Today, we’ll discuss about Insect bite allergy in children, which is also known as Papular utricaria, in medical terms.
What is it ?
In many children, it is seen that after any kind of insect bite, for example from mosquito, fly, ants etc. there is itching, rashes in the affected area. Sometimes the itching is so intense, it causes wounds, skin vesicles as well as secondary infections such as bacterial infections in the affected area. This can cause pit formation or large wounds, which gradually dries up and leaves a black scar.
This is a major cause of worry for the parents, who are not able to understand the cause and start doctor shopping, which means to frequently change doctors for consultation and treatment.
But it is advised for them not to do so and understand that this is just a case of hypersensitive reaction (allergy) which is caused due to insect bite.
This condition can appear in children as early as 1.5 to 2 years of age and it has a very high rate of recurrence. It can last up to 10 to 14 years of age.
Parents are advised to make their children wear full sleeves, to minimize exposure to insect, especially in the areas of arms, legs and the face.
However, this condition is not contagious and is not very serious or harmful. But it is advised to consult a dermatologist as early as possible, because there are high chances of secondary infections, as discussed earlier.
DIAGNOSIS
Diagnosis is done by examination of the patient and should be confirmed by a dermatologist because there can be other skin diseases with similar symptoms, such as :-
Scabies
Atopic dermatitis
Eczema
Viral rash
TREATMENT
Soothing agents, such as Calamine, moisturizers etc.
Steroid cream
Antibiotic cream, in combination with steroids, in case of secondary infection
In case of severe secondary infection, oral antibiotics are given.
Anti histamine – Cetrizine, Levocetrizine, Hydroxyzine syrup, for reducing itching.
One must keep in mind that Papular utricaria cannot be treated rapidly, it takes time for the body to get desensitized to the insect bites. Gradually, our body releases hormones which make our skin skin resistant to allergy from the insect bites.
PREVENTIVE MEASURES
Use mosquito nets, and wear full sleeved clothes.
Insect repellant creams and lotions, such as odomos can be used after patch testing, that is to see whether it’s suitable for the skin of the child.
Blog by: Dr. Uttam Kumar Lenka, Consultant Dermatologist. Kolkata.
We all have heard about high cholesterol levels in the blood, in many people. But when there is deposition of cholesterol in the skin, this condition is called Xanthelasma.
Most commonly, it is manifested as deposition of yellow tissues in the upper layer of the skin of the eyelids. But in severe cases, this deposition can occur all around the area of the eye.
WHEN DOES IT OCCUR ?
Xanthelasma is usually seen to occur in people over 40 to 50 years of age.
However, in families where either of the parents are having this condition, the children can get this condition much earlier in life.
WHY DOES IT OCCUR ?
There is no documentation or study as of yet, of the definite cause of this condition.
However, it is usually seen in people with high levels of blood cholesterol.
But in 50% cases, the patient is seen to have normal levels of blood cholesterol and in those cases, the cause of occurrence of this condition is not known.
It can occur as a side effect of taking various medicines, for example steroids, cyclosporine, retinoid, and medicines for HIV etc. and there are many such medications, which increase the blood cholesterol level of the patient, which can cause Xanthelasma.
SYMPTOMS
Xanthelasma has no painful symptoms, neither does it cause irritation or itching of the affected area.
The only thing that the patient may face is cosmetic problem. Since it looks bad over the skin, people may tend to avoid social gatherings and it may lower their self confidence. For this reason, people suffering with this condition tend to seek treatment.
DIAGNOSIS
The diagnosis can easily be done through clinical examination and can be done by the patient only.
However, there are some other diseases which present similar symptoms and can be confused with Xanthelasma. For example :-
Syringoma
Necrobiotic Xanthogranuloma
In such cases, other tests are done to confirm the diagnosis.
TREATMENT
There are many available methods of treatment. However no treatment guarantees to be fully effective and there are always chances of recurrence.
The available methods of treatment are :-
Surgery – It involves surgical removal of the tissues where there is deposition of cholesterol. This remains effective for 3 to 4 years, but there are still chances of recurrence after that.
