HOW TO OVERCOME OBESITY

HOW TO OVERCOME OBESITY

FACTS ON OBESITY:
• Globally, there are more than 1 billion overweight adults, atleast 300 million of them are obese.
• Obesity and overweight is a major risk to Type 2 diabetes, cardiovascular disease,hypertension and stroke and certain forms of cancer.
• The key factors are increased consumption of energy dense foods high in saturated fats and sugars and physical inactivity.
• As a rule,women have more body fat than men.Most healthcare professionals agree that men with more than 25% body fat and women with more than 30% body fat are obese.
OBESITY:
“Obesity” refers to an excessive amount of body fat.
“Overweight” refers to an excessive amount of body weight that includes muscle,bone,fat & water.
MEASUREMENT OF OBESITY:
Body Mass Index:
The BMI is a tool used to assess overweight and obesity and monitor changes in body weight.It is calculated by dividing a person’s weight in pounds by height in inches squared.
WEIGHT CATEGORY BMI SCORE
Underweight Below 18.5
Healthy weight 18.5 to 24.9
Overweight 25 to 29.9
Obese 30 and above
CAUSES OF OBESITY:
The balance between caloric intake and energy expenditure determines a person’s weight.Some contributing factors for obesity are:
• Genetics: A person is more likely to develop obesity if one or both parents are obese.
• Overeating: Overeating leads to weight gain.especially if the diet is high in fat.
• Slow metabolism: Women have less muscle mass than men.Muscle burns more calories than other tissues.As a result, women have slower metabolism than men, and hence have a tendency to put on more weight than men,and weight loss is more difficult in women.
• Physical inactivity: The National Health & Examination Survey showed that physical inactivity is strongly correlated with weight gain in both sexes.
• Medications: Medications associated with weight gain includes Steroids,Antidepressants and anticonvulsants.
• Psychological factors: Emotions influences eating habits in some persons,specially during boredom,sadness,stress or anger.
• Lack of sleep may also contribute to obesity.

CONSEQUENCES OF OBESITY:

Health risks:
• Gallbladder diseases & gall stones.
• Fatty liver diseases.
• Gastroesophageal reflux.
• Osteoarthritis and Gout.
• Pulmonary problems including sleep apnea.
• Reproductive problems in women including menstrual irregularities and infertility.
Psychological and Social Effects:
Emotional suffering may be one of the most painful parts of obesity.Feelings of rejection,shame or depression may occur.

MANAGEMENT OF OBESITY:
Doctors generally agree that people who have BMI of 30 or more can improve their health through weight loss.
Preventing additional weight gain is recommendedif one has BMI between 25 and 29.9.
Treatment of Obesity:
The method of treatment depends on level of obesity,overall health condition & readiness t lose weight.Treatment may include a combination of diet,exercise,behavior modification,weight loss drugs and Bariatric surgery.
Following steps are important to work towards a healthier weight.
1) Establish a reasonable target weight:
• Discuss the BMI score with ur expert doctor & let them assess the related risk factors for disease and health problems.
• Depending on person’s circumstances,a reasonable target goal may be a weight loss of 10% of body weight over six months.
• In some case, minimum goal may be to prevent further weight gain.
• It is best to lose weight gradually—keep in mind that small amount of weight loss can have positive health impact.
2) Best Health Diet Tips:
• Drink plenty of water or other calorie free beverages.
• Think about what you can add to diet, not what you should take away.
• Consider whether you are really hungry.
• Be choosy about nighttime snacks.
• Enjoy your favourite foods.
• Eat several mini-meals during the day.
• Eat protein at every meal.
• Order children’s portion at restaurants.
• Use non-food alternative to cope with stress.
• Have oily free food and also avoid junk foods like pizzas,burgers,etc.
• Avoid to have food while watching television.
3) Be as active as possible:
• Any kind of physical activity is beneficial.Not only can it assist with weight loss & maintenance,it also improves health in many ways.
• Work towards a long term goal of atleast 30 minutes of a moderate physical activity on most days of the week.
• It is best to start any new physical activity gradually,taking special care to prevent injury.
4) Choose Aerobic activities that are fun:
People are more likely to remain active if they like what they are doing.Choose activities accordingly:
• Brisk walking or jogging
• Bicycling
• Swimming
• Aerobic exercise classes
• Dancing
• Playing basketball or soccer
5) Be Good to yourself:
Try some of this ideas to help relieve stress and stay on track with your fitness and nutrition goals.
• Get plenty of sleep.
• Practise deep breathing and relaxing muscles one at a time.
• Take a breath and go for a walk.
• Take short stretch breaks throughout the day.
• Try taking yoga class to energize yourself and reduce stress.
• Try a new hobby,like a pottery class.
• Surround yourself with company of enjoyable people.
• Laughter is one of the most relaxing thing.
• Think of activities that will give your spirit a little lift.
6) Weigh every week & keep records:
• People who weigh once a week tends to be more successful at maintaining a weight loss.
• Keeping records is helpful in assessing overall progress in weight.
• Keeping a record of food consumed each day can help maintain the focus on diet plan and provide additional information related to progress.
• Keeping an activity chart can help in keeping track of whether physical activity goals are being met.
• Keep realistic fitness goals.
7) Role of medication in the treatment of Obesity:
Medication treatment of obesity should be used only in patients who have health risks related to obesity—such as Diabetes,Hypertension,etc.
Like diet and exercise, the goal of medication treatment should be realistic.With successful medication treatment, one can expect an initial weight loss of at least 5 pounds during 1-3 months of treatment and a total weight loss of 10-15% of the initial body weight.
8) Surgery for Obesity:
For those severely obese patients and associated all risk factors of obesity, Bariatric surgery offers good option not only to reduce weight but also relief in risk factors.

