winters to treat dry, rough & frizzy hair.

- It is a simple, safe & cost-effective treatment option for hairfall & hairloss. A concentrate of platelet rich plasma derived from centrifugation of patients’ whole body is injected into the scalp (at times it may be combined with a dermaroller with microneedles to make it relatively pain free). The various growth factors released from these platelets are believed to act on the stem cells (situated in the bulge region of the hair follicle), where they stimulate development of new hair follicles.
Dermaroller / micro-needling causes neo-vascularization (development of new blood vessels) & thereby increases the vascularity (blood circulation) of the upper layers of the scalp & hence stimulates hair regrowth
Thus, this is considered as a valuable adjuvant treatment for the male & female patterned hairloss & hairfall.

This technique involves microinjections of vitamins, amino acids, plant extracts & minoxidil in the middle layer of the skin. This improves blood flow & also delivers target growth factors at the strategic site of the hair bulge area to stimulate new hair growth. This is a relatively painless procedure with minimal or no downtime. This could be combined with dermarollers too for painless delivery of the meso solutions in the scalp.

Tight hairstyles should be avoided. Tight braids, ponytails, tight rubber bands & pins pull hard enough on hairs to make them weak & fall out. If this happens, it's best to choose hairstyles that put less strain on hair roots. Always tie hair a little loose. The sooner this is done the better to avoid permanent damage.

Hair transplantation is a surgical procedure of hair regrowth for people suffering from serious issues of balding. This has now become very popular due to the increased demand from younger generation facing the problem of balding & consequently low self esteem, low self confidence & depression
It is by far one of the most effective method to mask baldness. This procedure involves a surgical process during which, hair follicles are taken from the donor area, usually the occiput ( back area of scalp above the neck) & planted to the recipient area where balding has affected (usually the frontal hairline & the crown area of scalp). Another very effective use of hair transplantation is seen in the case of people who have lost their hair due to accidents.
FUT and FUE are broadly the two main types of hair transplants:
FUT- in this process, a small strip of scalp from the occiput (back of the head) is removed. This strip is then separated into thousands of smaller units of hair & scalp tissue (called ‘follicular units’). Each follicular unit contains about 1-6 hair along with its muscle, fat, nerves, blood supply & lymphatics. These follicular units are meticulously planted on the recipient areas of hairloss by creating small holes (called slits). The area from where the strip has been removed will be covered by stitches.
FUE- in this type of hair transplantation, instead of cutting & stiching the scalp strips, hair follicular units are individually extracted with specialized instruments called hair punches and planted on the recipient areas. The donor area heals with normal & indiscernible scar tissue in about 10-15 days.
With any kind of hair transplant, the new transplanted follicular units, initially shed off in the first 2 weeks & finally new hair start sprouting in about 3 - 4 weeks. It however takes about 6 - 8 months for visible results.

Chemical peeling implies gentle exfoliation of the layers of the skin in a very controlled manner using specific medical solutions containing alpha & beta hydroxy acids, which are usually derived from organic sources of various plants & fruits.

Chemical peeling is primarily used for the following indications -

• Even out the skin tone & decrease pigmentation
• Remove sun tanning by increasing skin turn over & promoting exfoliation
• Treat acne (due to their comedolytic & keratolytic effect)
• Anti-aging benefits (to reduce & delay development of wrinkles)

Chemical peeling primarily uses the following chemicals –

• Alpha hydroxy acids (like glycolic acid, lactic acid, pyruvic acid) which are primarily used to decrease skin pigmentation & promote anti –aging
• Beta hydroxy acids (like salicylic acid) which are used to treat different types of acne (pimples)
• Cosmeceuticals (like Vitamin C, retinoic acid, arbutin, hyaluronic acid etc)

Chemical peel works in the following ways –

• Decreasing skin turnover time & promoting exfoliation of the upper layers of the skin to flake off the pigmentation faster
• Neocollagenosis – Increasing the collagen production in the deeper layer of the skin, which usually decreases with age, causing the skin to sag & wrinkle.
• Anti-inflammatory effect in the pilo-sebaceous unit (hair follicle) to reduce sebum production & colonization by pimple causing bacteria.

