Friday, May 29, 2009

SKIN MARKERS OF MALIGNANCY

SKIN MARKERS OF MALIGNANT DISEASE
Some skin disorders are precipitated by an underlying malignancy and others almost always indicative a visceral neoplasm. Early recognition may assist detection of the underlying neoplastic disease.

Disorders with a strong association with underlying malignancy:
1) NECROLYTIC MIGRATORY ERYTHEMA:

This is usually caused by a tumour of the pancreatic islet alpha cells that secrete glucagon, but it is sometimes caused by hyperplasia or benign adenomatosis of these cells. Rarely no underlying abnormality can be found. Areas of erythema, which becomes eroded and crusted, develop around the groins, on the lower trunk, around the flexures and at the sides of the mouth. They may temporarily remit at one site, to appear elsewhere. The skin disorder responds to removal of the underlying tumour, but usually complete removal is not possible.
Characteristically, there is degenerative change in the upper dermis. Blood tests reveal increased circulating glucagon, hyperglycemia and hypoaminoacidaemia and it is the last of these that may be responsible for this curious skin disorder.

2) ACANTHOSIS NIGRICANS:

Acanthosis nigricans may occur in association with endocrine disease and also, rarely, accompanies lipodystrophies. An identical clinical picture accompanies obesity and is then known as pseudo acanthosis nigricans.When the condition occurs in an adult unaccompanied by obesity or endocrine disease, an underlying neoplasm is usually the cause. The neoplasm involved is often a gastrointestinal adenocarcinoma.
There is a velvety thickening and increased rugosity of the skin of the flexures- the axilla and groin in particular. The sides and back of the neck and the sides of the mouth are also affected.
The thickened areas are also pigmented and bear skin tags and seborrhoeic warts. There may also be some generalized increase in pigmentation, as well as thickening and increased rugosity of the buccal mucosa and the palmar skin.
There is overall hypertrophy of all components of the skin of the affected areas. Insulin- like growth factors may be involved.

3) ERYTHEMA GYRATUM REPENS:

This is probably the rarest of the specific markers of visceral malignancy. This odd disorder is almost always a marker of a neoplasm, often carcinoma of the bronchus.

Large rings composed of reddened polycyclic bands are seen; the rings contain concentric rings; giving a wood-grain effect. The rings gradually enlarge and change shape. Rarely, other dramatic types of annular erythema may be signs of an internal malignancy.

4) SKIN METASTASES:

Carcinomas of the breast, bronchus, stomach, kidney and prostate are the most common visceral neoplasms to metastasize to the skin. Secondary deposits on the skin may be the first sign of the underlying visceral cancer. The lesion themselves are usually smooth nodules, which are pink or smooth colored, but may be pigmented in deposits of melanoma.

5) ACQUIRED ICHTHYOSIS:

When generally scaling without erythema begins in adult life, it is quite likely that there is an underlying neoplasm, particularly in reticulosis. This has to be distinguished from mild dryness of the skin and the slight irritation seen in many chronic disorders, known as xeroderma.
Other causes of acquired ichthyosis include AIDS, sarcoidosis and leprosy, but if these can be excluded, a neoplastic cause is the most likely explanation.

Disorders that are sometimes associated with underlying malignancy:

1) BULLOUS PEMPHIGOID:

This subepidermal blistering disorder occurs mainly in those over 60 years of age, who are anyway more likely to be affected by a neoplasm. Nonetheless,there are a few patients with pemphigoid in whom the skin disorder is provoked by the malignancy and remits after the neoplasm has been removed.

2) DERMATOMYOSITIS:

Women over the age of 40 years with dermatomyositis may have 50% chance of malignant tumour of the genitourinary tract, but infants with the disease have no greater risk than a control group. Overall, even in adults, the association is not common and most cases of dermatomyositis occur without an identifiable cause. There is an impression that dermatomyositis provoked by malignant disease is more severe.

3) FIGURATE ERYTHEMA:

Rarely, annular erythema and erythema multiforme seem to be caused by underlying malignant disease.

BY:
DR CHETAN LALSETA
M.D.(Skin & V .D)
DERMATOLOGIST & COSMETOLOGIST
“C POINT”—A UNIT OF MCSPL
SHRADDHA HOSPITAL,INDIRA CIRCLE CHOWK,
RAJKOT-360005

http://www.cpoint.in/
http://www.mcspl.in/
http://www.drlalseta.blogspot.com/
chetanlalseta@gmail.com
09825199585
Sponsored by the business degree web page.