BY:
DR CHETAN LALSETA
M.D.(Skin & V.D.)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
“C POINT”—A UNIT OF MCSPL COMPANY
SHRADDHA HOSPITAL,INDIRA CIRCLE CHOWK,
RAJKOT-04
9825199585
chetanlalseta@gmail.com
www.cpoint.com
www.drlalsetablogspot.com

Sponsored by the business degree web page.

SKIN CHANGES DURING PREGNANCY

COMMON DERMATOLOGICAL MANIFESTATIONS DURING PREGNANCY
Pregnancy is a physiological event and skin being a dynamic organ, variety of skin changes can be seen during pregnancy.Some of the commonest one,usually harmless, are mentioned here and how one can help to overcome them.
SKIN CHANGES DURING PREGNANCY INCLUDES:
1) Stretch marks(Striae)
2) Skin tags
3) Changes in hair growth
4) Acne vulgaris
5) Pregnancy glow
6) Generalised hyperpigmentation
7) Accentuation of moles & freckles

1) What are stretch marks(striae)?
Stretch marks are linear lesions that most often develop over the breasts,hips,abdomen & thighs. They begin as reddish purple lines and with time,they become white atrophic(cigarette paper like wrinkled) scars.Stretch marks are common in pregnancy and it occurs in 50 to 90% of pregnant women.
Do stretch marks cause any symptoms?
Most of the times they are aymptomatic but rarely may cause burning and itching.
What causes stretch marks in pregnancy and who gets them?
The exact mechanism of development of stretch marks is still not fully understood.It is commonly thought to be caused by rapid weight gain and subsequent overstretching of the skin;though not proven.
Stretch marks are often seen in more than one family member.A personal history(e.g.appearance of striae during teens),race(more common in Africans compared to Caucasians)and other genetic factors play part in the development of stretch marks.They are more frequently seen in young women who are overweight and have large babies.
When do stretch marks appear during pregnancy?
Usually stretch marks begin to appear around 25th week of pregnancy,although some women may develop even earlier.
Is there any health risk if stretch marks are present?
No there are no risks associated with stretch marks. However they may look cosmetically unpleasant and may cause emotional distress.
What happens to stretch marks after delivery?
Most of the stretch marks fade of its own after delivery.
Can stretch marks be treated or prevented?
There are no good and satisfactory proven treatments to treat or prevent stretch marks.Many therapies are done empirically and may offer some benefit in few cases.
Olive oil massage,castor oil,cocoa butter soothing,glycolic or fruit acids,homeopathic creams and/or oils are used with little effects.Many expensive and painful treatments are often tried without any outcome and hence is not recommended.
Daily massage of the skin with simple moisturizer may be tried
Post pregnancy retinoids can be used as they help to fade stretch marks-however they are absolutely contraindicated during pregnancy because of their potential harmful effect on foetus. LASER treatment (585 nm flashlamy-pulsed dye laser) may be effective in some cases.