Yes. Chemical peeling is a very safe, non invasive procedure, in the hands of a trained dermatologist & cosmetologist. It is one of those few office procedures which can be performed even on a pregnant woman.

There are various types of peeling procedures that may be used to get the best results, depending upon the patient & the disease severity. These are –
A) Comination peels – Two or more peeling agents are used together to optimize the results of the peel (eg using a combination of glycolic acid, kojic acid & lactic acid to reduce skin pigmentation faster, compared to using just one of them)
B) Sequential peels – Two or more peeling agents are used in a sequential manner (one after the other) to reduce treatment time & cost of procedure. E.g. – using glycolic acid on the face to reduce acne marks, followed by using a coat of salicylic acid on the active pimples to expedite their healing
C) Rotation peels – Different peeling agents used in rotation to maximize the benefit of the treatment. For e.g.- Initial few sittings using salicylic acid to reduce the active pimples, followed by next few sessions of lactic acid peels to reduce the leftover acne marks.
Also peeling agents are classified as superficial, medium depth & deep peels depending upon the depth of the peeling agent into different layers of skin.

Instructions before & after chemical peel –

• Skin should not be dry, flaky & irritated. Use moisturizers 3-4 times a day
• You shouldn’t be suffering from any active viral infection like – warts, herpes, molluscum etc.
• Stop anti-acne creams like (retinoic acid & benzoyl peroxide) 3 days prior & 4-5 days after the peeling procedure.
• Avoid sun exposure as much as possible & use sunscreens multiple times a day. Preferably cover your face with a scarf, use an umbrella & wear loose, soft, cotton, covered clothing
• Avoid strong soaps, detergents to be used on the treated area.
• Avoid scratching, rubbing, itching on the affected area.
• Use ice packs for soothing effect. Avoid hot water baths for a week
• Minimize use of cosmetics, perfumes, deodorants for a week after peeling

Any change in the colour or tone of skin is termed as pigmentation. Pigmentary changes on the skin are due to an imbalance in the natural pigment called melanin, which is formed in the melanocytes (pigment producing cells). Such pigmentary changes can be of 2 types –

• Hypopigmentation – light colored skin spots due to decreased melanin
• Hyperpigmentation – dark colored skin spots due to increased melanin

Hyperpigmentation is caused by an increase in melanin. Melanin is the natural pigment that gives our skin, hair and eyes their color. A number of factors can trigger an increase in melanin production, but the main ones are sun exposure, hormonal influences, age and skin injuries, inflammation & as an aftermath of many diseases like – psoriasis, eczema, lichen planus, acne, fungal infections & vitamin B 12 deficiency etc.
Hypopigmentation is caused by decrease or loss of melanin from melanin & / or melanocytes. These usually are a result of conditions like - vitiligo (leucoderma / white patch), eczemas (pityriasis alba) after skin inflammation & could also be due to age related changes (idiopathic guttate hypomelanosis).

Melasma is one of the commonest pigmentary disorder & implies patches of brownish skin discoloration usually affecting the cheeks, bridge of the nose & forehead. It is mostly seen in middle aged women especially during pregnancy. Melasma can be due to hormonal changes during pregnancy or from sun exposure. It is more often seen in women suffering from thyroid disorders. In women, melasma often fades on its own after pregnancy or after an affected woman stops taking oral contraceptive pills. Sunscreens & skin lightening creams can help reduce melasma.

Melasma can be treated by usage of skin lightening creams under medical supervision. Most of these creams contain hydroquinone, either alone or in combination with other cosmeceuticals. Also oral antioxidant supplements & vitamin C are good adjuvants to other treatments of melasma. Pigment lasers, chemical peeling & skin polishing (micro dermabrasion) also help in reducing melasma significantly.