Tuesday, May 26, 2009

SURGERY IN VITILIGO

VITILIGO SURGERY

INTRODUCTION:
In India, Vitiligo is considered a social stigma and the affected patient & family ostracized, hence it is important to treat and cure patient fully with all available modalities. Often we come across vitiligo patients who have stop responding to all possible medical therapies or who are responding very slowly to the same. Also, sometimes patient with clinically inactive lesions present for correction of their cosmetic deformity.
Apart from these, smaller group of secondary leucodermas (following thermal or chemical burns,etc) also need correction of the depigmented lesions.When inactive lesions occur on the unexposed, cosmetically unimportant areas, patients are ready to accept those lesions and hence can be left alone. However, frequently such hidden lesions also necessitate treatment, along with those occurring on the exposed sites. In such situations, camouflaging creams for daily application can be advised, but may not be acceptable to all, due to time consuming application, color mismatch, temporary action and cost factors. In such situation, one can think of surgical management of vitiligo.
Since 1964, various surgical techniques and modifications have been reported to treat recalcitrant but stable vitiligo with permanent and complete repigmentation.
Depigmentation in Vitiligo and secondary leucoderma results due to depletion of local melanocytes following their destruction by underlying disease. The various surgical procedures are designed with either of the following 4 aims;
1) Introduction of the artificial pigments into the lesions for permanent camouflage e.g. tattooing.
2) Removal of the depigmented areas forever e.g. Excision with primary closure.
3) Repopulation of the depleted melanocytes by various grafts e.g. Thierch’s grafts, ultra thin grafts, suction blister and miniature punch grafts, non cultured epidermal suspension or transplantation, epidermal and melanocyte cultures.
4) Therapeutically wounding the lesion so as to stimulate the melanocyte from the periphery and the black hair follicles to the proliferate, migrate and repigment the lesion e.g. therapeutic dermabrasion, laser ablation, cryosurgery, needling, local application of phenol or TCA.

SURGICAL MODALITIES FOR VITILIGO:

1) Cosmetic Tattooing
2) Excision & closure
3) Thin Thierch’s graft
4) Suction blister technique.
5) Miniature punch grafting.
6) Therapeutic wounding—Dermabrasion, Laser ablation,needling,cryosurgery,etc
7) Ultra thin grafting.
8) Grafting of non-cultured epidermal suspension.
9) Skin cultures—autologous, allologous or foetal; either epidermal containing both keratinocytes and melanocytes, or pure melanocytes only.
10) Others—Trypsinised autograft injection, single hair transplant homologous grafting, etc.

However, certain patient selection criteria should be strictly adhered to before taking any patient for surgical intervention.

PATIENT SELECTION CRITERIA:
1) Patient should have realistic expectations. Avoid psychologically unstable patients.
2) Patient not responding adequately to medical line of treatment.
3) Vitiligo lesions should be strictly stable for last two years i.e. existing lesions should not be expanding and no new lesion should have appeared in the interim.
4) The stability of the lesion should be confirmed by first doing trial grafting in a small vitiliginous area, 1-2 months before undertaking surgery of the entire lesion.

SUMMARY:

Good cosmetic end results will be obtained by strictly following the patient selection criteria and choosing appropriate surgical techniques depending on each individual case.
BY:
DR CHETAN LALSETA
M.D.(Skin & V .D)
DERMATOLOGIST & COSMETOLOGIST
“C POINT”—A UNIT OF MCSPL
SHRADDHA HOSPITAL,INDIRA CIRCLE CHOWK,
RAJKOT-360005

Monday, May 18, 2009

MICRODERMABRASION

MICRODERMABRASION: (SKIN POLISHING)
Microdermabrasion is an anti-aging and skin rejuvenating cosmetic procedure.It is widely used for a variety of cosmetic objectives ,including the improvement of Fine lines,Wrinkles,Photoaging,Acne,Scars and Stretch marks.
HOW MICRODERMABRASION WORKS?
In this method, a controlled flow of Aluminium oxide crystals is used to gently exfoliate the uppermost superficial dead layers of the skin It is a very effective skin polishing treatment using fine crystals that are directed on the skin through a vacuum tube and thus allowing a radiant translucent skin to emerge. This treatment removes dead surface skin cells to improve texture, softness, and brightness. It also stimulates cell and collagen production and reduces the appearance of large pores. Various defects in the surface of the skin can thus be addressed to reveal fresher, clearer skin in an effective and painless manner. Special Diamond tip Microdermabrasion is helpful in superficial to mediun depth scarring.This treatment or procedure can be done with other facial treatments to optimize results.
FAQ ABOUT MICRODERMABRASION:(SKIN POLISHING)
Why does one need Microdermabrasion or Skin Polishing? At what age can one start this service?


