Medical Dermatology

Welcome to Medical Dermatology of Dr Kumar Clinic  We are board-certified Dermatologists who are serious about taking great care of our patients. We strive to create a personal experience for each and every patient, and we care about doing it right. From checking moles and other skin lesions to managing the most severe skin conditions, our expertise is totally focused on skin health for children and adults.

1. Acne

What is'Acne' ?

Acne commonly known as 'pimples' is a chronic inflammatory disorder of the sebaceous unit present in the skin.In mild to moderate cases, there may be black heads (comedones), white heads (papules) or pustules. In severe cases, there are nodules, cysts and abscess which lead toscarring if not treated on time.

Do acne normally occur in teenagers ?

Acne is more common in the age group of 13 - 30 years but it may occur or persist even beyond this age limit. Males are more frequently affected than females due to androgen activity. Females may get a pre-menstrual flare due to the increase in level of a hormone called Progesterone

How do pimples form ?

The skin has minute glands called sebaceous glands which open into the hair follicle. These glands secrete an oily substance called sebum, which empties into the skin surface through the hair follicle. During puberty, the male sex hormones which are normally present both in males and females are on the rise and they activate the sebaceous glands to increase in size, which in turn leads to increase in the secretion of sebum. Secondly, the cells are shed more rapidly and they stick together, plugging the opening of the hair follicle, resulting in 'white heads'. The pigment melanin in the white heads when exposed to air, forms black heads. Thirdly, bacteria especially the 'propionibacterium acne' in number and add to the formation of acne. When the follicle gets clogged, its wall ruptures. The sebum, bacteria and dead cells escape into the surrounding tissue and lead to formation of more severe form of acne in form of pustules, nodules, abscesses and cysts.

What are the factors affecting the formation of acne ?

Acne commonly occurs in people who are genetically predisposed. Use of cosmetics such as creams, oil based moisturizers, oil based foundations, etc. can cause acne. Application of heavy oil or gel on the scalp leads to pimples on the back and forehead. People who workin chemical or oil industries and come in contact with hydrocarbons, heavy oils, cutting oil, wax, grease and coal tar derivatives can develop acne. People working in hot and humid climate can develop acne. Drugs such as oral contraceptives, steroids, isoniazid, lithium, phenytoin,iodides etc. can cause pimples. Squeezing or picking at a pre-existinglesion will lead to secondary infection and increased pigmentation.Stress will exacerbate acne. Finally, if acne persists in spite of medical treatment or if the patient has other features such as or hair loss, anendocrine disorder must be considered and investigations carried outaccordingly.

What are the 'Do's and Dont's in treatment of acne ?

  • Wash your face with an anti-bacterial soap at least 3-4 times a day.
  • Increase the intake of citrus fruits such as oranges, grapes, limeand lemon and other food stuff which are high in vitamin C and zinc.
  • Drink plenty of water.
  • Do not pick or squeeze the pimples as this causes infection, pigmentation and scarring.
  • Avoid the use of oily cosmetics, cleansing milk and gels.
  • Do not apply excessive hair oil if you have acne over the forehead.
  • Avoid stress factors.
  • Be patient and give medicines some time to act. You may have to take antibiotics for 8 - 10 weeks.
  • You may require surgical intervention in the form of comedone extraction, cryoslush, cryo-peel with liquid nitrogen or superficial chemical peel. These are best performed by a dermatosurgeon.

2. Psoriasis

What is Psoriasis ?

It is a chronic inflammatory disease of the skin characterised by a relapsing and remitting course. It manifests as pink, scaly, raised lesions on the elbows, knees, lower back and scalp along with certain nail changes like pitting, discolouration, subungual hyperkeratosis and onycholysis inabout 25-50% of the cases. In 5-10% of patients, the disease can be associated with joint involvement.

It is multifactorial in aetiology, with genetic factors and environmental insults playing their role. A positive family history is present in about one third of the patient.

Psoriasis is not a contagious disease

  • The following factors may exacerbate the disease :
  • Stress
  • Trauma
  • Infections (Streptococcal upper respiratory tract infections)
  • Medications (Lithium, Antimalarials, Propranolol and other beta blockers, NSAIDS, Terfenadine and steroid withdrawal)
  • Winter season

Age of onset is usually 16-22 years and 57-60 years. The lesions vary from a few to numerous and when numerous, tend to be symmetrically distributed.

