eczema

Ditch the itch

https://www.telegraphindia.com/1170717/jsp/knowhow/story_162231.jsp

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Your Health - Dr. Gita Mathai

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Itchy red rashes are irritating. If they appear frequently, they interfere with the quality of life. Around 10 per cent of children and three per cent of adults have periodic flare ups of rashes. This phenomenon is loosely termed eczema and it is assumed that the cause is allergies. Quite often, the symptom runs in families. Some members itch, others sneeze (rhinitis), or wheeze (bronchial asthma). Fortunately, if the symptoms start in infancy, there is hope. The child may outgrow the allergies by the time he or she is 10.

Any part of the body can be affected by eczema but it always starts with uncontrollable itching. A rash may follow. Scratching does not relieve the itch, it only perpetuates it and makes it worse. It may result in secondary infection and crusting. Once the eczema disappears, the area may remain hypo or hyper pigmented for some time.

The exact cause of eczema is not known. One theory is that because the skin is unduly sensitive, it cannot perform its barrier function efficiently. Rough clothing, detergents, soap, sweating, exposure to cold temperatures, pollen, animal dander, nickel in fashion jewellery, colouring in food, face powder, perfume, makeup, exposure to sunlight and even mental stress can cause a flare up. Sometimes eczema is not due to an allergy but is an itchy infestation of the skin like scabies. This causes symptoms that persist till the scabies is treated and cured. Varicose veins cause stagnation of blood in the lower limbs. This can also cause eczema till the veins are treated.

Traditionally, we give babies an oil massage before their bath. Usually we use coconut oil. It penetrates the skin and efficiently moisturises it. A mixture of 250ml coconut oil, 250ml sesame oil and 100ml paraffin, castor or olive oil is an even better moisturiser. Oiling the whole body for 15 minutes everyday (also in adults) and then bathing with a mild soap will help prevent eczema. Adding a teaspoon of salt and soda bicarbonate (baking soda) to the bathwater also helps. Applying coconut oil after a bath is counter productive as it attracts ants which bite, causing itching and scratching.

Most detergents contain chemicals such as sodium lauryl sulphate, which remain behind in small quantities in the clothes despite rinsing well. They penetrate the skin when sweating occurs, aggravating eczema. Commercially available "hypoallergic" or "doctor tested and recommended" detergents have not been ratified or proven to be safer. It is preferable to use non-allergic soaps made from neem oil. They are marketed in India by the government-run chain of Khadi stores.

Treatment of eczema is an ongoing process that involves enjoying remissions and tackling sudden exacerbations. Known allergens should be consciously avoided. The skin should be moisturised regularly before a bath and after, when it is still damp. Non-staining preparations like paraffin oil and ointments with paraffin wax are efficient and inexpensive. Low dose one per cent steroid creams can be applied for short durations if moisturisation is not enough.

The itch, scratch, itch cycle has to be broken. Application of cold compresses to the itchy area reduces the desire to scratch. Antihistamines will reduce the itch. The newer non-sedating anti-histamines can be taken during the day too.

Adults (except pregnant women) and children over the age of two who do not respond to the above measures can be treated with prescription creams containing immunomodulators like pimecrolimus or tacrolimeus. These potentially increase your cancer risk with long-term use. So be careful of that.

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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dieting Blues

Dieting Blues

I have been trying to loose weight (rather unsuccessfully ) after the birth (37 years ago) of my second child. (He often says  I blame everything on him)!

My friend and classmate in medical college is an expert on weight loss. She set up a very successful clinic. She is in great demand and She motivates her dieters, and allows them  no excuses at all. The regimen does not require any exercise, so it is very popular. The diet is totally carbohydrate free with just protein and fat. There are raw green leafy vegetables too. After some time  you feel like a mutant herbivore. You also begin to chew the leaves you are allowed to eat in a desultory fashion. It keeps your mind off food. The diet works, and,  even though your dreams are full of biriyani, parottas and dal makhani, the weight just melts off.

Keeping the kilos  off is quite another matter. After a year or two, when chewing cud is not a viable option, and pongal vadai irresistible, it just creeps back on again. Also there is the unsightly sagging in the areas of weight loss, usually the arms, the face , the sundry other regions covered with skin. The areas from which the fat has disappeared leaves long streaks, ugly discoloured pink or white visible stretch marks.

Another classmate looked very slim and trim. At the alumni reunion she was a source of great envy. Her stomach was flat her arms toned.

