From pins to planes

About three billion years before my grandfather and your great grandfather existed, first forms of life arrived on earth according to most scientists. According to Wikipedia the number of Earth’s current species is estimated at one trillion and less than one percent have been clearly understood and described. Our planet’s earliest organisms were unicellular and over a period of time they evolved into complex multicellular organisms. It is not very clear to scientists whether the first protein of life – RNA or Ribonucleic acid – came from complex interaction of chemicals or they were blasted onto earth by some impact of a large meteor from elsewhere in the solar system.

Modern humans evolved from a lineage of upright-walking apes that has been traced back over six million years. Human beings evolved over millions of years, walked out of the forest, lighted a fire, cooked their meals, grew their grains, developed their machines, rode bicycles and finally flew in their aircraft across the globe. They never looked back as they invented communication technology, gene therapy and what not and they were set to conquer everything forever. The story looks too predictable, right?

After the industrial revolution around 180 years ago the humble farmer transformed into a big manufacturer of a variety of machines which could manufacture virtually anything from a tiny pin to huge machineries which created mass employment. By the beginning of the 20^th century the Wright brothers created a flying machine which transported people across the globe and in another few decades the cellphone and internet was functional. Thus, a hungry trader sitting in a remote corner of Meghalaya can watch NASA putting out a satellite into space even as he struggles to push his handcart onto the unpaved mud path in his village.

Meanwhile the affluent class flaunted their wealth and kept globe-trotting without any care-in-the-world even as poorer sections struggled to feed and vaccinate their young ones. This arrogance among the masses gave rise to a generation of people who always expected that the earth could spin the way they decided.

Luxury and corruption

With money in their pockets and a mobile phone in their hand, the youth thought that the sky is their limit, especially with the older millionaires planning rides to space and the relatively less affluent planning trips after foreign trip on terra firma.

It was not long before greed overtook mankind and this also sprouted a generation of corrupt political leaders which spoiled the system of governance in our country. Corruption percolated from the ministers and high-ranking officials to the lowly chaprasi (peon) in government offices. Roads could be laid and metro rail networks could be built across cities with public funds but a share of the loot had to be apportioned to the official who sanctions the project, the party in power as well as the clerk who releases the final cheque!

Paid but not sprayed!

The public gradually learnt that in some cases there was no need to carry out work but just need to ensure that the paperwork is complete.

Government spends huge amounts to spray pesticides in trains but so long as the right persons are paid, there is no need to spray even a can of pesticide. So what if bugs bite passengers or children fall sick? Likewise, there is no need for the flood-affected destitute to get the financial compensation so long as middleman fudges the records accurately!

E-governance, a mockery

Have you tried to make a complaint on the citizen portal of any government or quasi-government department in India? It is very impressive.

The moment one files a complaint the system generates an automatic response and gives a complaint number. Surprise, surprise! Within a week the complainant receives an email that “the complaint has been resolved,” even while the dangerously dug up road remains uncovered or without proper barricades. If the complainant is persistent and repeats the complaint, he gets a message that he is complaining too much! This is not an exaggeration and the author is witness to this.

India is a vibrant democracy, they say. Elections are regularly held but no matter which when party comes to power the conditions on the ground level do not change. People are frustrated but no one really cares as bureaucrats are busy buying swanky cars with taxpayer’s money but the potholed roads remain as bad as the surface of the moon!

The poor were busy making both ends meet while the upper class profited even as they grumbled about poor economy etc. In the midst of such non-governance, government officials keep busy jet-setting across the globe on “study tours” and life is always hunky-dory for them.

Intermission!

Bang! Enter a new version of an old virus, as if straight out of a novel: The Novel Coronavirus-2! A mutant of the earlier SARS virus put on a new cap and has gone out for a kill bringing the entire world to a standstill. What is unbelievable is the scale of its havoc across continents as it spread through travelers from China to Iran, Italy and the United States all in a span of less than a few weeks.

We could never have imagined earlier that an entire nation, leave alone the whole world, could lock its people indoors and shut down all sorts of physical movement outside but allow birds and animals to roam free!