One can achieve complete to near complete remission of melasma through various treatment modalities as mentioned above. However it is notorious to relapse. One cannot guarantee a complete & permanent cure forever. Sun exposure for as less as half an hour is enough to kickstart the process of melasma in a genetically predisposed individual. Even visible light & UV radiation from gadgets (laptops, mobiles) can trigger its developmen.

If the patient is not suffering from any hormonal imbalance & thyroid disorders then the most important trigger is sun exposure. To prevent against melasma, you need to regularly use a broad spectrum sunscreen that blocks not only the sun's rays, but also its light (Visible light) and heat (Infrared radiations). There are two main types of sunscreens:

• Chemical sunscreens containing octinoxate, octocrylene (UVB blockers) & oxybenzone, avobenzone (UVA blockers). These absorb the UV light
• Physical sunscreens containing zinc oxide and titanium dioxide (that block UVA spectrum, Visible light & Infrared wavelengths). These reflect or scatter the UV light.

The sun blocking effect of a sunscreem lasts only for about 2 -3 hours, hence it is imperative to keep reapplying the sunscreen every 3 hourly to maximize its effect. In a tropical country like ours & a humid city like Mumbai, a water resisitant sunscreen is preferred, which protects against UVR for a period of about 45 mins.

Glutathione is a very potent antioxidant used for the treatment of liver diseases. However in the last couple of years it has gained a lot of popularity amongst cosmetologists for the treatment of skin pigmentation. It is a relatively safe product which when consumed in the dosage of about 500mg -1000mg orally, over a period of 3 -4 months, lightens the overall tone & complexion of the body. Recently a sublingual spray preparation is found to be more effective. Some doctors even give it intravenously along with vitamin C as a skin lightening cocktail, however it is not FDA approved for the same. Glutathione cream is also used to treat melasma.

A colourful diet rich in antioxidants is very helpful to neutralise the oxidative stress caused by reactive oxygen species. Dietary antioxidants also help fight against damage caused by sun exposure. Also one should consume foods rich in dietary glutathione like - asparagus, avocado, cabbage, brussels sprouts, spinach, broccoli, garlic, chives, tomatoes, cucumber, almonds, and walnuts. However, a variety of factors can affect the levels of this vital nutrient, including storage and cooking.

Tranexamic acid (TXA) is known to reduce melanin in the skin has been recently recommended for the use in melasma. It can be given as an oral preparation, a topical preparation, or an intralesional agent. It is probably the first oral medication that has proven efficacy in the treatment of melisma. It is usually given as a 250 mg tablet twice daily & also as a topical cream for treatment & maintenance of melasma. However it is to be taken under medical supervision & also to be used with caution in patients with a family history of stroke, smokers, women taking OC pills & after a prolonged air travel.

Psoriasis is a chronic, recurrent, autoimmune skin disorder that causes skin cells to multiply up to 8- 10 times faster than normal. This rapid skin cell production makes the skin build up into layers of bumpy red patches covered with silvery white scales. They can grow anywhere, but most appear on bony prominences like the scalp, elbows, knees, and back.

Psoriasis is an autoimmune skin condition, which means, that the immune system mistakenly attacks healthy skin cells, causing them to rapidly multiply & form thick scaly patches. An exaggerated immune response following an infection (eg. sore throat) is one of the commonest triggers for psoriasis. If one is sick or battling an infection, the immune system will go into overdrive to fight the infection. This immune response results in psoriasis flare-up. Other common triggers are – smoking, alcohol, medicines (pain killers, beta blockers) stress, injury to skin, vitamin D deficiency, dry skin, bad weather (dry, cold, arid, non humid weather conditions) scratching the affected patches & certain foods.