2) SKIN TAGS(ACROCORDON):
Skin tags are very small 1-5 mm,loose,polyp like,skin coloured growths of skin that usually appear in underarms,neck or breasts.The increased incidence of skin tags during pregnancy is hormonally induced at areas exposed to mechanical irritation.They may disappear after delivery.However if they persists, can easily be removed by electrocautery,radiofrequency or CO2 LASER.
3) CHANGES IN HAIR GROWTH:
During pregnancy more hair goes into the resting phase,a particular part of the normal hair cycle.This causes diminished shedding of the hair and is perceived as hair thickening by patient.Three months after delivery the hair cycle normalizes causing temporarily more hair loss in many women.This is known as Telogen Effluvium.This process is usually completed in 6-12 months after delivery.Thereafter the hair will usually be the same as before pregnancy.
Pregnant women may sometimes experience male pattern hair growth like in beard region.This phenomenon is also related to hormonal change.It tends to disappear in few months after delivery.
4) ACNE VULGARIS:
The increased levels of female hormones during pregnancy usually improves acne. But there may be worsening of acne in some patients.
5) PREGNANCY GLOW:
During pregnancy the blood circulation of the skin is significantly increased which causes face to be brighter.The increased production of hormones may stimulate glands that produce sebum resulting in shiny face.”Pregnancy glow” is an old fashioned phrase to describe this phenomenon.
If patient feels skin too oily,an oil free cleanser or a mild alcoholic (50-70%) solution containing salicylic acid(1-3%) for cleansing the face can be used.Cold and warm water may also be used.
6) GENERALISED HYPERPIGMENTATION:
Increased skin pigmentation is common during pregnancy particularly in dark skinned women in whom up to 90% may be affected.There is darkening of nipples,genitalia and linea alba will develop.In some women recent scars will darken.The unsightly and sometimes distressing facial pigmentation called melasma or chloasma also known as ‘Mask of pregnancy’affects many women.It gets worse with sunlight and can be reduced by the use of High Sun Protective Factor UVB & UVA sunscreens.It usually disappears after pregnancy by itself,if not it may be treated by Dermatologists.



BY:
DR CHETAN LALSETA
M.D.(Skin & V.D.)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
“C POINT”—A UNIT OF MCSPL COMPANY
SHRADDHA HOSPITAL,INDIRA CIRCLE CHOWK,
RAJKOT-04
9825199585
chetanlalseta@gmail.com
www.cpoint.com
www.drlalseta.blogspot.com

Mirror skin polishing & brightening treatment

Introduction
Our skin tends to get affected by external & internal factors like stress, hectic lifestyles & increasing levels of environmental pollution. As a result skin is dull, dry, dehydrated with reduced elasticity. There are many procedures available today that help to rejuvenate skin. MIRROR Skin Polishing & Brightening or ‘Microdermabrasion’ as it is commonly known is one of the most effective yet safe technologies available. This regime is a breakthrough in skin treatment. If your skin needs to regain its natural radiance and skin clarity, this is the perfect treatment for it.

MICRODERMABRASION.

It is a skin procedure done at MIRROR to enhance the quality of the skin. It is a machine- based manually controlled abrasion of the superficial layer of skin. 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’S ABOUT MIRROR SKIN POLISHING & BRIGHTENING TREATMENT

Why does one need Skin Polishing & Brightening? At what age can one start this service?

MIRROR Skin Polishing & Brightening 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 MIRROR Skin Polishing & Brightening.Practically in post pubertal age group,in both males & females, this treatment can be done safely & effectively.

How is Skin Polishing & Brightening different from facials?
The MIRROR Skin Polishing & Brightening 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.
It can be used synergistically with chemical peels when better results are expected.


What is the procedure involved in MIRROR Skin Polishing and Brightening?
Crystal Sensitivity Check: on your forearm
Cleansing the face is then cleansed with the MIRROR 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 MIRROR 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.



MIRROR 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 MIRROR Skin Polishing and Brightening Safe?
Yes,MIRROR Skin Polishing & Brightening is an extremely safe procedure and is recommended for all skin types. At MIRROR 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 MIRROR Skin Polishing and Brightening treatment?
MIRROR skin polishing & Brightening 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 MIRROR Skin Polishing & Brightening?
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 of MIIRROR Skin Polishing and Brightening usually lasts about 30 minutes per session.