Yet, as I write this, billions of people across the planet are on an international lockdown and this is an unprecedented event in the history of mankind. A tiny bit of RNA has shaken the very core of our existence flattening out billionaires, educationists, scientists, doctors, teachers and everyone! Viruses are such tiny fragments which cannot reproduce on their own unless they find a host cell. Such a speck is probably “not even a life form” according to some scientists.

Now imagine how this tiny, invisible, lifeless crumb has been holding up every aircraft, space shuttle, president, prime minister, man, woman and child on earth, for weeks together and sending everyone scurrying for cover into their mansions or cubbyholes. What is even scarier is that it has just hit Indian shores and cases of suspected community spread are yet being analysed. If the pace of community spread increases, it will be a long and hard battle ahead for our country which is already struggling with so many known challenges.

Oh My Covid!

So what is this invisible force which we call coronavirus? It seems to have opened the eyes of leaders of developed and developing nations, forcing people across the globe to introspect on the wayward ways of mankind, at least temporarily.

As a country, Hindus believe that there were 33 crore gods catering to every sub-community and belief system. Only God could bring the entire world to a standstill and it appears as if, this time we have given God a new name: Covid-19!

Would this new God produce a change in our thinking? Would this global pandemic produce a change in attitude among the ordinary citizen to the highest ranking official the world over? Would there be a transformation among humans to love all flora and fauna as trustees of the planet and not just being owned by the two-footed animal in suit and ties? Would the persons involved in handling social infrastructure be more understanding of the needs of the man on the street? Would governments big and small stop bullying each other? Would the man on the street understand that no one owns this world but we all belong to it—together?

Everyone will agree that like Coronavirus, God too is invisible and people all over the world regard it as a supreme being which has power over nature and on human fortunes. It is a point worth pondering: has God taken on a new avatar to open the minds of homo sapiens who seem to have lost the way from the times of homo erectus or “upright man”?

If Covid-19 manages to make a sizeable change in our mindset from today itself, it would seem that God has appeared on the planet, in disguise. One hopes that the change happens in this generation’s lifetime.

The post Has mankind finally met God? appeared first on Complete Wellbeing.

Pimple patterns and recurrence

Pimples need no description because, like it or not, we’ve all had our share of them in one form or another. Whiteheads, blackheads, big painful eruptions or flat red patches. Acne worsens in humid, summer months and improves in dry, cold season. However, those who work in factories and around hot places keep developing pimples round the year. Most women find their skin clear till the time of their next menstrual period. The skin feels oilier and eruptions appear a couple of days prior to their menstrual period.

Women who overuse oil-based cosmetics and others who have recurrent ‘pampering’ sessions of bleach and facials at beauty salons may sometimes develop a cluster of pimples due to excessive rubbing of creams into the pores of the face. Certain medications, like anti-TB drugs increase sebaceous gland activity, leading to pimples.

Skin ointments containing steroid medications when used to help clear blemishes from the face, also eventually causes the skin to thin down and trigger a cluster of tiny eruptions.

Ways to deal with them

Topical medications

A variety of creams, gels and face washes are now easily available in the market and most of them are effective in minimising pimples. Those containing antibiotics like clindamycin, clarithromycin and azithromycin help to clear inflamed pimples, whereas agents like tretinoin, benzoyl peroxide, glycolic acid and adapalene help in drying and peeling blackheads and scars.

Oral medications

Antibiotics like doxycycline and minocycline are given in daily or weekly doses for 6 – 12 weeks. Isotretinoin is a wonder drug for acne that is now easily available. It clears eruptions and gives a radiant glow to the skin. A word of caution, do not take it if you’re trying to conceive as it has a likelihood of causing birth defects in the newborn. A three-month washout period is necessary after stopping the drug before you attempt to conceive.

Hormonal medications

Women with ovarian cysts or irregular menses along with pimples, sometimes have an imbalance in their hormone levels. A treatment with oral contraceptive pills for 3 – 6 months should help regularise your menstrual cycles plus clear the skin. However, these doses should be consumed only after consulting a gynaecologist.