With psoriasis, it’s important to avoid foods that can trigger inflammation. Quite a few food triggers are known to trigger psoriasis. Most common ones are as follows –

• Red meat, dairy, eggs & processed meat products – these contain a polyunsaturated fatty acid called arachidonic acid. Research has shown that by-products of arachidonic acid may play key a role in creating psoriatic lesions.
• Gluten containing foods – Psoriatic patients are known to have increased markers of gluten sensitivity. The following gluten rich foods should be avoided - wheat and wheat derivatives, rye, barley, and malt, pasta, noodles, and baked goods, certain sauces and condiments, beer and malt beverages.
• Nightshade plants - Nightshade plants contain solanine, which has been known to affect digestion in humans and may contribute to inflammation in psoriasis. Hence these plants like – tomatoes, potatoes & eggplants should be avoided.
• High glycemic index foods & junk food predispose psoriatic patients to develop metabolic syndrome hence better avoided

Almost all anti-inflammatory diets including fruits and vegetables are helpful. Fruits and vegetables are high in antioxidants, which are compounds that decrease oxidative stress and inflammation. A diet high in fruits and vegetables is recommended for inflammatory conditions such as psoriasis. Foods to eat include: broccoli, cauliflower, brussels sprouts, leafy greens, such as kale, spinach, and arugula, berries, including blueberries, strawberries, and raspberries cherries, grapes, and other dark fruits.

- Psoriasis treatments reduce inflammation and clear the skin. Treatments can be divided into three main types: topical treatments, light therapy and systemic medications.

• Topical Treatments – applying a thick layer of moisturizer, multiple times a day, is the most important part of treatment. Specific creams & ointments are prescribed to be applied on the affected areas. These include - topical corticosteroids, calcineurin inhibitors, anthralin, coaltar derivatives, vitamin D analogues.
• Systemic Treatments – Orally taking stronger medications (cyclosporin, methotrexate, vitamin A derivatives called, retinoids & immunobiologicals ) when larger surface area of the body is involved or psoriasis is increasing at a faster pace. These are prescribed by a dermatologist depending upon patient factors (age, sex, co-morbid conditions etc.) & disease factors ( type of psoriasis, extent of the disease & location). These are stronger medicines which warrant to be taken under absolute medical supervision & with a physician’s consent.
• Ultraviolet therapy - This treatment uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight.
  Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications

No. Psoriasis does not cause skin cancer.

No, like any other autoimmune condition psoriasis cannot be permanently cured. Psoriasis is known to be a chronic, recurrent skin condition. However with proper medications the recurrent episodes of psoriasis can be controlled & the patient can have a long disease free interval. Avoiding the triggers (specific medicines, foods, lifestyle, avoiding to scratch) goes a long way in preventing & minimizing the psoriatic flares.

Psoriasis is an absolutely non contagious skin condition. It does not spread from person to person. It is safe to marry someone with psoriasis.

Yes, psoriasis is associated with ‘metabolic syndrome’(Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels).

'Vitiligo' is also known as the 'white patch disease' or 'leucoderma'. It is a disease that causes the loss of skin colour in patches. Vitiligo occurs when pigment-producing cells, called melanocytes, die or stop functioning. Loss of skin colour can affect any part of the body, including the mouth, hair and eyes. It may be more noticeable in people with darker skin. Treatment may help in improving the appearance of the skin.

Melanin is the pigment that gives the skin its characteristic color. Vitiligo is caused by a loss of pigment in the skin, due to destruction of these pigment-forming cells known as melanocytes. There are various theories proposed for the causation of vitiligo –

A) Autoimmune theory
B) Oxidative stress theory
C) Neurohumoral hypothesis
D) Melanocytorrhagy theory of melanocyte survival

Vitiligo quite often "runs in families," suggesting a genetic basis. This means that it is not possible to predict the chance of development of vitiligo in other family members. About 25% to 40% of people with vitiligo have a relative with vitiligo, and about 5% have siblings with vitiligo.

Vitiligo is not a contagious skin condition & hence does not spread from person to person. A person with vitiligo marrying another person with vitiligo is medically not recommended as there is a slightly higher chance of it passing on to the next generation.

