rape a taboo word

Treat rape right Your Health DR GITA MATHAI Stay safe Always be aware of your surroundings. Never walk on the road daydreaming, talking on the cellphone or listening to music. Look up and stay alert. Always carry a cellphone Be wary of strange men offering help. If you are stranded, call for assistance. Trust your instincts. When in doubt shout and run as fast as possible (martial arts and fitness training will help) in the opposite direction. Look for a well-lighted area or try to enter a shop. Whether you live in a city or a village, if you are in the wrong place at the wrong time, you can fall a victim to robbery, murder, and, in the case of women and children, molestation and rape. Statistics show that 25 per cent of children in India and 99 per cent of women have faced unwelcome sexual advances at some point in their lives. Ninety per cent of them admit to actual unwelcome or frightening physical contact. The exact incidence of rape is difficult to determine, as many victims do not report the crime. It may have involved a family member, a teacher (school or private tuition) or a neighbour. The family may not have wanted the “shame” or publicity that would result from filing an FIR with unsympathetic, unhelpful police officials untrained to handle these cases with discretion and empathy. Some rapes are random crimes of opportunity that occur during the course of another crime such as kidnapping or robbery. In such cases the rapists are usually between 25-35 years of age, have not completed high school, have a history of violence, alcohol and drug use, are athletic and macho but unsuccessful in relationships with women. They rarely leave the victims alive. In other cases the attack is planned. Such rapists are better educated, and less violent. They are either acquaintances or family or have been secretly stalking the victim. Children are sexually attacked by paedophiles, who are usually soft-spoken, educated men who may be married with children of their own. They come in contact with their victims through work or family. They win the trust of the child, and after the rape, frighten the child into silence with physical or psychological threats to self or family. After a sexual attack, if you want to prosecute the perpetuator, it is important to get a medical examination done as well as lodge an FIR. Internal and external lacerations and injuries need treatment. A single booster dose of tetanus toxoid is required. About 15 per cent of victims are in danger acquiring a sexually transmitted disease (STD). Medication needs to be taken immediately as a preventive measure. Treatment options are available for hepatitis B, gonorrhoea , syphilis, herpes, chlamydia, and trichomonas vaginalis. A single injection of ceftriaxone, plus an oral dose of azithromycin, and either secnidazole, tinidazole or metronidazole, will provide broad-spectrum coverage. Herpes can be tackled with a 5-7 day course of acyclovir. Hepatitis B requires only a booster dose in an immunised individual. If the immunisation status is not known, immunoglobulin needs to be given followed by three doses of the vaccine. The risk of acquiring HIV infection is less than one per cent. However it is important for medico-legal reasons to document the HIV status immediately. The test should be repeated after six months and a year. A 28-day regimen of medication for HIV should be started within 72 hours. A blood test should be done for syphilis after three months. Criminals do not follow any particular fighting style. A person trained in one of the martial arts will be able to resist and tackle a criminal to the ground. So it makes sense to train in martial arts. They teach discipline, focus, evasion and attack. They concentrate on fitness and most incorporate running as part of the training. All children should know their address and phone numbers. Teach them that certain body parts are not to be touched, to not speak to strangers or enter unknown vehicles. Don’t let them go out after dark and encourage them to tell you everything. And yes, make sure that your children learn martial arts. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

fit or fat?