Can I return to regular activities immediately after a session of MIRROR Skin Polishing & Brightening?
MIRROR Skin polishing and Brightening 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?
To maintain the look achieved one monthly session is recommended.Can I undertake MIRROR Skin Polishing & Brightening just before a special occasion such as a party?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 MIRROR skin lightening & brightening procedure 2 to 3 prior to occasion.
FOR QUERIES OR COMMENT,CONTACT;
DR CHETAN LALSETA
M.D.(SKIN & V.D.)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
MIRROR LASER & COSMETIC CENTRE,
( A UNIT OF MCSPL COMPANY)
SHRADDHA HOSPITAL,
INDIRA CIRCLE CHOWK,
RAJKOT-04
CONTACT NO: 98251 99585
Chetanlalseta@gmail.com

HAIR DISORDERS

HAIR DISORDERS

Hair disorders are amongst the common skin problems affecting all class of population at one or another time. Commonest of them are briefly mentioned here.
1) ALOPECIA AREATA:
Definition and clinical features
A non-scarring auto immune disorder affecting any hair-bearing area. Typically, there is a sudden onset of solitary or multiple circular or oval bald areas,usually affecting the scalp.The residual hair follicles are visible confirming a lack of scarring.Diagnostic exclamation mark hairs may be visible at the margins of the lesion. The affected scalp is usually normal in color but may be erythematous.Hairs at the edge of the patch may be easily removed on slight traction. Spontaneous regrowth frequently occurs but the areas may spread peripherally and may eventually involve the whole scalp( Alopecia Totalis) and sometimes even facial & body hairs( Alopecia Universalis).
Rarely, a diffuse alopecia may be seen without discrete bald patches.Nail changes may also occur as fine regular pitting or a roughened sand paper appearance(Trachyonychia).
Epidemiology
A common disorder affecting all races and either sex equally. It occurs at any age,with maximum incidence between 10-30 years.
Differential Diagnosis
Fungal infection of scalp—may be confirmed by Wood’s light and mycological examination.Trichotillomania—shows broken hairs of varying length.Telogen effluvium also causes diffuse non-scarring alopecia.
Investigations
An autoimmune basis is suggested.Organ specific antibodies may be demonstrated. A family history of alopecia areata occurs in 20-50% of patients. Scalp biopsy is supportive.
Management
Spontaneous regrowth may occur in localized disease.Topical,intralesional & systemic corticosteroids can produce temporary regrowth.Contact sensitization therapy using irritants or allergens & PUVA are also used. The more extensive the hair loss, the less likely the prospect of regrowth.Extensive involvement, atopy, other autoimmune diseases, nail involvement and onset in childhood are poor prognostic factors.

2) TELOGEN EFFLUVIUM:
Definition and clinical features
Sudden extensive hair loss occurring 4-8 weeks following the precipitating event. Several hundred hairs may be lost per day, producing an alopecia diffusely affecting the entire scalp.Pre-existing androgenetic alopecia may become more evident, the scalp appears normal and duration is variable(recovery is usually complete within 6 months).
Epidemiology
Occurs at any age but most frequently in young adults.Female:Male ratio is 2:1.
Differential Diagnosis
Diffuse scalp alopecia can also occur with alopecia areata, hypothyroidism,iron deficiency,anaemia,and may be caused by drugs.
Investigations
Trichogram (plucked scalp hairs) will show an increase in the number of telogen hairs and reduction in anagen hairs.
Special points
Acute precipitating factors include childbirth,pyrexia, haemorrhage,changing or discontinuing hormonal therapy(including oral contraceptive pills),eating disorders,strict dieting and nutritional deficiencies.
3) ANDROGENETIC ALOPECIA(MALE PATTERN BALDNESS):
Definition and clinical features
Miniaturisation of hair follicle through successive cycles affecting the fronto-vertex and crown of the scalp, producing a gradual conversion of terminal to villus hairs. The scalp hair loss begins with recession at the temples and the frontal hairline in men(Hamilton pattern) and thinning over the crown and vertex. This slowly progresses over years, in severe cases hair remains at the occiput and sides of the scalp alone.Vellus hair may remain on the vertex.In women(Ludwig pattern) the frontal hairline is frequently kept but a difuse thinning occurs over the top of the scalp.In women, associated hirsutism,acne vulgaris,obesity and irregular menses may suggest an underlying polycystic ovarian syndrome.
Epidemiology
Affects all races world wide, occurring physiologically from the late teens to the 50s.In women, occurs usually post menopausally.The condition requires genetic predisposition and normal amounts of circulating plasma androgens.
Differential Diagnosis
Telogen effluvium may produce diffuse alopecia but usually affects the back and sides of the scalp as well as the fronto-vertex.Hair styles producing traction may cause recession of the anterior hair margin.
Investigations
In women,hormone profile and ovarian ultrasound scan may confirm underlying polycystic ovarian syndrome.
Management
Treatment includes topical measures such as Minoxidil lotion, systemic antiandrogens in women or scalp reduction or hair transplantation surgery.
4) TRICHOTILLOMANIA:
Definition and clinical features
Self-induced alopecia produced by deliberate trauma to the hair. A diffuse area of thinned hair with a poorly defined margin.Scalp skin is normal.Affected hairs show breakage of varying lengths.The area may be solitary or multiple. A normal,long haired margin often remains.The scalp is usually affected but hair loss may also occur in the eyebrows, eyelashes or body hair.
Epidemiology
Trichotillomaia occurs more frequently in females than males(3:1) but may occur at any age.Most frequently it occurs between the ages of ages of 5 & 10 years developing as a habit tic.In older women it may be a sign of underlying psychiatric disorder.Anxiety & emotional stress are precipitating factors.
Differential Diagnosis
Alopecia areata produces more discrete,completely bald areas of patches.Tinea capitis can produce broken hairs,scaling and inflammation may be present.
Investigations
Hair microscopy will reveal broken hairs of varying lengths.
Management
Occlusion of the area often allows recovery.Children frequently outgrow the habit tic,whilst in adults psychiatric therapy may be required.