“What exactly is your secret?” I asked. The rest of the women (many of whom had paunches that led from the front) listened with interest.

“I eat only every alternate day,” she replied. There was a shocked silence.

On the other days, “I only drink water. Since I work, I do not really notice the lack of food.”

She added , “ I also use the cross trainer for an hour on the days I don’t fast.”

 I decided to try it. To motivate myself further, I went to work without carrying any breakfast or lunch with me. I took black coffee and lime water (not lime juice). By 11:30 AM I started to see double. The patient’s face split into two halves sideways and then joined again. I once saw a movie about a schizophrenic lady. The credits had her face split into two halves which sporadically joined together. My stomach let out loud audible rumbles.   I send my staff out to buy curd rice.

That was the  end of the fasting!

After my Achilles tendon tear, this year, the orthopedic surgeon warned me.

“You are going to be in bed for three months. Even with a normal diet, you will gain weight. Your leg won’t be able to take it. You have a high chance of re-rupture.”

Visions of this purgatory (cast and bed rest) haunted  me.

I cut my food intake in half.

I lost 7 kilos in three months. The physicians were not happy.

“No one can diet like this. We need to do a whole body PET scan to rule out occult malignancy.”

My protests fell on deaf ears.

The good news? The scan was normal!

scars

https://www.telegraphindia.com/1170626/jsp/knowhow/story_158677.jsp

Scars will fade

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Your Health - Dr. Gita Mathai

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The skin covers our body, like a well-fitted, elastic garment. It does not normally have any cuts or breaks. If the skin suffers an injury, just like material which is torn and darned, an obvious blemish forms. It may be due to a fall, surgery, trauma, burns or just boils or pimples. This is a scar.

Initially, damage causes bleeding, followed by the formation of a blood clot. This dries, and then new granulation tissue forms over the wound. Then a scab forms which may itch. New skin forms over the wound. This is smaller in size than the original skin so the edges of the wound pull together. Over the next two to three years, the scar may fade completely.

While scar tissue has the same composition as skin, it is inferior in quality and often, of a different colour or texture. It also does not have hair follicles or sweat glands, unlike skin.

Unsightly scarring can occur even with mild trauma, especially if the injury has occurred where the skin is taut, if the person is young or if there is a familial tendency to develop severe scars.

Acne causes severe scarring in one per cent of the population. It may appear as pits or waves. Since 90 per cent people suffer from acne at some stage, it is a severe cosmetic and social problem. Scars are less if acne is treated as soon as it develops. Pricking or squeezing the pimples can lead to secondary infection and severe scaring. Also, if there is no improvement after a couple of months of home treatment (wash the face twice a day with mild cleansers and apply OTC anti-acne medication), a dermatologist should be consulted.

Burns, (water, chemical or electrical) can extend deep into muscles and even bones. As they heal, the edges of the skin pull together causing disfigurement. They produce contracted scars. If scarring occurs over joints, mobility can be affected.

Some scars are "hypertrophic". Although they appear to rise above the wound, they do not extend beyond its boundaries. They do not pain or itch but can be disfiguring.

Scars which extend beyond the margins of the wound, are red or brown in colour and are itchy or painful are called Keloid scars. It can be due to acne trauma, ear piercing or surgery. They can grow slowly over months or years. They are cosmetically unappealing and the symptoms can be very troublesome.

To prevent scar formation, as soon as injury occurs, stop any bleeding by applying pressure. Then clean the wound with soap. Topical antibiotic creams reduce the risk of infection. Clean bandages should be placed on the wound. These should be changed as soon as they become soiled. Gaping wounds need suturing.

Scars tend to fade over time. So it is best to wait a year before opting for aggressive treatment. Advertised OTC creams to treat scars are usually not very effective. Dermatologists and surgeons can offer a variety of options like skin grafts, dermabrasion, chemical peels, laser surgery, skin grafts or filling the scars with collagen.

Applying an ice pack for 20 minutes, several times a day, can relieve the symptoms of mild keloids. The keloids should be moisturised. Steroid creams and oral antihistamines can relieve the itching. Mix a teaspoon of baking soda with three teaspoons of hydrogen peroxide and apply it to the keloid. Keep it on for 15-20 minutes and then wash it off. Do it three times a day to see results.

Non responsive symptomatic keloids require specialised treatment with steroid injections, silicone gel sheets, laser treatment and cryotherapy (freezing), or as a last resort, radiation.

Most scars usually fade away, but it takes time.

Dr Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in