Big fat problems Your Health DR GITA MATHAI Dissatisfied with their body image, people complain to their physicians that they are either “too fat,” or their “shape is wrong.” With medical help (or a miracle) they wish to lose weight all over or only on their thighs, hips, arms or stomach. The converse also holds true. Obviously overweight people too sometimes declare, “I’m okay” and have no desire to diet or exercise. The small minority who wish to gain weight can do it by increasing food intake at meals and snacking frequently. They too need to exercise — 20 minutes of aerobic exercise and 20 minutes of weight lifting every day. “Looking good” or having ideal body weight is not a “feeling”. It is a scientific number based on calculations using a measuring tape and a weighing scale. The body mass index or BMI is calculated by measuring your weight in kilos and dividing it by the square of your height in metres. BMI has its own limitations. If it is calculated for adults who are very muscular, or very thin, they may fall erroneously into the healthy category. The value is also not reliable in very short adults or pregnant women. Between the ages of two and 20, the calculation is different. Ideal body weight has to be read off from charts. Any child over the 95th percentile is obese. Childhood obesity has to be tackled seriously. Fat children become sedentary overweight adults. Overweight individuals may have subcutaneous fat uniformly distributed all over the body, or mainly a paunch with the fat concentrated in the stomach area. An apple-shaped body with a big stomach is more dangerous than a pear-shaped body with big hips. The waist:hip ratio can be measured to determine the health status. The normal value is less than .85 for women and less than .90 for men. A person with subcutaneous as opposed to visceral fat can have a high BMI and still fall within the healthy range for the waist:hip ratio. The waist circumference alone can also be measured. In women, a waist circumference greater than 35 inches, and in men a waist circumference more than 40 inches is considered dangerous. Without any equipment the “stand-up” test can be performed. The person is asked to sit on the floor and then stand up. Each manoeuvre is given five marks. If an extra part of the body like the hand or thigh is used for balance, a mark is subtracted. If there is even a transitory loss of balance, half a mark is subtracted. A healthy individual scores eight and above irrespective of age or body weight. A score of five or less indicates poor health. The pull up test involves asking people to pull themselves up on a bar using their hands. Very fit men can do 10 of these and women around two. Studies have now shown that all these values have to be taken into consideration to evaluate health. Once a person falls into the “unhealthy” category the risks for metabolic disorders such as diabetes, an abnormal lipid profile, hypertension, stroke and heart disease exponentially increase. The lifespan also reduces. Weight loss is a lucrative commercial business. All kinds of fad diets are available on the Internet and in the market. They usually concentrate on removing or reducing one or the other constituent (fat, carbohydrate or protein) in the food. Meals may be replaced or supplemented with shakes and powders to help lose weight. Some advertise, “Exercise is not required”. These claims are backed up with “before and after” photographs. Dieting alone can make you thin, but not necessarily fit. Without exercise, your ratio of fat to muscle remains the same. The dangers of obesity are still present. Keeping the weight off permanently also becomes a challenge as the abnormal meal patterns are difficult to sustain over a prolonged period. The powders provided are not only expensive, they may contain chemicals like creatinine, amino acids, hormones and sometimes even steroids. Surgery can also be done to reduce the capacity of the stomach. Once that occurs the weight will come down but the fitness level does not necessarily improve. This does not mean that you should not try to get your weight down to the ideal range. Extra kilos, even if you are fit, place extra strain on the heart, spine, hip and knee joints. Exercising for 40 minutes a day will keep you mentally alert and physically fit well into a ripe old age even if you do not look thin. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

mouth ulcers

mouthful of pain Your Health DR GITA MATHAI At any given time, 20 per cent of the population is suffering from one or more mouth ulcers (aphthous ulcers). These can develop inside the cheeks, tongue, on the roof of the mouth or the inside of the lips. They may be one or many, small or large. Usually such ulcers are less than 10mm in size and three in number. There may be also be enlarged painful lymph nodes below the jaw. The mucosa in the mouth is abundantly supplied with nerves so mouth ulcers are extremely painful. Contact of hot or spicy food increases the pain so those suffering from mouth ulcers are often unable to eat. Unfortunately, no clear single cause for the ulcers has been identified. Children can develop mouth ulcers due to a viral infection, teething, fungus or an injury. In some adults, ulcers may start after a swollen area in the mouth is inadvertently bitten. Usually, around adolescence, ulcers start to “just appear” several times a year, spontaneously and mysteriously. Women are more likely to suffer from such ulcers. Stress, illness, antibiotic use and general debility may also precipitate mouth ulcers. The viruses implicated in mouth ulcers are Herpes, Coxsackie, Cytomegalovirus and Hepatitis C . The Herpes virus tends to produce multiple ulcers. Adults with herpetic ulcers may be diabetic, immunocompromised, or have cancer. These ulcers respond well to antiviral medication. Fungal infection with candida (monilia) produces a red sore mouth and cheeks with white curd-like patches. If the patches are scrubbed clean, a raw red surface is seen. Children who use feeding bottles usually suffer from such an infection, even if the nipple is apparently sterilised adequately. Those who use pacifiers are even more prone to it. Such a child finds it difficult to swallow and may lose interest in feeding. In adults, monilial infection can occur with uncontrolled diabetes, prolonged antibiotic use, cancer and its treatment. It is one of the markers for HIV infection. Constant trauma to the mucosa of the mouth can also cause ulcers. This may be due to abrasive, poorly aligned dentures or broken irregular teeth with rough and jagged edges. Failure to brush the teeth morning and evening causes build up of hard yellow plaque on the inside of the teeth near the gums. Once this has occurred, vigorous brushing no longer removes the tartar. Bacteria are able to gain a foothold in the crevices resulting in recurrent mouth ulcers with accompanying bad breath. Food, particularly fast food, is often coloured with red or yellow dyes. These are often contaminated, substandard and non-food grade. They can cause contact allergy, damage to the mucosa as well as ulcers. Smoking as well as chewing tobacco, paan, gutka, supari and Pan Parag (all of them are toxic) can damage the lining of the mouth. Continuous use can cause loss of pigmentation (leukplakia), visible as white patches on the inside of the mouth. This condition can be precancerous. It needs a diagnostic biopsy, expert evaluation and follow up. Illnesses like ulcerative colitis and SLE (Systemic lupus erythematosus, a long-term autoimmune disorder) affect the immune system of the body and can produce chronic mouth ulcers. Deficiency of iron, zinc and the B group of vitamins can cause a red sore mouth with a smooth tongue and fissured lips. The mucosa becomes thin and delicate. It is easily traumatised producing ulcers. The response to treatment is difficult to assess as ulcers spontaneously disappear in 2-3 weeks even if untreated and do not scar. Ulcer treatment Sucking on an ice cube before eating numbs the pain. Local anaesthetic ointments dull the pain. Mix equal quantities of antacid and benedryl syrup and swirl it in the mouth several times a day. Steroids (if prescribed) can be applied locally (They will aggravate ulcers due to infections). Ulcers due to the herpes virus respond to a short course of antiviral medication. Any ulcer in the mouth which does not heal after two weeks of treatment needs a biopsy to rule out cancer. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