MICRODERMABRASION(SKIN POLISHING) is recommended for every one since at some point in time we are subjected to stress & increasing levels of environmental pollution. These factors cause our skin to get dull and pigmented. Due to over exposure to the sun, our skin gets damaged and one shows early signs of ageing. Such skin concerns need to get addressed and this is done with visible results through our service called C POINT Skin Polishing treatment.Practically in post pubertal age group,in both males & females, this treatment can be done safely & effectively
How is Microdermabrasion or Skin polishing different from facials?
The CPOINT Skin Polishing procedure has some advantages over facials;
It is useful in a wide range of skin problems like acne prone skin,fine wrinkles,photodamaged skin and superficial and medium depth acne scarring safely and effectively.
Removal of dead cells is uniform and is done very effectively and the service remains to be non-invasive
What is the procedure involved in MICRODERMABRSION or SKIN POLISHING?
Crystal Sensitivity Check: on your forearm.
Cleansing the face is then cleansed with the Cleansing gel.
Skin Polishing & Brightening: The dead, superficial skin cells on the uppermost layer of the skin are removed through a controlled flow of crystals.
Application of CPOINT products: After the procedure, a combination of products, which brighten the skin and improve skin tone are applied to your face. These products also have moisturizing & sun protection properties.

What is the chief skin concerns that CPOINT Microdermabrasion or Skin Polishing addresses?


CPOINT Skin Polishing & brightening addresses skin concerns such as dull skin,superficial & medium depth acne scars, fine lines and wrinkles & Sun damaged skin. This service can also be undertaken as part of your regular skin care and enhancement regime

Is the treatment for Microdermabrasion or Skin Polishing Safe?Yes,Microdermabrasion or Skin Polishing is an extremely safe procedure and is recommended for all skin types. At C POINT as an added precaution a crystal sensitivity check is done to rule out a rare case of sensitivity.

Are there any side effects whilst doing a Microdermabrasion or Skin Polishing?


C POINT skin polishing is absolutely safe,painless & non-invasive procedure and there are no side effects of it. However, very sensitive skin may become red due to the exfoliation action. However, this effect is transient. A cold compress is recommended in such a rare case.

What are the body parts for Microdermabrasion or Skin Polishing?


Most commonly employed body parts are face,neck,forearm & back,however in indicated person it can be done practically at any body parts.

How long does each session take?


The duration for Microdermabrasion or Skin Polishing usually lasts about 30 minutes per session.

Can I return to regular activities immediately after a session of Microdermabrasion or Skin Polishing?


C POINT Skin polishing requires no post procedure care. You can resume normal activities immediately. However in some cases of sensitive skin, direct sun exposure to excessive sunlight should be avoided and a sunscreen with a minimum SPF of 15 should be used regularly.

How many sessions are required to see best results?


Our skin is a dynamic organ. Excessive exposure to years of dust, pollution and harmful UV rays occurs continuously. Everyone has different skin and skin tones, with different levels of skin concerns. However at least 4 sessions are required to see visible results.Depending on indications, number of sessions and duration between session may vary accordingly.

Does this service have to be continued to maintain the results achieved?




Due to the exfoliation action, the immediate effect can be reddening of the skin, which subsides within hours. In extra sensitive skin, the effect lasts a day. Therefore Ideally you should get C POINT skin polishing procedure 2 to 3 days prior to occasion.

PHOTOGRAPHS OF PRE AND POST TREATMENTS.











BY:
DR CHETAN LALSETA
M.D.(Skin & V .D)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
“C POINT”—A UNIT OF MCSPL
SHRADDHA HOSPITAL,INDIRA CIRCLE CHOWK,
RAJKOT-360005
http://www.cpoint.in/
http://www.mcspl.in/
http://www.drlalseta.blogspot.com/
chetanlalseta@gmail.com
Sponsored by the business degree web page.

