rickly heat? Don’t try talc
Your Health
DR GITA MATHAI
A genuine “Indian summer” is upon us now with temperatures all over the country in the high thirties and forties. Earlier, Indians used to wear white cotton clothes in summer but now most prefer to dress in synthetic silks, and polyester fabrics, little realising that those clothes are totally inappropriate in this weather.
Even school children — who are issued uniforms with the material and tailoring regulated by the school — end up wearing thick synthetic clothes when ideally they should wear pure cotton or at least a 60 per cent cotton and 40 per cent polyester mix.
To survive, our bodies need to maintain an average internal temperature of 98.6ºF or 36.6ºC and it uses sweating to regulate the temperature. When the outside temperature is high, the body secretes sweat from glands situated in the layer below the skin. The sweat reaches the surface through coiled tubes and forms a thin film of fluid. As this layer evaporates, the body cools down. Sweating can be excessive when the temperature is high, there is increased physical exertion, there is little or no circulation of air and if the clothes are made of synthetic material that traps the sweat. (Nowadays many sports companies manufacture sports clothes out of special material that “wicks” away the sweat).
If sweat pores get blocked (by dead skin cells, dirt or talcum powder), the trapped sweat forms tiny clear bumps below the surface of the skin called miliria crystalline (prickly heat). These look unsightly but do not really cause any symptoms. Eventually, they turn red (miliria rubra), and evolve into a brown scaly rash which can be confused with pimples, folliculitis or chicken pox.
Prickly heat usually appears in covered areas where sweat cannot evaporate easily or the pores are blocked. The forehead is affected if it is covered with a fringe or cap. The upper back and chest, and the arms are other common locations. In adults the rash sometimes appears on the inner thighs or in areas where there are body folds. It is aggravated by friction between the skin and tight fitting non-absorbent synthetic clothing. The continuous rubbing can lead to the skin eventually peeling off, leaving a raw red area.
Prickly heat causes itching and a tingling sensation but scratching can cause secondary infection with bacteria. The appearance of the rash then changes and there can be a yellow pus discharge. The person may develop fever. Uninfected prickly heat, however, does not cause fever. Although prickly heat is uncomfortable and unsightly, with a little care it can be easily prevented.
• Stay away from the direct heat of the sun as far as possible
• Wear loose fitting cotton clothes or at least a 60-40 mix of cotton and polyester
• Make sure school uniforms are stitched out of natural materials, preferably thin materials
• Try to ensure that schools have fans and ventilation.
• Do not scratch. The more you scratch, the more it will itch.
• Use a mild dose of antihistamine to control itching.
• Do not apply thick oil-based creams and talc. They will only block the pores further.
• Bathe two or three times a day in tepid water. Add a teaspoon of sodium bicarbonate to a bucket of water before bathing till the prickly heat disappears.
• Use soap containing trichlorhexidine (Dial, Neko) Do not apply soap directly to the skin. Use a moist wash rag, a herbal scrubber or a loofah.
• If prickly heat becomes red and pustular, changes appearance or the temperature rises, consult a doctor immediately.
Contrary to advertisements on television, talc does not soothe, relieve or prevent prickly heat. Talc is made up of finely powdered combinations of ground zinc stearate, and silicates. It blocks the skin pores, increasing the sweat build up and aggravating prickly heat.
Talc causes other medical problems as well. The size of the particles is so small that they can easily be inhaled. The particles can reach the smallest areas of the lung and cause pneumonia, inflammation or swelling of the airways. This can be fatal in babies. If applied to the groin and genital areas, talc can migrate through the vagina, uterus, and fallopian tubes to the ovary. Some scientific studies have found a relationship between the use of talcum powder and cancer of the ovary.
Baby powder is talc based and should not be used. Nappy rash is different from prickly heat and the treatment is different too.
If you get prickly heat, bathe two to three times a day. Use plain calamine lotion (not creams and ointment) to relieve the itching. If secondary infection has occurred, consult a doctor.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Sunday, May 29, 2011
Sunday, May 15, 2011
rabies
Animal bites
Your Health
DR GITA MATHAI
Dogs are man’s best friends. They may be street dogs, available for free, or expensive pedigreed animals. People from all walks of life have them at home. But dogs are also responsible for 90 per cent of rabies cases. India has around 30,000 reported deaths from this disease every year. The exact number, however, could be much higher as many cases are not diagnosed or reported.
Rabies is caused by a virus. Once it enters the body through a bite or lick from an infected animal, it travels silently along the nerves till it reaches the brain. This means that after an asymptomatic period — which can range from two weeks to two years — the person begins to experience symptoms. Initially, these are non-specific and may be mistaken for flu. There may be fever, headache and body pain. Later, there may be slight or partial paralysis with weakness of the limbs, anxiety, insomnia, confusion, agitation, terror and hallucinations. The throat muscles eventually become paralysed, making both speech and swallowing painful and later impossible. The person panics when presented with liquids to drink and cannot quench his or her thirst as the muscles go into painful spasms. Death usually occurs within two to 10 days.
It is difficult to suspect or diagnose rabies unless the person mentions the animal bite and also exhibits the classical symptoms of rabies. There is a fluorescent antibody test to demonstrate the presence of a viral antigen to confirm the diagnosis but it is available in very few centres.
Other animals like cats, monkeys, bats, rodents as well as horses and cattle too can transmit rabies. Unaware of this, in case of a bite by any of these animals, many people just apply an antiseptic solution and do not take it seriously. Human to human transmission of rabies does not occur unless a corneal or some other organ transplant has occurred from an infected donor.