cigarettes the cancer sticks

In the Sixties and Seventies, puffing on what we now call the cancer stick was considered sophisticated by adults and “cool” by the younger generation. Movie stars, politicians, doctors, academics — they all smoked. My professors in medical college disappeared into the canteen at 10 am every day for a smoke and a coffee.

Forty years have gone by. One professor has developed lung cancer and another has succumbed to it. The world has belatedly woken up to tobacco addiction in its myriad forms (puffs, chews or snuff). The Indian government has passed a few laws but not only is it too little too late, the enforcement too is rather lax.

We know the effects of addictive drugs such as cannabis and heroin. They have been banned. If the tobacco industry had not managed to conceal the dangerous and addictive nature of tobacco for so many years, it too would have joined the list of banned drugs.

Tobacco grows in India, has always been freely available and its use is widespread, often starting in the teenage years. Males tend to smoke cigarettes or beedis while women seem to prefer chewing tobacco, gutka or snuff. Some female addicts begin their day by brushing their teeth with tobacco and then placing a wad of it in a corner of the mouth. Social acceptance has resulted in more young urban women openly smoking.

Tobacco use varies from state to state. In India 30-50 per cent of males and 20-30 per cent of females above the age of 15 use tobacco regularly. Many more, particularly children, are affected by exhaled second hand smoke.

There are more than 4,000 chemicals in tobacco, most of which are harmful. The main constituent is nicotine, which immediately makes the heart beat faster and pushes up the blood pressure. It crosses over into the brain where it affects certain chemicals. There is a pleasurable feeling of relaxation and reduction of tension and stress. As the nicotine is cleared from the blood stream, the tension and stress return, producing a craving for “another fix”. As the body enzymes become more efficient at removing this poison, the cravings return at shorter intervals. The consumption of tobacco perceptibly increases. Other harmful chemicals in tobacco are ammonia, acetone, cadmium, vinyl chloride, naphthalene and carbon monoxide. In short, imagine eating or inhaling smoke from a burning concoction of paper, moth balls, old batteries, toilet cleaner and nail polish remover!

Smoking causes long term changes in the lung tissue. Their function and air exchange is compromised with perpetual breathlessness, chronic obstructive airways disease and emphysema. Smoking or inhaling second hand smoke causes 90 per cent of lung cancers. It is responsible for 1.4 million deaths annually worldwide.

The chemicals in tobacco affect every organ in the body. Cancers can occur in the oral cavity, pharynx, larynx, oesophagus, pancreas, stomach, urinary tract, and blood (acute myeloid leukaemia).