Chemical cautery – This is done with 50 to 70 % Trichloroacetic acid. When applied over the affected area, frosting occurs and the skin peels off in 8 to 10 days and new skin comes in its place. This remains effective for 6 to 7 months and recurrence can occur as well.
However, this process has to done under strict supervision of a dermatologist as it is a very sensitive procedure, and if not done properly can damage your eye.
Electrocautery & Radiofrequency cautery – In which the affected tissue is burned by application of heat
LASER treatment – There are many options available for laser treatment such as Nd:YAG, Er:YAG etc.
*One should keep in mind whatever the method of treatment is, there is always a chance of recurrence. Therefore, it is recommended not to opt for expensive treatment methods such as laser, but instead cheaper methods are available such as chemical cautery, which can be easily repeated in case of recurrences.
For more details, kindly watch and subscribe to my Youtube Channel.
Blog by: Dr. Uttam Kumar Lenka, Consultant Dermatologist. Kolkata.
Today, we’ll discuss about Pimples, also sometimes called Acne or Muhase(मुंहासे) in hindi.
Why does it occur, what are the problems it can cause and how to get rid of it?
There are oil glands, also called sebaceous glands present in the deeper layer of our skin. These glands have ducts which open up in the surface of our skin. Oil (sebum) is produced within these glands and gets secreted via their ducts.
*Sebum is essential for the skin. It keeps the skin soft, smooth & shiny.
Problem/defect in secretion of these glands can cause pimples :-
Excessive oil secretion can cause pimples
If the secretion is normal, but there is blockage in the ducts or pores through which the oil/sebum is secreted, it causes pimples.
Bacterial infection can cause pimples – A specific bacteria called Propionibacterium Acne or simply P.acne feeds on the sebum produced by our glands and grows on it. Our body’s immune system tries to remove the P.acne bacteria and this reaction causes inflammation and painful Red bumps (acne) in the affected area.
CAUSES OF ACNE / PIMPLES
There can be multiple factors that can cause pimples or acne, some of the most common of which are discussed below :-
Genetic – It is observed that, if in a family the father or mother has a case of pimples, there is a good chance of it appearing in the children too.
Hormonal Imbalances – There are significant hormonal changes during the age of 13 to 25 years. This may cause increased activity of the sebaceous glands in our body, hence increased oil secretion and cause pimples.
Side effects of medicines , such as
Anti convulsants ( for example Carbamazepin, Phenytoin )
Anti Tubercular, used in treatment of Tuberculosis (Isoniazide)
Anti depressants (Lithium, Sertraline)
Side effect of steroids
Excessive use of cosmetics – Cosmetics which are oily / greasy, or which have high concentration of chemicals like Lanolin, Petrolatum etc, block the pores of our sebaceous glands, hence causes pimples.
Diet – There is no definite proof or data to show that our diet directly causes pimples but it is said that eating
High glycemic diet (containing high amount of sugars) &
Fast foods (especially which contains lots of oil) may cause pimples.
Also, there are many aggravating factors which do not cause pimples but, if there is someone already suffering from pimples, these factors can make the condition worse :-
Stress
Insomnia (lack of sleep)
For example, during exams, many students suffer from lack of sleep due to exam stress and anxiety, and this can aggravate the problem of pimples.
Hot & humid climate – hot climate causing excessive sweating can also lead to pimples.
SITES AFFECTED
There is a misconception among most people that pimple can only occur in the face. However, that is not at all true. Pimple can occur anywhere in our body, where there are sebaceous glands. For example, it can occur in :-
Face
Shoulder region
Chest region
The back, and even in the
Scalp region
TYPES OF ACNE
Neonatal Acne – It appears in the infant within 2 weeks after birth. It is caused due to the influence of maternal hormones.
Usually, there is spontaneous recovery by 1-3 months of age. Or it can be cured by giving medicine too.
Infantile Acne – Occurs in children during 6months to 16 months of age.
Pre-pubertal Acne – Occurs in children during 7 to 12 years of age.
Acne Vulgaris – Most common type of acne. Occurs in children during 13 to 25 years of age.
*Over 70-80% of individuals are affected during this age gap.