BY:
DR CHETAN LALSETA
M.D.(SKIN & V.D.)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
MIRROR LASER & COSMETIC CENTRE,
SHRADDHA HOSPITAL,
INDIRA CIRCLE CHOWK,
RAJKOT-04
CONTACT NO: 98251 99585
Chetanlalseta@gmail.com

HAIR DISORDERS

HAIR DISORDERS

Hair disorders are amongst the common skin problems affecting all class of population at one or another time. Commonest of them are briefly mentioned here.
1) ALOPECIA AREATA:
Definition and clinical features
A non-scarring auto immune disorder affecting any hair-bearing area. Typically, there is a sudden onset of solitary or multiple circular or oval bald areas,usually affecting the scalp.The residual hair follicles are visible confirming a lack of scarring.Diagnostic exclamation mark hairs may be visible at the margins of the lesion. The affected scalp is usually normal in color but may be erythematous.Hairs at the edge of the patch may be easily removed on slight traction. Spontaneous regrowth frequently occurs but the areas may spread peripherally and may eventually involve the whole scalp( Alopecia Totalis) and sometimes even facial & body hairs( Alopecia Universalis).
Rarely, a diffuse alopecia may be seen without discrete bald patches.Nail changes may also occur as fine regular pitting or a roughened sand paper appearance(Trachyonychia).
Epidemiology
A common disorder affecting all races and either sex equally. It occurs at any age,with maximum incidence between 10-30 years.
Differential Diagnosis
Fungal infection of scalp—may be confirmed by Wood’s light and mycological examination.Trichotillomania—shows broken hairs of varying length.Telogen effluvium also causes diffuse non-scarring alopecia.
Investigations
An autoimmune basis is suggested.Organ specific antibodies may be demonstrated. A family history of alopecia areata occurs in 20-50% of patients. Scalp biopsy is supportive.
Management
Spontaneous regrowth may occur in localized disease.Topical,intralesional & systemic corticosteroids can produce temporary regrowth.Contact sensitization therapy using irritants or allergens & PUVA are also used. The more extensive the hair loss, the less likely the prospect of regrowth.Extensive involvement, atopy, other autoimmune diseases, nail involvement and onset in childhood are poor prognostic factors.