Even if cancer does not develop, the teeth become yellow, plaque ridden, loosened from the sockets and may eventually fall out. Conversation becomes difficult because of halitosis (bad breath). The bones weaken, leading to early osteoporosis. The body metabolism changes, precipitating glucose intolerance and eventually diabetes. Atherosclerotic plaques build up in the blood vessels, leading to heart disease, paralysis, stroke and vascular disease. Blocks develop in the peripheral blood vessels. Walking becomes painful. Numbness, burning and tingling in the limbs interferes with sleep.

The IQ (intelligence quotient) falls with tobacco use and cognitive skills decline. This places users at risk for early dementia and Alzheimer’s.

Women who use tobacco tend to be less fertile, have smaller babies, weaker bones and reach menopause two to three years earlier. They also tend to have small babies who may develop Attention deficit -hyperactivity disorder (ADHD). They may have supernumery or less than five digits. Fingers and toes may be stuck together.

Tobacco use shortens the life span considerably. The death rate from related causes is 60 per cent higher in both sexes between the ages of 30 and 70.

The bad news is that addiction gets established within a year. By that time, the brain receptors change. The craving for nicotine may be present lifelong.

The good news is that you can stop and reverse many harmful body changes. No matter what your age, it’s high time you said bye to that stick.

Time to stop

• You can do it on your own—the mind is a very powerful tool.
• Set a date and stick to it.
• Avoid areas and friends who use tobacco.
• The government as well as private organisations run programmes to help de-addiction.
• Cravings can be reduced with nicotine patches and aversion produced by some medication.
• Regular aerobic exercise (running, walking, swimming or cycling), and yoga, improve fitness and lung capacity and reverse the negative effects.

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

hair loss and gain

Hair today, gone tomorrow

Your Health DR GITA MATHAI

Everyone would like a full head of hair, and, when it begins to fall at an alarming rate, anxiety and consternation set in. Hair loss appears to be a common problem, and its treatment a lucrative business, if the number of advertisements for oils, shampoos and revitalising products are to be believed. Hair growth and loss has its own natural cycle. Scalp hair grows about half an inch a month during a long growing phase that lasts from two to six years. This is followed by a resting phase that lasts two to three months. At the end of the resting stage, the hair is shed. Losing 75-100 hairs a day is normal. At any given time, 10 per cent of hair is in the resting and 80-90 per cent in the growing phase. After hair is shed, a new hair grows from the same follicle, starting the cycle once more. As people age, their rate of hair growth slows. Some of the hair follicles die and the number of follicles shows a gradual decline. If the loss is greater than 150 hairs per day, there is a pathological process affecting the normal hair renewal process. This needs medical evaluation. The affected person alone may be sensitive to his or her hair loss. It may be within the normal spectrum and may not be taken seriously by the doctor. Also, 50 per cent of hair needs to fall before it becomes obvious to the doctor. Hair loss may be due to dietary factors with sub-clinical malnutrition. This may be the result of fad or crash diets, with an accompanying deficiency of proteins, vitamins and minerals, particularly iron and zinc. Hormonal imbalances cause increased hair loss, with the hair also becoming thin, brittle and lacklustre. The hormonal balance can go awry because of malfunction of any of the endocrine glands. Thyroid hormones are notorious for this. Androgens (male hormones) cause male pattern baldness. If a women has excess androgens for any reason, she tends to become bald. The female to male hormone ratio can be altered as part of the natural changes at menarche, pregnancy, lactation and menopause. The predisposition to lose hair after a certain age is genetically transmitted in families. It usually affects males, but females can also start going bald. Hair loss can occur in well-defined, circular patches. Expert evaluation is required to rule out conditions likealopecia areata. Local treatment can initially reverse the process. One it progresses to alopecia totalis (loss of all hair) treatment is not very successful. Hair loss may be may be due to “hair pulling” or trichotillomania where people, particularly children, twist and pull out their own hair, eyebrows, or lashes. It is a habit precipitated by psychological and social stress. There is spontaneous improvement with psychiatric help if the stress factors are removed. Chemotherapy causes reversible hair loss. Radiation injury and surgical scars cause permanent hair loss. Medical treatments are available to reverse hair loss. Applications of minoxidil solution (two per cent in women and 5 per cent in men) to the scalp twice a day results in improvement in about six months. Once the application is discontinued, the new hair falls out within a few weeks. Finasteride, when taken regularly, blocks the formation of the active male hormones in the hair follicle and causes hair growth in men. It cannot be used in women. Hair transplantation is a plastic surgery procedure which can be used in men and women and provides permanent hair replacement. It involves moving hair from donor sites to recipient sites with simultaneous removal of the bald skin. For proper care and maintenance of normal hair a few tips need to be followed. • Mix half kg coconut oil, half kg sesame oil and 100ml castor oil. Boil the mixture after adding a bunch of curry leaves, a clove and 20 peppercorns. If you need to darken the hair, mix in henna leaves or powder and petals of red hibiscus. Massage this oil into the hair twice a week using the tips of fingers (not nails). Vigorous massage may break the hair at the roots • Use only half a teaspoon shampoo to wash hair. Apply shampoo on the hair shaft and not the scalp.  • Blow-drying damages hair. If a dryer has to be used, cover the head with a towel and allow the air to heat the towel instead of applying it directly to the hair • Heat and chemical treatments for curling or straightening hair eventually damage it. Crinkling and curling can be safely done at home by plaiting wet hair tightly and leaving it overnight Dr Gita Mathai is a paediatrician with a family practice at Vellore. Question