This does not cause any physical problems in our body, but it may lead to mental / psychological problems, as people often tend to see their faces in mirrors, and this can cause mental irritation. This may lead to lack of mental focus and self confidence.
Adult Acne – May occur in adults after 30 years of age. Usually, it occurs due to hormonal imbalances.
WHAT TO DO
In case of appearance of pimples, the first thing that you should do is consult a dermatologist.
This helps in proper diagnosis of your condition, as there are many skin diseases which mimic the appearance of pimples or acne.
Skin rashes mimicking acne are ;-
Milia
Trichoepithelioma
Gram negative Folliculitis
Acne Rosasea
Syringoma
Veruca Plana
Sycosis Barbae
After diagnosis, the severity or grade of acne / pimple is assessed.
The gradation of pimples is done as follows :-
Grade 1 – Pimple contains only black heads and white heads
Grade 2 – Papules are present along with black heads and white heads
Oral Isotretinoin – effective, and should be taken by dermatologist’s advice only.
Chemical peeling – In this process, certain chemicals such as Salicylic acid, Glycolic acid are used. They induce (a) rapid drying / clearing of pimples & (b) removes the pigmentation as well.
Also, in case of pregnant women, oral medicines are deferred, so it is an appropriate alterantive.
It is a highly effective way of treating pimples. For chemical peeling, you should consult your dermatologist. The number of sessions and the number of days required for this depends on the severity / grade of your condition.
LASER treatment – It is also an effective way of treatment, however it’s quite expensive as well.
*For doing chemical peeling or LASER treatment, always consult a dermatologist. Never do Laser in Saloon / Parlor, as it can cause various side effects, which can be bad for your skin.
DOs & DON’Ts
Early Treatment – People often tend to ignore their pimples, thinking that it will gradually go away. And yes, it might go away. But, if you delay its treatment, and it does not goes away on its own, this may lead to pigmentation (darkening of the skin) and scarring, which might remain for the rest of the life. This can reduce the self confidence of the individual.
Thus, you must always consult a dermatologist for effective and fast recovery.
Use face wash twice daily, after waking up and before going to bed.
Remove your makeup
Use Light moisturizer, which are Non-comedogenic, Aqua/Gel based. This will make your skin soft.
Use broad spectrum Sunscreen SPF 30 – There is a misconception that sunscreen aggravates pimples in oily skin. However, that is not true. There are many Non-comedogenic & Oil free sunscreens, which can be used to keep your skin healthy and pimple free.
Drink plenty of water
Include fresh fruits in your diet
Do NOT pop or squeeze your pimples – This may spread the inflammation and there are high chances of pigmentation occurring in that area.
Avoid using Over-the-counter (OTC) products or self medication – These medicines may reduce your pimples temporarily but may contain steroids which will actually flare up the pimples and cause many side effects.
10. Avoid excessive Scrubbing – Scrubbing won’t cause peeling off of your pimples but might aggravate your problem and cause inflammation in the area.
11. Do not experiment on your face – Do not use toothpaste or other sorts of home remedies on your face for removing your pimples.
Toothpaste contains a certain antibiotic called Triclosan, which may reduce inflammation, but it does not completely cures pimples. It is also not effective for everyone.
Experimenting on your face can cause various side effects such as allergic contact dermatitis, which will just worsen your condition and take more time for treatment.
For more details, kindly watch and subscribe to my Youtube Channel.
Blog by: Dr. Uttam Kumar Lenka, Consultant Dermatologist. Kolkata.
IGH (Idiopathic guttate Hypomelanosis). You might know about Vitiligo, it is an auto-immune disease in which people get white patches on their skin, which may spread all over their body.
However IGH is a totally different disease. It may look similar but it’s not at all related to Vitiligo.
🔹It usually occurs in patients above 50 to 60 years of age.
🔹In IGH, small white spots 2-5mm in diameter, usually occurs in hands and legs, and skin that’s more exposed to the sunlight, or in sites of skin damage.
🔹These are not painful and does not spread across the entire body. However this may cause cosmetic problems for many patients.
The main underlying cause of IGH is decreased melanin synthesis which causes loss of pigmentation and appearance of white spots.