Treatment of vitiligo depends on disease factors (extent, severity, location, speed of spreading) & patient factors (age, sex, other diseases etc.). However no treatment of vitiligo can guarantee a complete & permanent cure of this condition. Broadly the following treatment modalities are routinely employed to treat vitiligo –

• Immunomodulatory Creams (with or without steroids) may be used for limited areas.
• Systemic Immunomodulatory agents (with or without steroids) may be used to control the spread of the disease, when larger body surface area is involved.
• Ultraviolet Light therapy – A specific wavelength light, called narrow band light is a useful adjunct to stimulate pigment production & decrease the further spread of the disease.
• Surgery – Skin grafting, punch grafting & melanocyte transfer are the surgeries used to treat the affected white patches depending on the extent & location of the white patches.
• Laser – Excimer light & laser are newer treatment options for vitiligo.
• Laser assisted PRP enriched epidermal suspension transplant is a very safe and effective treatment for stable vitiligo

There are no specific restrictions as such & patients are usually advised to have a protein rich nutritious diet laden with a lot of antioxidants (naturally colored fruits & veggies). The following are some of the problem foods that people with vitiligo cite & are better avoided – junk food, seafood, artificial colours & preservatives, curd, papads & pickles, berries, brinjal, garlic, oranges, tomatoes & coffee.
The following are the foods that people with vitiligo have cited as helpful & should be consumed – seasonal fruits, salads (lettuce, kale, radish), green leafy veggies, colored roots & tubers (beetoot, carrot) dates etc.

Vitiligo is broadly classified based on the activity & distribution of the lesions. When vitiligo is spreading to involve newer areas it is termed as unstable vitiligo, whereas when it is not spreading for a period of atleast 6 months to a year, it is termed as stable vitiligo.
When vitiligo involves just a segment / area of the body, it is termed as segmental vitiligo; whereas involvement of multiple areas constitute vitiligo vulgaris & involvement of the lips & acral areas of the body (elbows, knees, fingertips, toes etc.) make up acrofacial vitiligo or lip-tip vitiligo.

Vitiligo by itself does not “lead” to other conditions. However, there are many other autoimmune-related conditions, which may arise in vitiligo patients. Thyroid disorders (especially hypothyroidism) & diabetes mellitus are quite common in those with vitiligo, (infact treating thyroid disorders is important in treating vitiligo). Other related autoimmune conditions are much rarer, but include alopecia areata, pernicious anemia, lupus.

No. Leucoderma does not cause skin cancer.

Yes. 'Members of Vitiligo Support Group' have created their own safe homemade skin stain, made entirely out of rubbing alcohol, calamine powder, zinc oxide, iron oxide and ordinary food colours. By mixing the ingredients together, a brownish color results, and the tone can easily be adjusted to match your skin.

Some amount of sun exposure, usually 5 to 10 minutes of sun exposure a 2-3 times a week, may be useful in healing white patches. However, it is always a good idea for people with vitiligo to use full sleeves covered clothing & sunscreens, whenever they will be spending more than a few minutes in the sun to prevent contrast between the tanned & white patches.

The latest fractional carbon dioxide CO2 lasers are the most effective treatment on the market for non-surgical revitalization of the skin. Since the CO2 laser is the strongest of all the lasers in the market and capable of producing exceptionally great outcomes, it can safely be used for improving the texture of all the skin types including the eyelid, around the mouth and on all the areas of face, neck, arms, hands, chest and legs. Wrinkles, fine lines, blotchiness of skin tone, sun damage spots on the face and hands, traumatic scars or acne scars can be treated very effectively. The CO2 laser has the longest wavelength which is why it is safe for improving even darker skin tones after suitable adjustments in the settings.

The CO2 laser system is highly effective for revitalization of skin using a micro-ablative technique. Typically, the CO2 laser beam is fractionated into hundredss of small rods of light by the fractional CO2 laser. These micro beams of light hit the deeper layers of skin. They focus at a specific portion of the skin surface at one time. They help in rejunenating the skin by pushing out the old sun damaged skin and replacing it with the new, young & fresh skin.
This treatment tightens the skin by causing ‘neocollagenosis’ i.e. stimulates the natural production of collagen that gives skin its elasticity. It also improves the skin tone and texture by reducing the wrinkles, open pores, acne scars, stretch marks and age marks on the hands, face & neck. As a result, you get a brand new younger looking and fresher skin.