2) TELOGEN EFFLUVIUM:
Definition and clinical features
Sudden extensive hair loss occurring 4-8 weeks following the precipitating event. Several hundred hairs may be lost per day, producing an alopecia diffusely affecting the entire scalp.Pre-existing androgenetic alopecia may become more evident, the scalp appears normal and duration is variable(recovery is usually complete within 6 months).
Epidemiology
Occurs at any age but most frequently in young adults.Female:Male ratio is 2:1.
Differential Diagnosis
Diffuse scalp alopecia can also occur with alopecia areata, hypothyroidism,iron deficiency,anaemia,and may be caused by drugs.
Investigations
Trichogram (plucked scalp hairs) will show an increase in the number of telogen hairs and reduction in anagen hairs.
Special points
Acute precipitating factors include childbirth,pyrexia, haemorrhage,changing or discontinuing hormonal therapy(including oral contraceptive pills),eating disorders,strict dieting and nutritional deficiencies.
3) ANDROGENETIC ALOPECIA(MALE PATTERN BALDNESS):
Definition and clinical features
Miniaturisation of hair follicle through successive cycles affecting the fronto-vertex and crown of the scalp, producing a gradual conversion of terminal to villus hairs. The scalp hair loss begins with recession at the temples and the frontal hairline in men(Hamilton pattern) and thinning over the crown and vertex. This slowly progresses over years, in severe cases hair remains at the occiput and sides of the scalp alone.Vellus hair may remain on the vertex.In women(Ludwig pattern) the frontal hairline is frequently kept but a difuse thinning occurs over the top of the scalp.In women, associated hirsutism,acne vulgaris,obesity and irregular menses may suggest an underlying polycystic ovarian syndrome.
Epidemiology
Affects all races world wide, occurring physiologically from the late teens to the 50s.In women, occurs usually post menopausally.The condition requires genetic predisposition and normal amounts of circulating plasma androgens.
Differential Diagnosis
Telogen effluvium may produce diffuse alopecia but usually affects the back and sides of the scalp as well as the fronto-vertex.Hair styles producing traction may cause recession of the anterior hair margin.
Investigations
In women,hormone profile and ovarian ultrasound scan may confirm underlying polycystic ovarian syndrome.
Management
Treatment includes topical measures such as Minoxidil lotion, systemic antiandrogens in women or scalp reduction or hair transplantation surgery.
4) TRICHOTILLOMANIA:
Definition and clinical features
Self-induced alopecia produced by deliberate trauma to the hair. A diffuse area of thinned hair with a poorly defined margin.Scalp skin is normal.Affected hairs show breakage of varying lengths.The area may be solitary or multiple. A normal,long haired margin often remains.The scalp is usually affected but hair loss may also occur in the eyebrows, eyelashes or body hair.
Epidemiology
Trichotillomaia occurs more frequently in females than males(3:1) but may occur at any age.Most frequently it occurs between the ages of ages of 5 & 10 years developing as a habit tic.In older women it may be a sign of underlying psychiatric disorder.Anxiety & emotional stress are precipitating factors.
Differential Diagnosis
Alopecia areata produces more discrete,completely bald areas of patches.Tinea capitis can produce broken hairs,scaling and inflammation may be present.
Investigations
Hair microscopy will reveal broken hairs of varying lengths.
Management
Occlusion of the area often allows recovery.Children frequently outgrow the habit tic,whilst in adults psychiatric therapy may be required.



BY:
DR CHETAN LALSETA
M.D.(SKIN & V.D.)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
MIRROR LASER & COSMETIC CENTRE,
SHRADDHA HOSPITAL,
INDIRA CIRCLE CHOWK,
RAJKOT-04
CONTACT NO: 98251 99585
Chetanlalseta@gmail.com

DRUG ERUPTIONS

DRUG ERUPTIONS

Drug eruptions are probably the most frequent manifestation of drug sensitivity. Their true incidence is difficult to determine because mild and transitory eruptions are often not recorded and because skin disorders may be falsely attributed to drugs. Certain patient groups are at increased risk of developing an adverse drug reaction. The ampicillin induced rash seen in patients with Infectious mononucleosis is a classical example. Elderly patients and patients with AIDS appear predisposed to adverse drug reactions. Most commonly drugs causing adverse drug reactions are Antimicrobial agents, Antipyretic/ Antiinflammatory analgesics, Antipschycotics & Antihypertensives agents.

1) EXANTHEMATIC( MACULOPAPULAR REACTIONS):

Definition and Clinical features:

The commonest of all cutaneous drug eruptions, occurring in 2-3% of patients, and seen with almost any drug at any time up to 3 weeks after administration.
Typically, there is fine erythematous morbilliform maculopapular eruption of the trunk and extremities that may become confluent. Exanthematic drug reactions often start in areas of trauma or pressure and can be very variable,with either predominantly small papules, or large macules , a reticular eruption , or polycyclic or sheet – like erythema. Intertriginous areas may be favoured, palmar & plantar involvement can occur and face may be spared. Purpuric lesions are common on the legs and erosive stomatitis may develop. Drug exanthema may be accompanied by fever,pruritus and eosinophilia. These eruptions usually fade with desquamation, sometimes with post inflammatory hyperpigmentation.