monsoon fevers

That feverish feeling Your Health DR GITA MATHAI The monsoon may be over but it has left behind the rash of mysterious illnesses it brought with it. All across the country, people are still suffering from high fever, rashes and head and body ache — but the causes are different. There have been deaths from dengue, encephalitis (brain fever) and malaria. While not fatal, chickungunya, influenza, jaundice and typhoid too are making their presence felt. If someone you know “feels sick and feverish”, don’t panic. Get a digital thermometer and check the temperature. Body temperature varies, depending on age, physical activity and time of day. An early morning temperature higher than 37.2°C (>98.9°F) or a late afternoon temperature higher than 37.7°C (>99.9°F) is considered fever. There has been an upsurge in the number of dengue cases this year with reports of fatalities. Four distinct types of viruses cause dengue. So just because you had it once doesn’t mean you are immune. Dengue starts with high fever, red rash, headache, painful blood shot eyes, and severe backache. The fever subsides on its own after 3-4 days, only to return with a vengeance a few days later. The dangerous dengue haemorrhagic fever is caused by two or more sequential infections of different types. The fever is followed by bleeding, falling blood pressure, circulatory collapse and shock. The diagnosis of dengue is confirmed by enzyme linked immunoassay (Elisa) and haemagglutination blood tests. There is no specific treatment or immunisation. Symptomatic treatment with paracetamol helps. If there is bleeding or a falling platelet count, blood transfusions may be required. Malaria sets in with headache, high temperature and diarrhoea. The fever returns every alternate or third day with shivering and sweating. It is diagnosed by checking blood smears. Medication is curative. It is important that treatment be given as soon as possible. Chickungunya sets in suddenly with high fever, red rashes, muscle aches and excruciating pain in the small joints of the hands and feet. Once the fever subsides, the joint pain remains for around 10-15 days in the young, 1-2 months in the middle-aged and 3-6 months or even up to five years in older people. There is no specific curative treatment. Colds occur several times a year, usually when the weather changes. It causes a runny nose, cough, headache, chills, fever and body ache. Influenza or “flu” starts with fever (102-104°F) and symptoms similar to the common cold except in a more severe form. Encephalitis means high fever that may cause seizures or loss of consciousness. The monsoons cause flooding in urban areas. Water stagnates and sometimes the water supply gets contaminated. This leads to diarrhoea, dysentery and hepatitis. In addition, the rodents who get flushed out of their habitat can spread leptospirosis. This is characterised by high fever, severe headache, chills, muscle aches, and vomitting. It may include jaundice, red eyes, abdominal pain, diarrhoea, and rash. There is a lot of overlap between the symptoms of these illnesses. So blood tests are required for an accurate diagnosis. Influenza, typhoid and hepatitis A can be prevented with immunisation. The influenza vaccine has to be taken every year, usually in November. The typhoid vaccine has to be repeated every three years. The hepatitis A vaccine is administered in two doses six months apart for lifetime immunity. Immunisation is also available for Jap B encephalitis. Dengue, malaria, chickungunya and viral encephalitis spread through mosquito bites. Breeding of mosquitoes should be prevented. Mosquito repellent gels, especially ones containing lemon grass oil, are fairly efficient. It is better to apply it to clothes than on skin. Don’t use them on children younger than a year or on pregnant women. • As you walk, turn over discarded tyres, bottle caps and coconut shells so that water does not stagnate inside • Put a handful of salt into air conditioning and cooler trays so that mosquitoes cannot breed • Do not place trays under potted plants. Empty pots and vases regularly • Fix mosquito meshes on open tanks, wells, and doors and windows • Ornamental fish that eat mosquito larvae, such as Gabusia and Poecili (guppy) should be added to public ponds, canals and sewers • Sleep inside a mosquito net to prevent bites. Wear full-sleeved shirts, full pants and covered shoes for the same reason 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