Cleansers

Mild cleansers which help to dry up the skin can be a respite for acne as well. Medically prescribed face washes containing one per cent salicyclic acid are very useful during the summer, particularly for people with oily skin. These can be used twice daily. With regular treatment most of the sequelae of acne can be cleared. While most drugs help to clear active eruptions, the residual scars, marks and pits need to be treated with additional techniques which may include use of chemicals or machines.

Use of cosmetics should be kept to a minimum while treatment for pimples is on. It is also important to avoid facials, bleaches and other beauty treatments while anti-acne gels are used, to avoid the risk of irritation.

Chemical peels

Chemical peels, also known as cosmetic peels, help to remove the uppermost layer of the skin, giving a youthful appearance to the face. A chemical solution containing a very mild acid is gently applied on the skin and is left on for 3 – 5 minutes. The chemical is then washed off and a sunscreen is applied. The procedure is repeated every fortnight, each time with an increasing concentration of the solution.

After a period of 2 – 3 months both pimples and scars fade to a great extent. In older individuals the deep scars do not clear completely with chemical peeling and one may require to undergo dermabrasion, a procedure in which the skin is peeled off mechanically and allowed to heal evenly.

Microdermabrasion

Commonly known as skin polishing, microdermabrasion is a technique to remove scars on the skin. In this procedure, a pen-like instrument is run over the scarred area of the face or the back. The ‘pen’ contains aluminium oxide crystals that will flow through a tube to gently scrape the skin and the crystals get sucked away under vacuum. The scraping action removes the superficial layers of the skin, which contains dead cells and marks.

This procedure needs to be repeated at monthly intervals in cases where the scars are deep. It is also done to remove tiny growths on the skin or where the skin is tanned. Unfortunately, its effects are short-lived, hence  it is popular in salons and spas catering to pre-wedding or pre-festival procedures.

Filler injections for scars

Sometimes huge pimples can leave deep ‘holes’ or concave scars on the face giving an ugly look. In the past, people suffering from such cosmetic problems had to live with them for the rest of their lives. But now there is hope in the form of filler injections where proteins are injected into these holes and the skin gets lifted up, giving it an even appearance. The effects of the injection are temporary and therefore the procedure needs to be repeated at yearly intervals.

Laser resurfacing

Laser is a revolutionary method of skin treatment. It involves using an intense beam of light focussed through a hand-held instrument. The beam dissolves certain fibres deep in the skin which eliminates acne scars to some extent. It needs to be repeated several times at 4 – 6 weekly intervals to almost fully eliminate the scars.

Dietary conundrum

“Doctor, what should I eat to cure acne?” This is a question every dermatologist is asked almost daily. There is great confusion about whether or not oily foods aggravate acne. Present studies reveal that foods rich in glucose are known to prolong acne but there is considerable disagreement among dermatologists on this issue. Until a consensus is reached, it is advised to have a balanced diet, rich in fruits, vegetables and drink plenty of water.

Unlike in the past, the present armamentariums of topical and oral medications for acne can do wonders for the skin. The rule to be remembered is to start treatment at an early stage to prevent permanent scarring.

The post Pimple pains: How do I get rid of my acne? appeared first on Complete Wellbeing.

Fortunately, there are ways in which we can slow down the clock. By understanding the mechanisms of skin ageing, we can delay the process, that too, with simple measures.

Slowing it down

The first thing we need to do is address the key factors that affect skin ageing.

Water

Water is a major component of our body, particularly the skin. The skin appears dry and shrivelled in the absence of sufficient water.

To counter that, drink enough water every day to keep your skin soft and supple [although 1.5 litres is believed to be the norm, it’s not a golden standard and you drink as per your own body’s requirements]. You can consume fluids in the form of fruits, juices, milk shakes or butter milk, instead of just plain water. In summer, the fluid intake has to be more than in other months as we lose more water through increased sweating.