09825199585

MYTHS & REALITIES ABOUT DERMATO-COSMETOLOGY

MYTHS AND REALITIES IN DERMATOLOGY

INTRODUCTION

Quite often, we read or hear some cosmetic information which we may not always be able to substantiate by restoring to standard textbooks of dermatology. Hence, a compilation of common myths prevalent in our society are discussed here to provide scientific knowledge to those patients seeking cosmetic counseling.

MYTHS RELATED TO SKIN, HAIR AND NAIL CARE :

1) Soaps or shampoos which produce more lather have better cleansing action.

Reality : Lather productiom is dependent on addition of foam boosters to soaps or while cleansing is related to their detergent content. Hence, amount of lather produced is not proportional to cleansing activity of either soaps or shampoos, foam baths or bubble baths.

2) Foreign cosmetics are better than local ones.

Reality : The efficacy of these products depend on their basic contents and vary for individual. The fact that it is produced abroad with multiple additives does not certify any cosmetic to be better than it’s Indian counterpart.

3) Household cosmetics are harmless.

Reality : Home remedies can also irritate or sensitise the skin or have comedogenic potential and should be used with care.

4) Skin creams and moisturizers with vitamin A, E and other plant extracts prevent aging and skin wrinkling.

Reality
: Most of these substances are not absorbed topically and hence, carry no added advantage over a plain moisturizer. Some of them are humectants and thus act as moisturizers and temporarily improve wrinkles due to their plumping action.

5) Oil massage before bath gives a glowing skin.

Reality : Although, any massage improves the local circulation, the best results of oil application are obtained when applied on slightly moist skin, as during or after bath especially in those with dry skin. The regular use of oil massage in infants can produce folliculitis, especially if persons with poor hygiene are employed for this purpose.

6) Cleansing milks, facial packs and facials are more effective ways to clean the deep pores.

Reality : Soaps are equally effective for facial cleaning and above products, offer no significant advantage except for placebo effect.

7) Oily foods precipitate or aggravate acne.

Reality : Dietary factors are not involved in pathogenesis of acne and hence, food restrictions are unnecessary.

8) Regular steaming is good for skin.

Reality : Although, steaming hydrates the blocked pilosebaceous ducts so that comedone extraction become easier, it’s regular use in normal people can cause large, open pores. Even in acne patients, it should be used only for 1 – 2 minutes every 7 – 8 days. More frequent usage can result in damage to elastic fibres in long run causing premature aging.

9) Regular hair oil application prevents premature canities and prevents hairfall and give luxuriant hair growth.

Reality : Premature hair greying is genetically determined, it’s expression dependent on environmental factors, other than oil application. The only purposed served is probably improvement in local circulation, if massage is done after application, with improvement in hair growth.

10) Shaving the scalp or cutting hair improves growth in diffuse alopecia.

Reality : The rate of hair growth remains the same after these procedures. Also, no new hair follicles are formed by shaving or cutting the preexisting hair.

11). Shampoos with additives like pro-vitamin B5, keratin etc. are more effective in damaged hair.

Reality : Damaged hair due to abuse of hair styling techniques and hair products need a mild detergent shampoo with conditioner containing protein like hydrolysed animal protein are beneficial as they penetrates hair shaft and restores damaged hair protein structures. Various other additives only enhance commercial appeal, since they are not absorbed in scalp and hair shaft is dead cutaneous appendage.

12). Application of kajal improves eyesight and eyelashes growth.

Reality : Kajal contains carbon and apart from it’s cosmetic purpose of enhancing eye appeal, it serves no beneficial action. On the contrary, it’s application can cause contact dermatitis and conjunctivitis.

13).Use of castor oil increases growth of eyelashes and eyebrow hairs.

Reality : Application of any oil does not affect rate of hair growth; except for possible effects of ensuing massage action.

14).Trimming of cuticle is an essential part of nail care.

Reality : Cuticle is designed to protect underlying nail matrix from getting invaded by pathogens and irritant and allergen substances. The habit of trimming or pushing it back during manicure can damage the cuticle with resultant complication like acute and chronic paronychia.

15).Medicated soaps are better cleansing agents and good for diseased skin.

Reality : The normal skin flora acts as a defence against the pathogenic species and prevents their inhabitation of skin surface through bacterial interference. Medicated soaps with germ fighters destroy this beneficial flora; thereby allowing pathogenic bacterial invasion of the skin. Usually they also produce excessive dryness/irritation of the skin due to additional contents and hence should not be recommended excepts for recurrent skin infections/acne vulgaris.

16).The regular use of pumice stone and scrubbers cleans the skin better and reduces hyperpigmentation.