Drug Associations:
Drugs commonly causing exanthematic reactions include—ampicillin & penicillin,sulfonamides,phenylbutazone,phenytoin,carbamezapine,gentamicin and gold.

2) BULLOUS DRUG ERUPTIONS:

Definition, Clinical features and Drug Associations:

This is a heterogenous group involving many different clinical reactions & mechanisms. Pemphigus and pemphigoid may be drug induced. Penicillamine induced pemphigus is usually of the foliaceus type, while captopril causes a pemphigus vulgaris type eruption. Cicatricial pemphigoid has been described with clonidine and previously with practolol. Fixed eruptions and drug induced vasculitis may have a bullous component, while toxic epidermal necrolysis has widespread blistering. A number of drugs may induce phototoxic bullae. Bullae, often at pressure points, can be present in patients comatose after overdosage with barbiturates, methadone, tricyclic antidepressants and benzodiazepines.

3) URTICARIA:

Definition and clinical features:


Urticaria is the second most common allergic cutaneous reaction to drugs. Allergic urticaria is the cutaneous manifestation of a Type 1( IgE antibody mediated) or Type 3(immune complex mediated) hypersensitivity reaction. Some drugs,e.g. morphine & codeine, can act as direct histamine liberators. Urticaria may accompany serum sickness reactions or systemic anaphylaxis.
Urticaria appears as firm,erythematous,oedematous plaques with normal overlying epidermis and no scaling. Lesions characteristically last for less than 24 hours and are replaced by new lesions in different sites. Giant, papular, arcuate and annular lesions may be seen. Angio-oedema may occur. Pruritus is prominent and bronchospasm,hypotension and eosinophilia may occur. Urticaria usually resolves quickly when the offending drug is withdrawn but,not uncommonly,episodes of urticaria may persist for several weeks after drug discontinuation.

Drug Associations:

Penicillin and salicylates are common provokers. Other commonly implicated agents includes blood products,vaccines,radiocontrast agents,NSAIDS,opiates,cephalosporins & ACE inhibitors.

4) STEVENS-JOHNSON SYNDROME:

Definition and clinical features:

Stevens-Johnson syndrome is a severe variant of erythema multiforme(EM) characterized by widespread involvement of mucosal surfaces.
A prodrome of fever, malaise and prostration is followed by eruption of mucosal bullae, with or without the widespread cutaneous target lesions of EM. Mucosal surfaces, commonly the oral mucosa, respiratory tract and conjunctiva may be extensively involved and secondary infection is common. Morbidity is significant with pain, ocular complications, respiratory compromise,dysuria and difficulty maintaining adequate oral fluid intake.

Drug Associations:

Erythema Multiforme is more commonly precipitated by various infections,but both EM and S J Syndrome can be drug induced. Commonly incriminated are sulfonamides,NSAIDS, barbiturates, phenylbutazone, phenytoin,carbamezapine,phenothiazines,chlorpropamide,thiazide diuretics and malaria prophylaxis.

5) FIXED DRUG ERUPTION:

Definition and clinical features:

A cutaneous reaction that characteristically recurs in the same site(s) each time the drug is administered. Usually just one drug is involved but cross-sensitivity to related drugs may occur. Typical lesions are well demarcated, round or oval,erythematous,dusky plaques with subsequent post inflammatory hyperpigmentation. Bullae are quite common.Lesions arise within 8 hours of drug administration and are common on the extremities, genitalia and perianal areas, Mucous membrane may be involved.

Drug Associations:

A large number of drugs have been reported,but especially tetracyclines,sulphonamides,oxyphenbutazone and fluroquinolones are known to cause fixed drug eruption.

BY:
DR CHETAN LALSETA
M.D.(SKIN & V.D.)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
MIRROR LASER & COSMETIC CENTRE,
SHRADDHA HOSPITAL,
INDIRA CIRCLE CHOWK,
RAJKOT-04
CONTACT NO: 98251 99585
Chetanlalseta@gmail.com

HYPERMELANOSIS--PIGMENTARY DISORDER

HYPERMELANOSIS
Hypermelanosis are a group of disorders characterized by abnormally darker skin that results from increased melanin production from a normal number of melanocytes. Disorders characterized by a higher than normal population density of melanocytes in the skin are usually referred to as “hypermelanocytes”.
Hypermelanoses may result from increased melanin in the epidermis (epidermal hypermelanoses) or the presence of melanin in the dermis(dermal hypermelanoses). Possible mechanisms for increased epidermal melanin without an increase in the number of melanocytes include the following:
· Increased melanosome production and transfer to keratinocytes;
· Increased melanosome size; and
· Decreased keratinocyte turnover, resulting in overloading of the keratinocyte with melanosomes.