Role of Diet: Diet has been suggested to play a role in the aetiology and pathogenesis of psoriasis. Diets with low carbohydrates and rich in vegetables and omega 3 polyunsaturated fatty acids (fish such as meckerel, salmons, sardines) improved psoriatic symptoms in some studies

Treatment: Treatment of psoriasis is aimed at reducing cellular proliferation (anti-tumor agents) and inflammation (antiinflammatory agents) in addition to taking care of the precipitating factors. Treatment is long term with regular followup.

Avoidance of stress and regular use of emolients prevents exacerbation

  • Topical:
  • Emollients - Liquid Paraffin
  • Keratolytic Agents - Salicylic Acid
  • Coal Tar
  • Anthralin
  • Topical Corticosteroids
  • Calcipotriene
  • Topical Retinoids - Tazorotene
  • Phototherapy
  • UVB
  • Narrow band UVB
  • Photochemotherapy
  • PUVA
  • Systemic
  • Methotrexate
  • Hydroxyurea
  • Azathioprine
  • Retinoids – Etritinate
  • Cyclosporine
  • Sulfasalazine (for arthritis)
  • Biological response modifiers

3. Vitiligo

What is Vitiligo

Vitiligo is an acquired skin disorder caused by the disappearance of pigment cells from the epidermis, and results in well defined white patches that are often symmetrically distributed. It is a cosmetically disfiguring and stigmatizing condition that may lead to psychological problems in daily life. It affects both sexes equally, though women more often seek remedy. The exact cause is unknown. Various hypothesis have been put forth:

  • Genetic factors
  • Autoimmunity
  • Neurogenic
  • Self-destruction

Genetic Factors: Between 30-40% of patients with vitiligo have a positive family history suggesting genetic causation.The exact mode of inheritance is not known Individuals from families with increased prevalence of thyroid disease, diabetes mellitus and vitiligo appear to be at increased risk.

Autoimmune Hypothesis: The autoimmune hypothesis is based on the clinical association of vitiligo with a number of disorders that have an autoimmune mechanism like thyroid disease, diabetes mellitus, Addison's disease.

Neurogenic Hypothesis: This hypothesis holds good only for vitiligo occurring in a segmental or dermatomal distribution. Self-destruction Hypothesis: This suggests that melanocytes destroy themselves due to a defect of natural protective mechanisms that remove the toxic intermediates (indoles) released in the process of melanin synthesis.

Precipitating causes : for vitiligo in a patient with susceptibility include physical trauma or illness, emotional stress and sunburn.

Clinical Features: Clinically, patients present with white patches that could be focal, segmental,generalised (wherein the lesions are symmetrically distributed),lip and tip or acrofacial pattern (where the lesions are seen around the mouth, fingers, toes and lips, nipples and genitalia).Areas subjected to repeated friction and trauma are also likelyto be affected. In long standing cases, the hairs within the patches also appear white.

Course and Prognosis: Spontaneous repigmentation is noted in 10-20% of patients, most frequently in sun-exposed areas in younger patients. This pigmentation is trivial and mainly starts around the hairs. Course is unpredictable; sudden onset followed by a period of stability or slow progression is characteristic.

Management: Certain investigations need to be done based on the complete medical examination to rule out/confirm associated disorders. These include thyroid profile, fasting blood glucose, blood profile for pernicious anemia, early morning cortisol estimation, anti nuclear antibody etc.

Vitiligo is not contagious

General measures: Reassurance forms the mainstay of the treatment. Vitiligo is usually mistaken for leprosy and the patients fear of deformities resulting form leprosy. Vitiligo is not contagious. Emotional upsets can worsen the disease. Sunscreens should be used to avoid sunburns of the depigmented patches and also to avoid new lesions when the disease is active. Camouflage using coloured cosmetics is an immediate remedy that the patient can try.Specific treatment should be done in consultation with a dermatologist. This includes :

  • Topical glucocorticoids (when the lesions are few)
  • Systemic glucocorticoids (in the form of minipulse; when the disease is extensive and progressing)
  • Photochemotherapy (use of psoralens and exposure to ultraviolet light A - PUVA)
  • Topical photochemotherapy - application of psoralens to the skin and then exposure to UV-A light; for children under the age of 12 years and adults with localised patches
  • Systemic photochemotherapy - ingestion of psoralens and exposure to UV light
  • Phototherapy using narrow band UVB - treatment with ultraviolet light B without the use of psoralens; preferable in children
  • Other immunomodulating drugs - levamisole, topical tacrolimus
  • Surgical - mini punch grafting, split thickness grafting, blister roof grafting. These procedures are done for the patches that are resistant to photochemotherapy and for those patches without black hair.