The effects of fractional CO2 resurfacing laser treatment will last for good. However, they would even longer if you protect your skin properly from the sun rays and other factors such as alcohol consumption, smoking, irregular sleep patterns, stress, weight loss or weight gain, etc. All of these factors can cause your skin to age & reduce the longetivity of the results attained.

Remember that the fractional CO2 laser treatment can be customized based on your specific problems. Patients who prefer to have two shallower treatments can avoid a lot of downtime, compared to a single deeper treatment which usually demands more downtime & may also warrant a general anaesthetic.
It will usually take 3 to 6 months to get maximum results. It may take about 4 to 10 days for your skin to heal after which it may remain pink for a period of 4- 6 weeks weeks. Your skin will look less blotchy and stay smoother during this period.

That depends on the area which needs to be treated e.g. Full face, just the cheeks, size of stretch marks etc. As a gesture, each of our subsequent treatment costs less. This consultation & post laser follow ups (not products) are included in the cost of your treatment.

Yes, as discussed before, this treatment has always been very effective for reducing acne scars and stretch marks. It is a very powerful treatment to improve the skin texture by skin resurfacing, due to its virtue of causing tissue remodelling & neocollagenosis.

Pre-treatment protocols like applying specific creams to improve the barrier function of the skin & also using sunscreens are discussed before any scheduled laser session. The skin needs to be optimally primed for the procedure. Also post treatment management is advised beforehand as this greatly improves the result and long term maintenance. You will also need to see the doctor to discuss and have realistic expectations of the outcome.

You should not return to normal outdoor activities or work for at least 48 hours (preferably 4 days) after undergoing the treatment. With our fractional CO2 treatments, you may need 5 to 7 days of downtime. Applying the post laser healing creams as directed are an absolute mandate.

There are very few reasons for avoiding fractional laser treatment. These include the use of medications that increase photosensitivity, chemotherapy, use of anticoagulants, poor history of bleeding disorders, pregnancy and history of painful scarring and healing.

It will depend on the amount of cumulative damage from the sun, wrinkles or acne scarring and also on the duration of acceptable downtime. You may need between 1 to 3 treatments for an optimal result. Since, darker skin types will need lower doses of treatment they may require even more number of sittings.

Usually prior to the laser treatment, a detailed discussion is done in order to decrease the likelihood of any complications during & after the CO2 laser treatment. Although there is very little chance of complications, the following can occur -

• Even if the procedure is performed effectively, using the right parameters (depending on the patients’ skin type) some patients may go through emotional difficulties or depression. Realistic expectations need to be discussed prior to the procedure to avoid any expectation –delivery mismatch between the doctor & patient.
• Some patients find the treatment slightly painful because of the reasons mentioned above. In rare cases, patients may experience a mild discomfort at the first day after the procedure. Ice packs help alleviate the discomfort.
• Some people may experience redness & swelling instantly after laser surgery for a temporary period. Redness usually subsides in about 2-3 hours, however rarely it may persist for upto 2 weeks. It is more common in patients with a history of flushing & dilated blood vessels. The swelling may take upto 2-3 days to decrease.
• In patients with a history of keloids & hypertrophic scars, there is a possibility of thick elevated scar formations called as keloid scars. It is necessary to carefully follow the post-operative instructions to avoid scarring.
• In the CO2 laser multiple grid like pinpoint wounds are caused to the outer layers of skin, through which the laser beams penetrate in the deeper layers of the skin and it takes approx. 4-10 days for them to heal. The healed skin surface may be sensitive to the sun for about 4 to 6 weeks. Hence using a sunscreen repeatedly is imperative.
• Rarely, in the darker skin shades of Indian patients, pigmentary changes may occur and may last for 2-6 weeks after the treatment. It generally takes 3 to 6 months to heal this hyperpigmentation.
• It is important to avoid any infection of the area. So gentle cleansing with a mild cleanser & clean water is mandatory.

Following the preoperative and postoperative instructions diligently definitely improves chances of a great outcome considerably.