Reality : Bare hands and nails are enough to cleanse the skin along with a soap on daily basis. If pumice stone / scrubber are used vigorously they may dry the skin excessively. Also, bathing brush dermatitis with bilaterally symmetrical hyperpigmentation on bony prominence can follow years of usage of such products.

17).Costly branded cosmetics are more effective and cannot produce side effects.

Reality : The effectivity /adverse reaction of any cosmetic depends on it’s compounds eg. PPD in hair dyes and hence is present in both cheap and costly OTC products. Sometimes, costly product or branded cosmetics may contain additives like fragrances or preservatives to which side effects can develop.


SUMMARY
These are certain points which clarify wrong beliefs common in our society so that correct cosmetic usage and adoption of scientific techniques be followed by the patients.









BY:
DR CHETAN LALSETA
M.D.(Skin & V .D)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
“C POINT”—A UNIT OF MCSPL
SHRADDHA HOSPITAL,INDIRA CIRCLE CHOWK,
RAJKOT-360005
http://www.cpoint.in/
http://www.mcspl.in/
http://www.drlalseta.blogspot.com/
chetanlalseta@gmail.com
09825199585
Sponsored by the business degree web page.

Friday, May 15, 2009

dr chetan lalseta: CANDIDIASIS

dr chetan lalseta: CANDIDIASIS

CANDIDIASIS

CANDIDIASIS
Candidiasis is an acute or chronic,superficial or disseminated mycotic infection caused by the fungus candida albicans and occasionally by other species of candida.It commonly involves skin & the mucous membranes and sometimes the viscera.
FACTORS PREDISPOSING TO CANDIDIASIS
1) Local factors:
Tissue damage, moisture, warmth, maceration, Topical corticosteroids, prolonged catheterization, etc.
2) Physiological states:
Infancy, pregnancy, old age
3) Metabolic & endocrinal factors:
Iron deficiency, Diabetes mellitus, Obesity, Cushing’s syndrome
4) Immuno compromised status:
• Primary or secondary to malignancy, AIDS, prolonged administration of antibiotics, systemic corticosteroids, oral contraceptive pills, cytotoxic drugs,etc
• Development of candidiasis in an HIV infected patient indicates deterioration of his immune status.

CLASSIFICATION OF CANDIDIASIS
Based on the anatomical site involved,candidiasis is classified into the following clinical syndromes:
CANDIDIASIS
MUCOSAL CUTANEOUS SYSTEMIC

Acute pseudomembranous Paronychia Gastrointestinal
Chronic hyperplastic Intertrigo Bronchopulmonary
Angular chelitis Diaper candidiasis Renal
Denture stomatitis Nodular Joints
Vaginitis & Balinitis Candidiasis Heart,Meningeal