Vitiligo is a treatable disease with any of these methods, provided the right method is started at the right time and continued till the cosmetic improvement is acceptable. Vitiligo

4. Urticaria

Urticaria, medically referred to as urticaria, are red, itchy, raised areas of the skin that appear in various shapes and sizes. They can appear round, in rings, or as patches on the skin, and can afflict any part of the body. An estimated 5% of people will suffer from hives at some point in their lives. Hives tend to change rapidly and move around the body, disappearing in one area and reappearing in another, sometimes with a few hours. Swelling deeper in the skin that may accompany hives is known as angioedema. Swelling from angioedema usually affects the eyes, lips, genitals, hands and feet, and generally goes away in less than 24 hours.

Types :

There are two types of hives, ordinary and physical

Ordinary hives : Ordinary hives flare up suddenly and for no apparent reason. Welts, itchiness and swelling develop, and usually go away within a few hours, only to reappear elsewhere on the body. This process will repeat for days or weeks. If the problem persists for more than 6 weeks, the hives are generally categorized as "chronic." Chronic hives can last from months to years, and in about 80% of these cases, the cause cannot be determined.

Physical hives : Physical hives are those caused by direct stimulation of the skin, such as from cold, heat, sun exposure, pressure, sweating, or exercise. In this case, hives appear directly where the skin was stimulated, and nowhere else. This form of hives will diminish on its own, and should not reoccur

Cause : Urticaria and angioedema form when, in response to histamine, blood plasma leaks out of small blood vessels in the skin. Histamine is a chemical released from cells along the skin’s blood vessels. As noted, the cause of many cases of ordinary hives is unknown. Histamine can be released by triggers such as viral infections, medications, food allergy, or insect stings.

5. Paediatrics Dermatology

What is Paediatric dermatology ?

Paediatric dermatology basically deals with dermatological or skin problems that children face. A paediatric dermatologist diagnoses and treats the skin, hair and scalp conditions of children and infants. He/she prescribes treatment for skin conditions and suggests medical or surgical treatments for skin conditions such as warts and other lesions of the skin. Children having dermatological conditions can take advice and benefit from the experience and expertise of recognized physicians. Dr. kumar clinic is one of the best skin clinics in Jamshedpur offering consultancy on paediatrics dermatology.

What are the benefits?

Children who have usual dermatological conditions can take advantage from the proficiency of specialized physicians. Although, adults may develop some complaints but differ considerably when dealing with a skin problem in childhood.

How safe is the treatment?

The treatment is such that it suits the skin of a child or an adolescent. The dosage is dependent on the weight of the child. Thus, it is important skin diseases in children are treated by a dermatologist with expertise in this area.

Caring Treatment for Paediatric Skin Conditions and Dermatology

Paediatric dermatology mainly concentrates on the treatment of children from birth to their teenage years, as during these times skin disorders mostly occur. During this age, common diseases like ringworm, chickenpox, acne, eczema or birthmarks can be noticed.

What are the common Paediatric skin disorders?

Common paediatric skin disorders may include distracting vascular (red) birthmarks, moles or warts, and infants and children are particularly vulnerable to eczema. Skin rashes, poison ivy, and ringworm, hives, and cradle cap can all appear. Acne is a disease that can also appear in adolescence and can cause scarring or affect self-esteem.

What Paediatric Dermatology treatments are offered at our Clinic?

We are engaged in offering diagnosis and treatment for various paediatric skin disorders. Our excellent medical facilities are for eczema, acne, contact dermatitis, psoriasis, congenital skin disorders, and removal of warts, vascular (red) birthmarks and moles. Young children are prone to become impatient as they are not able to answer the medical questions properly or communicate, thus need special care. Our experience in dealing with children has been amazing and we take every possible effort to make them feel better. Moreover, we also prescribe creams, lotions, or antibiotics to treat infections and also provide a range of both surgical and non-invasive procedures that can be used to treat many circumstances.

6. Sexual Problems

Sex should be a satisfying part of a marriage. But for some couples, common sex problems become a source of tension and arguments. Common sex problems can get in the way of the relationship, and some couples have even separated over them. You can, however, address common sex problems and try to resolve them before they destroy the relationship and get in the way of love. Of course, you must see a doctor for persistent physical problems with sex.

If you are concern about your relationship with your couple, don’t let sex issue affect your life, make an appointment with Dr.R.Kumar at Dr,kumar Clinic and solve your issues. Some of the common STDs are:

  • HPV (Human Papillomavirus)
  • Chlamydia
  • Gonorrhea
  • Syphilis
  • Herpes
  • Trichomoniasis

It is very important to practice safe sex and use protection whenever possible. While some of these diseases show symptoms, it is important to get yourself checked with a dermatologist.