Glutathione is an a very potent antioxidant naturally found in human cells that neutralizes free radicals, boosts the immune system and detoxifies the body. It is primarily used for treatment of inflammatory conditions of the liver, however it has been proposed as a good supplementary treatment for skin lightening.

It decreases skin pigmentation & causes skin lightening by

• Converting the pigment melanin to a lighter colour and
• Deactivating the enzyme tyrosinase, which helps produce the pigment, melanin.
• Decreases the free radical damage to the skin caused by reactive oxygen species

Glutathione has the ability to lighten the skin colour, by inadvertently blocking the enzyme ‘tyrosinase’ responsible for the production of melanin. The process of lightening the skin complexion generally takes a few weeks to about 3 months. However, it is advocated that glutathione should be continued in lower dosages to maintain the benefit.

Glutathione is POSSIBLY SAFE for most adults when taken by mouth, by inhalation, as a sublingual spray or by injection into the muscle or into the veins. But the possible side effects are not known. Rarely, some patients can have an adverse drug reaction to it.

Usually patients respond to glutathione treatment in about 3-4 months. Most of them believe their skin to have lightened by about 1-3 shades. However, there is a small fraction of patients who do not experience the desired improvement.

The Phlippine Food and Drug Administration (FDA) has approved oral glutathione products as nutritional supplements only. Injectable (intravenous/ “drips”) glutathione has been approved as a drug to protect cancer patients from hepatic & nerve side-effects of chemotherapy.

PRP treatment implies infusion (in skin, hair, wounds etc.) of a concentrate of platelet rich plasma, derived from centrifugation of patients’ whole blood to achieve growth of the desired tissue through release of various growth factors at the target sites. The infusion of PRP in the tissues may be achieved either by - simple injections, electroporation technique, dermaroller (micro-needling) or fractional CO2 laser

PRP treatment is used for the following indications –

• Hair – Hair regrowth ( alopecia areata, baldness etc. ) & reduce hairfall
• Skin – Skin tightening (reducing wrinkles), skin rejuvenation & anti- aging benefits
• Wounds – Promote healing of ulcers , bed sores, non healing wounds etc.
• Stretch Marks – Reduction of skin laxity over the stretch marks
• Acne scars – Improving skin texture by reducing size of open pores & acne scars

The various growth factors released from the platelet concentrate are believed to work on the stem cells, situated in the bulge area of the hair follicle, where they stimulate development of new hair follicles
They also provide the much needed nutrients to the existing hair follicles & stimulate their growth.
When used in combination with dermaroller or micro-needling, they cause expression of certain embryonic growth factors, which further accelerate the desired growth.

The specific growth factors released from the infused platelet concentrate, causes ‘neocollagenosis’ (induce the development of new collagen tissue) in the deeper layer of the skin, thereby reducing the laxity & causing tightness of the treated area.
It also increases certain matrix components via activation of fibroblasts, which play a key role in maintaining the structural integrity of the tissue & also promote wound healing.
Thus PRP treatment causes, improvement of skin texture, skin rejuvenation, flattening of acne scars by promoting tissue remodelling in aged skin

Yes. PRP treatment is a relatively safe, simple, cost effective procedure in the hands of a trained dermatologist & cosmetologist.
It is a feasible treatment option & a good adjunct for the routine treatments of hairloss, hairfall, skin rejuvenation, treatment of acne scars, stretch marks & non- healing wound.

Due to the hormonal upheavals, many women notice changes in their skin, hair and nails during pregnancy. Some of the most common changes include the following:

• Dark spots on the breasts, nipples, or inner thighs
• Melasma - brown patches on the face around the cheeks, nose, and forehead
• Linea nigra - a dark line that runs from the navel to the pubic hair
• Striae Distensae - Stretch marks
• Acne
• Spider veins
• Varicose veins
• Changes in nail and hair growth

Less common changes include the following -

• Pruritic urticarial plaques & papules of pregnancy
• Prurigo of pregnancy
• Intrahepatic cholestasis of pregnancy
• Autoimmune progesterone dermatitis

Dark spots and patches ( also called Chloasma – mask of pregnancy) are caused by an increase in the body’s melanin - a natural pigment that gives colour to the skin and hair. Dark spots and melasma usually fade on their own after you childbirth. Some women, however, may have dark patches that last for months & years. To help prevent melasma from getting worse, you are advised sun protection with a broad spectrum sunscreen and other physical measures (like hats, scarves, caps, etc.) when you are outside.