dandruff

Flaky, itchy and embarrassing

Your Health DR GITA MATHAI

Poor hygiene is not to blame Dandruff affects 90 per cent of the population at some time in their lives. It itches uncontrollably and produces an ungroomed appearance, with unsightly white flakes on the hair and clothing. Even newborn babies may develop a greasy, flaky scalp called "cradle cap". This, fortunately, disappears within a few months. Our skin is in a continuous process of renovation. It grows outwards, then dies and is shed. Normally, this is a well-regulated orderly process which takes a little more than 20 days and goes unobserved. In people with dandruff, the process is uncoordinated. The cycle completes itself rapidly in a week or less. Thus there is excessive shedding. The dead cells then cluster together and are visible as clumps or flakes of white material. Although dandruff is not infectious, it is associated with an organism called Malassezia (formerly called pityrosporum). This is a fat-eating, yeast-like fungus that feeds on the sebum secreted by hair follicles. It is present on the scalps of normal healthy individuals without causing problems. At certain times, overgrowth of Malassezia occurs, resulting in irritation and increased skin cell turn over. A large number of dead skin cells are then formed. As these cells fall off, the natural oil from the scalp makes them stick together. This makes the cells white and visible. The sudden overgrowth is caused by a change in the biochemical environment of the scalp. This may be precipitated by the natural hormonal fluctuations of adolescence or aggravated in adult life by stress, illness, neurological disorders and diseases of the immune system. It is a misconception that poor hair hygiene causes dandruff. Actually, excessive use of soaps and shampoos can damage the sensitive skin of the scalp. Dandruff may be confused with other dermatological conditions with a similar appearance, like psoariasis or seborrhic dermatitis. The diagnosis has to be confirmed before treatment is initiated. Treatment has to be individualised. As dandruff is chronic, treatment may have to be continued lifelong. • Mild forms can be controlled with daily cleansing using a gentle shampoo. This reduces oiliness and the build up of dead cells. Baby shampoos can be used as they are mild. • If there has been poor response to the above, one of the various anti-dandruff shampoos sold over the counter can be tried. These contain a range of active ingredients like zinc pyrithione, coal tar, salicylic acid or selenium sulphide. Trial and error will help to determine the most suitable shampoo. Some of these might leave the scalp dry. A conditioner or a non-greasy hair oil can be massaged on the scalp after shampooing. • After cleansing, the hair can be rinsed with a mug of water in which an aspirin tablet has been dissolved. • Ketoconazole shampoos contain a broad-spectrum anti-fungal agent. They may work even when other shampoos have failed. • Dandruff treatment is filled with folklore and word-of-mouth home remedies. Some natural shampoos containing henna, tulasi and neem are effective for some people. In others, if the product is contaminated there may be an allergic reaction. Use one of these shampoos daily until the dandruff is controlled. After that, use it two or three times a week. Sometimes, alternating shampoos of two or three different groups is more effective. The shampoo may have to be left on the scalp for a few minutes to give the active ingredients time to act before it is rinsed. The instructions on the container must be strictly followed. It is better to consult a dermatologist if the dandruff does not improve after a month of self-care. More aggressive treatment with steroid lotions may be required. The risk of persistent dandruff can be reduced by – • Eating a healthy diet with adequate proteins, vitamins and minerals, particularly iron, zinc and calcium • Reducing stress • Adequate exercise, preferably outdoor as sunlight reduces dandruff • Shampooing the hair regularly • Avoiding chemicals like hair sprays, styling gels, mousses and hair waxes Dandruff does not cause or aggravate baldness and hair loss. It is harmless and can be tackled with a little time and effort. Dr Gita Mathai is a paediatrician with a family practice at Vellore. If you have any questions on health issues, please write toyourhealthgm@yahoo.co.in