House pets — dogs or cats — need to be immunised. Vaccines are available in government veterinary hospitals and private clinics. Booster injections have to be given every year as long as the animal lives. This is often not done, particularly as the animal gets older.
Children often play with stray animals. They are prone to attack but such bites are less likely to be reported. Even if it is a pet animal, a bite or scratch should be taken seriously. The pet’s immunisation may be incomplete or they may be asymptomatic carriers of the rabies virus. Also, there is a silent reservoir of infection from wild animals, which may have attacked the pet and run away unnoticed.
If scratched or bitten, the bruise must first be cleaned thoroughly with soap and water. Soap kills the viruses in the wound. Iodine — either tincture iodine or povidone (Betadine) — should then be applied. The wound should be left open. Suturing should be avoided as a closed environment allows further multiplication of the viruses.
A bite is graded according to its severity. A course of injections (immunoglobins and anti-rabies vaccine) should be started immediately. Prior to the advent of the human diploid cell and other newer vaccines, anti-rabies was injected in the abdomen around the navel. This regimen had many side effects, of which pain was the least sinister and most tolerable! In addition, bites require tetanus prophylaxis and antibiotic cover against aerobic and anaerobic bacteria, which may have infected the wound from the teeth.
A number of pharmaceutical companies market the newer vaccines. The dosage schedule is printed on the package insert and should be meticulously followed. Post-exposure prophylaxis is usually given on days 0, 3, 5, 7, 14 and 28. The injections should be administered intramuscularly in the shoulder and not the buttocks. That’s because the high fat content of the buttocks interferes with antibody production.
Pre-exposure prophylaxis (before the bite) consists of three injections on days 0, 7 and 28 with a booster every five years. It must be taken by all owners of pet dogs or cats, veterinary surgeons, laboratory workers and travellers, especially if they are going to pass through endemic areas where appropriate treatment for animal bites may not be readily available. If your children have a penchant for playing with animals, it makes sense to immunise them too.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
DR GITA MATHAI
Dogs are man’s best friends. They may be street dogs, available for free, or expensive pedigreed animals. People from all walks of life have them at home. But dogs are also responsible for 90 per cent of rabies cases. India has around 30,000 reported deaths from this disease every year. The exact number, however, could be much higher as many cases are not diagnosed or reported.
Rabies is caused by a virus. Once it enters the body through a bite or lick from an infected animal, it travels silently along the nerves till it reaches the brain. This means that after an asymptomatic period — which can range from two weeks to two years — the person begins to experience symptoms. Initially, these are non-specific and may be mistaken for flu. There may be fever, headache and body pain. Later, there may be slight or partial paralysis with weakness of the limbs, anxiety, insomnia, confusion, agitation, terror and hallucinations. The throat muscles eventually become paralysed, making both speech and swallowing painful and later impossible. The person panics when presented with liquids to drink and cannot quench his or her thirst as the muscles go into painful spasms. Death usually occurs within two to 10 days.
It is difficult to suspect or diagnose rabies unless the person mentions the animal bite and also exhibits the classical symptoms of rabies. There is a fluorescent antibody test to demonstrate the presence of a viral antigen to confirm the diagnosis but it is available in very few centres.
Other animals like cats, monkeys, bats, rodents as well as horses and cattle too can transmit rabies. Unaware of this, in case of a bite by any of these animals, many people just apply an antiseptic solution and do not take it seriously. Human to human transmission of rabies does not occur unless a corneal or some other organ transplant has occurred from an infected donor.
House pets — dogs or cats — need to be immunised. Vaccines are available in government veterinary hospitals and private clinics. Booster injections have to be given every year as long as the animal lives. This is often not done, particularly as the animal gets older.
Children often play with stray animals. They are prone to attack but such bites are less likely to be reported. Even if it is a pet animal, a bite or scratch should be taken seriously. The pet’s immunisation may be incomplete or they may be asymptomatic carriers of the rabies virus. Also, there is a silent reservoir of infection from wild animals, which may have attacked the pet and run away unnoticed.
If scratched or bitten, the bruise must first be cleaned thoroughly with soap and water. Soap kills the viruses in the wound. Iodine — either tincture iodine or povidone (Betadine) — should then be applied. The wound should be left open. Suturing should be avoided as a closed environment allows further multiplication of the viruses.
A bite is graded according to its severity. A course of injections (immunoglobins and anti-rabies vaccine) should be started immediately. Prior to the advent of the human diploid cell and other newer vaccines, anti-rabies was injected in the abdomen around the navel. This regimen had many side effects, of which pain was the least sinister and most tolerable! In addition, bites require tetanus prophylaxis and antibiotic cover against aerobic and anaerobic bacteria, which may have infected the wound from the teeth.
A number of pharmaceutical companies market the newer vaccines. The dosage schedule is printed on the package insert and should be meticulously followed. Post-exposure prophylaxis is usually given on days 0, 3, 5, 7, 14 and 28. The injections should be administered intramuscularly in the shoulder and not the buttocks. That’s because the high fat content of the buttocks interferes with antibody production.
Pre-exposure prophylaxis (before the bite) consists of three injections on days 0, 7 and 28 with a booster every five years. It must be taken by all owners of pet dogs or cats, veterinary surgeons, laboratory workers and travellers, especially if they are going to pass through endemic areas where appropriate treatment for animal bites may not be readily available. If your children have a penchant for playing with animals, it makes sense to immunise them too.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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