CLINICAL SYNDROMES:
The clinical features of candidiasis vary depending upon whether the infection involves skin or mucous membrane. On keratinized surface of skin, the infection causes well marginated, erythematous, scaling pustules, whereas on the mucous membrane, the infection produces white, cheesy deposits surrounded by erythema.
Candidial Paronychia:
Candidial paronychia is a chronic inflammation of one or more nail folds.It is characterized by redness and swelling of the affected nail fold.The initial event is injury to the cuticle followed by detachment of the nail fold from the dorsal surface of the nail plate.This leads to the formation of pocket which then collects within it food debris etc. and facilitates growth of bacteria as well as fungi.The affected nail folds are sometimes painful and tender.Often,there is concomitant bacterial infection and beads of pus are exuded on pressing the affected nail fold. Subsequently, the nail becomes dystrophic, often ridged and develops green or brown colour.
This condition is usually found in housewives,washerwomen,people practicing manicure & pedicure,in those whose hands are constantly immersed in water for prolonged periods.
Nodular Candidiasis of Napkin Area:
This condition is a atypical reaction to the candida infection, manifesting as bluish-brown nodules or cutaneous horn like lesions.It involves the napkin area over the buttocks,genitalia,upper thighs and pubis.
Topical application of steroids is an important aetiological factor.
Chronic Mucocutaneous Candidiasis:
It is a distinct syndrome characterized by persistent,superficial candidial infection of the skin,nails and mucous membrane of the mouth and genitals, refractory to conventional topical therapy. It is not a single disease entity but is a manifestation of various underlying primary defects in cell mediated immune responses.
Systemic Candidiasis:
Under conditions leading to immunocompromisation, candida may cause systemic disease and involve the lungs,oesophagus,intestines or urinary tract. Candidemia may occur following prolonged use of indwelling catheters for intravenous infusions or in intravenous drug abusers,Rarely,hematogenous spread of candida may lead to meningitis, bone and joint lesions.
The underlying disease and iatrogenic factors predisposing to infection must always be sought and treated in all forms of systemic candidiasis.
Candidial Intertrigo:
Candidial intertrigo is characterized by erythema,moist exudation with an irregular ,fringed margin and subcorneal pustules in the affected area.Satellite pustules may develop and rupture leaving erosions and peeling skin.In case of interdigital space involvement,there is marked maceration.
It involves intertriginous areas of skin like interdigital spaces, genitocrural, perianal. Inframammary and axillary folds. It most commonly occurs in obese and diabetic individuals.
Candidial intertrigo should be differentiated from tinea,seborrhoeic dermatitis,bacterial intertrigo and flexural psoriasis.
Oral Thrush:
Oral thrush usually involves buccal mucosa,tongue,gums or palate and in severe cases in pharynx too pseudomembrane is formed by fungal mycelia,desquamated epithelial cells,fibrin,leucocytes and food debris attaching to inflamed epithelium.It is loosely attached to the inflamed mucosa and when removed,leaves behind erosions and bleeding.The lesions are often painful and interfere with eating.
The condition commonly occurs in premature babies,neonates and in old people with poor resistance. In neonates it can be acquired from the birthcanal of the mother.
Angular Cheilitis:(Perleche)
Basically,perleche is a form of intertrigo which may be caused by different factors, of which candida is the commonest.Riboflavin deficiency,presence of moisture due to persistent salivation or licking of the lips,depth of the fold and malocclusion of teeth are some other factors which predispose to infection.
Denture stomatitis:
This condition is characterized by bright red or dusky erythema of the affected mucous membrane, sharply defined at the margin of the denture.The epithelium is often shiny,atrophic,oedematous and eroded.
Balanoposthitis:
Candidial balanoposthitis involves skin of the glans penis and prepuce,causing inflammation of fissuring.In mild cases, tiny papules develop on the glans a few hours after sexual intercourse, grow into vesicles,pustules and rupture leaving a scaly edge. The patient complains of soreness and pain while passing urine.
The status where both sexual partners have symptomatic genital candidiasis is known as ‘Conjugal Candidiasis’.
In either of the above case,the sexual partner of the patient should be simultaneously treated , even if asymptomatic. In persistent or recurrent cases, the patient and sexual partner should be investigated for Diabetes mellitus.
Vulvovaginitis:
Candidial vulvovaginitis is characterized by beefy red erythema of the affected vulvar skin and vaginal mucosa accompanied by creamy white, thick curdy flecks of vaginal discharge. In some cases,it may extend to cause intertrigo of groins and natal cleft.In severe cases,subcorneal pustules may be seen peripherally.Patient usually complains of soreness,pruritus and dyspareunia.
It most often occurs in diabetics because of high concentration of sugar in urine, in women during pre-menstrual period, during pregnancy, in women taking oral contraceptive pills and in patients with AIDS.
It should be differentiated from Trichomonas infection,bacterial vulvovaginitis, physiological leucorrhoea during pregnancy and dermatoses affecting the vulva.
INVESTIGATIONS FOR CANDIDIASIS:
1) Direct examination under the microscope:
Lesions are scraped with blunt end of a scalpel and the material is mounted in 2-3 drops of 10% KOH solution.When viewed directly under a microscope, it reveals gram positive yeasts and pseudohyphae, often associated with inflammatory cells.
The presence of pseudohyphae suggests candida as a pathogen.Blastophores and pseudohyphae can be demonstrated by H & E stain.
2) Culture of the selective material on Sabouraud’s Dextrose Agar:
Candida albicans forms white,creamy colonies on Sabouraud’s dextrose agar in 2-3 days. The species is identified by rounded, refractile, double walled chlamydospores,produced by subcultures on corn-meal agar for 24-96 hours at room temperature and by germ tube formation.

