Dermatological consultations

We offer range of dermatological consultations including moles check and treatment of common dermatological problems.

Acne

Acne vulgaris (pimples, spots), characterised by a mixed eruption of inflammatory and non-inflammatory skin lesions affecting the pilosebaceous unit, ie the hair follicle and its associated oil gland. Metabolic and hormonal disbalance, impared function of skin oily glands and colonication of skin by bacteria all play role in development of the condition.. Acne can be presented as: comedo, papules, pustules, nodules and pseudocysts. It sometimes leaves patietns with scars and pigmented marks. It is most common in teenagers but adults and children are sometimes affected. Face, chest and back are the favourite sites.

Treatment of acne

Includes reducing excessive skin oil production and unclogging oily glands. For that various topical gels, creams and washes are prescribed. Antibiotics used to reduce inflammation and supress bacterial overgrowth. Female patients might be prescribed combined contraception pills to override hormonal disbalance. Both male and female patients will be advised on correction of metabolism by balanced diet lower in sugar and fatty food. Systmetic retinoids used to control inflammation and pilosebaceous proliferation. UV (phototherapy) light or Laser can be used for some patients.

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Psoriasis

Psoriasis is an autoimmune disease, and is the result of the body’s inflammatory processes affecting the skin.  Symptoms can vary, but it mainly  patches and plaques on skin with silvery scale build up.

Description and Symptoms of Psoriasis

There are various types of psoriasis, and the most common form is plaque psoriasis (also known as psoriasis vulgaris), and it constitutes roughly 85 to 90% of cases. Other types include guttate, inverse, pustular, and erythrodermic (not discussed here).  Symptoms can range from mild occasional outbreaks to severe, life affecting forms.

Plaque psoriasis consists of thick, red patches punctuated by flaky scales. These can appear as localised spots or cover the entire body.  The spots are most likely to be seen on elbows, knees, and the scalp.  However, other commonly affected areas include the backs of the forearms, shins, and around the navel.  Psoriasis can also affect the nails, causing pitting, whitening, discoloration, crumbling, and separation of the nail.

Psoriatic Arthritis

Psoriasis can provoke a form of arthritis.  It has been reported that this occurs for about 30% of those affected by the illness.  The symptoms typically occur later in the progression of the disease.  It most commonly affects the joints of the fingers and toes.

Impact of Psoriasis on the Quality of Life

Psoriasis can have a negative impact on quality of life.  The physical discomfort and a serious psychological impact.  Individuals with psoriasis may feel self-conscious about their appearance and have a poor self-image.  Although not contagious, others will often avoid both physical and social contact with those who suffer from it, leading to a sense of rejection, depression, and low self-esteem.

Common Psoriasis Triggers and Risk Factors

Psoriasis is generally believed to be a genetic disease triggered by environmental factors.  It can sometimes be triggered by an injury, or by certain medications.  Symptoms are often worse during cold weather months, and severity can be affected by diet.  Other environmental factors they may trigger psoriasis can include stress, infection, smoking, and heavy alcohol consumption.

Treatment of Psoriasis

There are many treatments for psoriasis, and these have varying degrees of effectiveness.  As each individual’s case will be affected by personal risk factors and lifestyle choices, several approaches will likely be needed to achieve the best result.  Treatments can be topical creams, UV light treatments, immune system suppression therapies (systemtic and biologic agents), or some combination of these.  Your doctor will work with you to manage and improve symptoms.

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Vitiligo

Vitiligo is an acquired, chronic, depigmenting disorder of the skin, in which pigment-producing cells (melanocytes) that determine the colour of skin are progressively lost. It appears as milky-white patches of skin and can be cosmetically very disabling, particularly in people with dark skin.

Vitiligo is the result of autoimmune destruction of melanocytes in genetically susceptible individuals. It is often associated with oother autoimmune diseses (lke diabetes or thyroid disease). It affects 0.5-2% of popultation , equally men and women of any age, it is more common in SubIndian continent.

Treatment of Vitiligo

  • Include topical steroids, calcineurin inhibitors, topical Vit D derivates, Ruxolitinib (a Janus kinase 1 and 2 inhibitor)
  • Phototherapy:  whole-body or localised broad or narrowband UVB, excimer laser UVB or tragetedUVB for small areas of vitiligo; oral, topical, or bathwater photochemotherapy (PUVA)
  • Steroids:short pulse therapy to slow rapid progression, or as mini-pulse oral steroids to stabilize active disease
  • Immunomodulators: Methotrexate, Cyclosporine, Mycophenolate Mofetil
  • Aniinflammatory antibiotics: oral minocycline 100 mg/day
  • Subcutaneous injections of steroid or afamelanotide
  •  Surgical melanocytes implantation
  • Depigmentation therapy (using 20% monobenzyl ether of hydroquinone), cryotherapy or laser
  • Cosmetic Coumuflage, sun protection

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Hyperpigmentation

Localised increase of pigment normally referrs to excessive melanin deposit. Other causes might include excess of haemosiderin or artifical pigment.

If dark patches are observed, the main diagnoses to consider are:

  • Benign pigmented skin lesions, such as  moles (melanocytic naevi) , lentigines (freckles and sun spots) , seborrhoeic keratosis
  • Skin cancers such as melanoma or pigmented basal cell carcinoma
  • Post-inflammatory pigmentation due to prior injury, current or prior inflammatory skin disease such as eczema, acne especially in dark-skinned individuals, or fixed drug erruption
  • Current or previous superficial skin infection, particularly pityriasis versicolour or erythrasma.
  • Chronic pigmentary disorders, such as melasma and aquire dermal macular hyperpigmentation
  • Photocontact dermatitis to certan plants
  • Thickened skin eg, acanthosis nigricans or ichtiolysis
  • Pigmented purpura due to bleeding into the skin, such as capillaritis or senile purpura
  • Intentional or accidental tattoo.

Treatment of Hyperpigmentation

If pigmentation due to melanin affects an exposed site, daily application of broad-spectrum SPF 50+ is important to minimise darkening caused by UVR. This is not effective for melanin located in the deep dermis or to reduce pigmentation caused drugs, or tattoos, carotene or haemosiderin.

Cosmetic camouflage can be used.

The following agents can be used to lighten epidermal melanosis alone or, more effectively, in combination: Hydroquinone, Tocial retinoids, Topical steroids, Fruty acids, Azelaic acid, L-ascorbic acid

Skin resurfacing using chemicalpeels, lasers/IPL or dermabrasiosn may be effective but unfortunately risks further damage to the epidermis and formation of more pigment. Cautious cryotherapy to small areas of postinflammatory pigmentation can be effective but risks causing permanent hypopigmentation.

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