In dermal hypermelanoses, melanosomes are formed in the epidermis by epidermal melanocytes & are transferred to the dermis, where they are found mostly within macrophages(melanophages). This phenomenon is called “epidermal melanin incontinence”.
Hypermelanoses can have sometimes characteristics anatomical distribution pattern.
Thus, Hyperpigmentation in the skin can result from:
1) Increased production of the melanin pigment, or pigment incontinence,
2) Accumulation of a large number of melanocytes, or
3) Deposition of other ( non-melanin) pigments or substances in the skin.
CLINICAL PRESENTATION OF FACIAL HYPERMELANOSIS
Hyperpigmentation disorders can be inherited or acquired, resulting from alterations occuring at any level in the melanogenesis pathway.
In clinical practice, acquired hyperpigmentations including Melasma, Post inflammatory hyperpigmentation, Solar lentigines and dyschromias of photoaged skin, represent the most commonest disorders of pigmentation.
CAUSES:
· Melasma (Chloasma)
· Post Inflammatory Hyperpigmentation
· Solar lentigines
· Phototoxic Dermatitis
· Erythema Dyschromicum Perstans
· Poikiloderma of Civatte
· Riehl’s melanosis
· Peribuccal Pigmentation of Brocq
· Drug induced facial hyperpigmentation
· Facial hypermelanosis secondary to systemic disorders
Exposure to sunlight, genetic predisposition, use of cosmetics and certain drugs are implicated in the pathogenesis of most facial hypermelanoses.

TREATMENT
Diseases leading to hyperpigmentation in certain specific disease patterns do require attention & treatment.
The most effective treatment of hyperpigmentation is PREVENTION. Individuals from different ethnic backgrounds have different skin types. The protection against ultraviolet radiation cannot be overemphasized.
If hyperpigmentation occurs, a variety of treatment modalities are available.
The choice of proper treatment should take into account the type of melasma to be treated, the skin complexion of the patient, possible previous treatments, the expectations and compliance of the patient 7 the season iin which the treatment is started.
Cosmetic camouflage may help in certain case though it is a temporary solution.
Different treatment options available includes Pharmacological treatment, Chemical peeling & Physical treatment.
Critical points, such as patient selection, disease improvement and treatment safety evaluation should be considered to choose the best option for the patient.
Despite the choice of chemical peeling, lasers and other physical procedures, pharmacological management with hypopigmenting agents remains the cornerstone of the pigmentation therapy.
PIGMENTATION CONTROL TARGETS & EFFECTIVE AGENTS.
Pigmentation Control Target Effective Agents
Tyrosinase Inhibition Hydroquinone, resorcinols, kojic acid
Arbutin, ascorbic acid.
Tyrosinase copper chelation Ellagic acid
Inhibition of tyrosinase glycosylation Glucosamine
Melanosome transfer Niacinamide, protease inhibitors
Downregulation of tyrosinase Retinoids
Antioxidants Vitamin C compounds, Vit E
Antiinflammatory agents Hydrocortisone, phytosterol
Increased Epidermal turnover Retinoids, salicyclic acid

COMPREHENSIVE APPROACH:
Both Physicians & Dermatologists are searching for long term solutions for hyperpigmentation problem.
The association of depigmenting agents with different mechanism of actions that act at different steps in pigmentation pathways is a useful strategy to improve clinical efficacy, reducing the duration of therapy and the risk of adverse events.
The combination approach should ideally be able to give faster results and increase patient compliance-----the key in pigmentation therapy.


BY:
DR CHETAN LALSETA
M.D.(SKIN & V.D.)
CONSULTANT DERMATOLOGIST &COSMETOLOGIST
MIRROR COSMETIC CENTRE,
SHRADDHA HOSPITAL,
INDIRA CIRCLE CHOWK,
RAJKOT-04
CONTACT NO: 98251 99585
Chetanlalseta@gmail.com