TREATMENT FOR CANDIDIASIS:
Treatment can be classified into two ways:
Topical and Systemic:
Topical:
1) Imidazoles:
Miconazole 2% gel/lotion/cream/powder twice daily
Clotrimazole 1% cream/gel/lotion/powder
100 mg vaginal tablet once daily for 6 days
Or 500mg single dose vaginal tablet.
Econazole 1% ointment, 150 mg vaginal tablet twice daily
Newer molecules like eberconazole,sertaconazole are also available.
2) Ethanolamine derivative:
Ciclopirox olamine 1% cream twice daily
3) Polyne antibiotics:
Nystatin 1 Lac units vaginal tablets BID for 2 weeks
Natamycin 2% cream or 25 mg vaginal tablets for 1 week.

Systemic:
1) Polyne antibiotics:
Amphoterecin B 0.3-.7mg/kg per day IV over 4-8 hrs in
systemic disease
Nystatin 5 lacs units thrice daily in Intestinal
Candidiasis.
2) Azoles:
Ketoconazole 200 mg orally OD or BID for 2 weeks in
Mucocutaneous candidiasis.
Fluconazole 150 mg single dose orally for vaginitis &
Balanitis.
150 mg once weekly for three weeks for
recurrent vaginal candidiasis.
Itraconazole 200mg/day for 3 days for vaginitis and
Balanitis.
200 mg on first day of menstrual cycle for
three months for recurrent vaginal candidiasis.

PREVENTIVE MEASURES AGAINST CANDIDIASIS:

Avoid:
• Prolonged warking in water.
• Tight fitting clothes,synthetic or woolen undergarments and socks.
• Closed and tight footwears.

Advised:
• Maintain good personal hygiene
• Use gloves and cotton liners while working in water.
• Use loose clothing and absorbent cotton undergarments and socks.
• Use open footwear.
• Thoroughly dry the intertriginous areas and apply simple talcum or an antifungal powder.
• Simultaneously treat the sexual partner, even if asymptomatic, in case of balanitis and vaginitis.

BY:
DR CHETAN LALSETA
M.D.(Skin & V .D)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
“C POINT”—A UNIT OF MCSPL
SHRADDHA HOSPITAL,INDIRA CIRCLE CHOWK,
RAJKOT-360005
www.cpoint.in
www.mcspl.in
www.drlalseta.blogspot.com
chetanlalseta@gmail.com
09825199585
Sponsored by the business degree web page.

Friday, May 1, 2009

BALANCE SHEET OF LIFE

Our Birth is our Opening Balance !

Our Death is our Closing Balance!
Our Prejudiced Views are our Liabilities

Our Creative Ideas are our Assets

Heart is our Current Asset

Soul is our Fixed Asset

Brain is our Fixed Deposit

Thinking is our Current Account

Achievements are our Capital

Character & Morals, our Stock-in-Trade

Friends are our General Reserves

Values & Behaviour are our Goodwill

Patience is our Interest Earned

Love is our Dividend

Children are our Bonus Issues

Education is Brands / Patents

Knowledge is our Investment

Experience is our Premium Account

The Aim is to Tally the Balance Sheet Accurately.

The Goal is to get the Best Presented Accounts Award.


Some very Good and Very bad things...

The most destructive habit....... ......... ......Worry

The greatest Joy......... ......... ......... ....Giving

The greatest loss........ ........Loss of self-respect

The most satisfying work........ .......Helping others

The ugliest personality trait........ ......Selfishnes s

The most endangered species..... ....Dedicated leaders

Our greatest natural resource.... ......... ..Our youth

The greatest "shot in the arm"........ ..Encouragement

The greatest problem to overcome.... ......... ....Fear

The most effective sleeping pill........ Peace of mind

The most crippling failure disease..... .......Excuses

The most powerful force in life......... ......... .Love

The most dangerous pariah...... ......... ...A gossiper

The world's most incredible computer.... ....The brain

The worst thing to be without..... ......... ..... Hope
The deadliest weapon...... ......... ........The tongue

The two most power-filled words....... ........" I Can"

The greatest asset........ ......... ......... .....Faith

The most worthless emotion..... ......... ....Self- pity

The most beautiful attire...... ......... .......SMILE!

The most prized possession.. ......... .....Integrity

The most powerful channel of communication. ....Prayer

The most contagious spirit...... ......... ..Enthusiasm

The most important thing in life........ ......... .GOD

DR CHETAN LALSETA
CONSULTANT DERMATOLOGIST
SHRADDHA HOSPITAL
INDIRA CIRCLE CHOWK
RAJKOT
GUJARAT,INDIA
09825199585
chetanlalseta@gmail.com
www.cpoint.in,
www.mcspl.in
www.drlalseta.blogspot.com