There is still not a full proof way of curing IGH but various modes of treatment have been found to be effective on many patients, which are –
1. Cryotherapy – using liquid nitrogen spray on the affected area, which then regenerates
2. Tacrolimus ointment – which helps in repigmentation
3. Retinoid cream – which helps in tissue regeneration and reduces signs of aging by promoting collagen formation in tissues
4. Many people have tried laser treatment and chemical control with 88% phenol, which have proved effective in reducing the white spots. However it’s not hundred percent effective.
Finally, I’d like to say that IGH is just a sign of aging and not a disease as such. So nothing to be worried about. It is often seen in people whose parents also have this condition.
If you’ve got white spots or patches in your skin, I’d recommend you to visit a Dermatologist who could differentiate if you’ve got Vitiligo or IGH or any other disease with similar symptoms. Thank you.
For more details, kindly watch and subscribe to my Youtube Channel.
Blog by: Dr. Uttam Kumar Lenka, Consultant Dermatologist. Kolkata.
Today, we’re going to discuss about Lichen Simplex Chronicus abbreviated as LSC or sometimes also called as Circumscribed Neurodermatitis.
So let us discuss what is LSC, what causes it and how can it be treated.
In some people, areas of skin becoms thick and black due to excessive itching and may lead to ulcer. This is called LSC.
Now, why does this occur?
Well, no exact cause for this is known as of now. However, it if often found in people with high levels of stress and anxiety.
The problem with LSC is that it is known to occur in both healthy and diseased skin. Diseased skin meaning skin with Fungal infection such as
Tinea Corporis Atopic Eczema Seborrheic dermatitis etc.
There are many such skin diseases in which the skin starts to itch excessively. This causes tge skin to become thick and black. The skin creases and lines become unduly prominent. This marks the beginning of LSC disease.
Where is its most common site of occurrence?
Back of the neck
Ankle
Wrist
In the private parts of both genders, such as Vulva in females and Scrotum in males, and in the anus.
The problems faced by the patient
Paroxysmal or Severe itching which may cause skin ulceration, wounds or infection
Appearance – Skin becomes thick and black with prominent skin creases.
This is called Lichenification of skin, hence the name Lichen Simplex Chronicus. Chronicus means long term, that is, the symptoms may last for a long duration in an individual and is also seen to relapse, even after treatment.
DIAGNOSIS
Diagnosis of LSC is done by general Clinical examination of the symptoms.
However there are other skin diseases with similar symptoms such as :-
Localised or Hypertrophic Psoriasis
Lichen Planus Hypertrophicus
Seborrheic dermatitis
Chronic contact dermatitis
In case of the diagnosis not being accurate via clinical examination, Skin Biopsy is used to diagnose LSC.
TREATMENT
Use moisturizer frequently to prevent dryness of skin.
Many steroid ointments can be prescribed for treatment as follows :-
(i) Topical High potent Corticosteroid – such as Clobetasol, Halobetsol etc.
(ii) Topical Medium potent Corticosteroid – such as Mometasone, can be used with application of plaster for longer duration of effect.
*Never use steroid cream for a long period without tge advice of a dermatologist, as it may cause Thinning and Atrophy of the skin.
3. Other Topical creams such as Topical Doxepin, Calcipotrial, Tacrolimus, Pimecrolimus can be used for treatment. However, they are not as effective as the topical steroid ointments.
4. Initraleaional steroid injection can be used for treatment as well, if treatment using application of cream and ointments is ineffective.
However, the injection has to be administered by a professional Dermatologist only as there can be risk of appearance of white patches on skin, Skin atrophy or Pitting of the skin.
5. Advanced therapy includes Botox Therapy, which has been found to be effective in many cases but is still not considered as a full proof method of treatment.
Whatever the treatment might be, it should be kept in mind that LSC is a chronic diseas and is often seen to relapse in many patients. Thus, along with Cream / Ointments or injections, patients are sometimes given Oral medications which include Anti – histamines (to reduce itching) or in severe cases Oral steroids are given, but in small doses.
For more details, kindly watch and subscribe to my Youtube Channel.
Blog by: Dr. Uttam Kumar Lenka, Consultant Dermatologist. Kolkata.