As your belly grows during pregnancy, your skin may become marked with reddish lines of thinned out overlying skin, called stretch marks. By the third trimester, many pregnant women commonly have stretch marks on the abdomen, buttocks, breasts,thighs, waist & behind knees. Using a heavy moisturizer may help keep the skin soft, but it will not help get rid of stretch marks. Most stretch marks fade after the baby is born, but they may never disappear completely. Vitamin E based creams may help to some extent. Dermaroller treatment & Fractional CO2 laser with PRP is very beneficial.

Many pregnant women have acne. Some already have acne and notice that it gets worse during pregnancy. Other women who may always have had clear skin will develop acne while they are pregnant.

If you get acne during pregnancy, take these steps to treat your skin:

• Wash your face twice a day with a mild cleanser and lukewarm water.
• If you have oily hair, shampoo every day and try to keep your hair off your face.
• Avoid picking or squeezing acne sores to lessen possible scarring.
• Choose oil-free cosmetics & non comedogenic sunscreens.

Some safe Over-the-counter (OTC) products containing the following ingredients may be used during pregnancy, these are :

• Topical benzoyl peroxide
• Azelaic acid (10 %)
• Topical salicylic acid (not on larger body surface area)
• Glycolic acid

Hormonal therapies, Vitamin A derivatives called ‘retinoids’ , antibiotics ( sulpha drugs, tetracyclines etc.) should not be used during pregnancy. If you want to use an OTC product that contains an ingredient not on this list, contact your health care professional.

- The hormonal changes in pregnancy may cause the hair on your head and body to grow longer, faster & also become thicker. Some women grow hair in areas where they do not normally have hair, such as the face, chest, abdomen, and arms.
About 3 months after childbirth, most women begin to notice hair loss from the scalp. This happens because hormones are returning to normal levels, which allows the hair to return to its normal cycle of growing and falling out. Your hair should return to normal within 6 months after giving birth.

Some women find that their nails grow faster during pregnancy. Others notice that their nails split and break more easily. Like the changes to your hair, those that affect your nails will ease after birth.

The weight and pressure of gravid uterus can decrease blood flow from the lower body and cause the veins in your legs to become swollen, sore, and blue. These are called varicose veins. Varicose veins also can appear on your vulva and in the vagina and rectum (usually called haemorrhoids or piles). In most cases, varicose veins are a cosmetic problem that usually go away after delivery

Although you cannot completely prevent them, however there are some things you can do to ease the swelling and soreness and prevent varicose veins from getting worse:

• Be sure to move around from time to time if you must sit or stand for long periods.
• Do not sit with your legs crossed for long periods.
• Prop your legs up on a couch, chair, or footstool as often as you can.
• Exercise regularly—walk, swim, or ride an exercise bike.
• Wear support hose.
• Avoid constipation by eating foods high in fiber and drinking plenty of liquids.
• Do calf muscle pumping exercises (like calf raises) regularly as advised

In pruritic urticarial papules and plaques of pregnancy (PUPPP), small, red bumps and hives appear on the skin later in pregnancy. The bumps can form large patches that can be very itchy. These red, bumps usually first appear around the navel and spread to the inner thighs, buttocks, and breasts. It is not clear what causes PUPPP. It usually goes away about 6 months after you give birth. They usually reappear during subsequent pregnancies.

With prurigo of pregnancy, tiny, itchy bumps that look like insect bites can appear almost anywhere on the skin. This condition can occur anytime during pregnancy and usually starts with a few bumps that increase in number each day. It is thought to be primarily caused immune system dysfunction that occur during pregnancy. Prurigo can last for several months and may even continue for some time after the baby is born.