Nutrients

The skin needs a sufficient supply of nutrients such as vitamins [specifically vitamin A] and amino acids for effective functioning. Regular intake of these nutrients keeps it looking well-nourished and youthful for long. Those who pay scant attention to their dietary needs, allow the skin to age faster. How nutrients affect skin is evident in those with deficiency of iron and B-complex vitamins. This is because, haemoglobin is the protein that carries oxygen to the cells of the entire body, including the skin.

So, include foods rich in vitamins A such as carrots, green leafy vegetables; protein-rich foods like meat, eggs, fish, milk and soya; and iron-rich foods such as dates and meat in your diet.

Also, crash dieting is a bad idea as it leads to skin sagging and stretch marks. Dieting should be a systematic and planned process, taken up under the guidance of an expert dietician.

Sleep

Sleep is when the skin does its repairs. That’s why adequate sleep is an important prerequisite for healthy skin. Someone who does not get sound sleep for about six hours remains irritable and the impact is evident on the skin.

So, get enough sleep every day. Also, the quality of sleep is as important as the quantity. Adequate rest often reflects on the skin.

Exercise

Regular exercise benefits the skin in multiple ways. It helps to tone muscles making the skin appear taut and even. The increased blood circulation during physical exertion helps to remove all impurities accumulated in the skin, making it healthier.

Make time for exercise, no matter what kind.

Moisture

As we age, the skin becomes dry, making it prone to itching. Persistent itching leads to discolouration and thickening of the skin. Notice how some elderly have dry and cracked skin, especially over the legs and forearms. Hence, we need to hydrate the skin externally to keep it looking youthful.

Take regular baths and wash the face frequently to hydrate the skin’s surface. Apply moisturisers to maintain the skin’s barrier function. Use oily creams [such as those containing vaseline, paraffin, squalene] to prevent loss of water and resultant dryness.

Those who have tendency to dryness should avoid using harsh soaps and opt for soaps containing moisturisers and oils instead. This helps retain water in the skin, keeping it damp and supple.

Directly rubbing a bar of soap on the skin depletes the natural oils secreted by the already ageing skin. To avoid the soap from harming your skin, use small quantities of soap with plenty of water just to work up a lather or use diluted liquid body wash.

Maintaining a regular skin care routine is an important aspect of looking young and healthy.

Sun protection

The sun can be really cruel to the skin, accelerating ageing and robbing it of its lustre.

Use a sunscreen with a SPF between 15 and 30. This usually works for most Indian skin types. Apply the sunscreen 15 – 20 minutes before exposure to sunlight.

Illness

In disorders of liver, kidney, thyroid and diabetes, the toxic waste often gets deposited in the skin, disturbing its structure and function. Paying prompt attention to internal diseases prevents skin damage and minimises the effects of ageing.

Erasing the signs

Discoloured skin

Many men and women develop brown or greyish patches on the cheeks. They can use camouflage to prevent the discoloured patch from becoming visible. However, it’s important that they use sunscreen on a regular basis when exposed to the bright sun. Unfortunately, whitish spots that develop with age do not clear with any treatment and need to be left alone.

Fine lines and wrinkles

Sagging skin is the foremost sign of ageing. With increasing age, skin becomes thin and loses its elastic support from beneath making the surface layer thin, loose and crinkled. Before frank wrinkles appear, the facial skin is thrown into numerous tiny folds called fine lines. It is most conspicuous on the face, around the eyes, the chin and the neck. Ultraviolet light from the afternoon sun also makes it dark and weakens its elastic fibres.

Using creams containing retinoic acid and undergoing chemical peel treatment minimises fine lines and wrinkles. Botox injections help ease tense muscles thereby relieving wrinkles, albeit for a period of 6 – 12 months.

Microdermabrasion helps scrape off dead cells from the surface of the skin to give it a shiny, even appearance. Non-ablative laser resurfacing is another procedure used to heat up and tone the skin. However, its long-term results have not been established and are still being evaluated. All these procedures have a temporary effect and need to be repeated for sustained results.

Surgical techniques like thread-lifting and cosmetic face-lifting help tighten loose facial skin, making it look young.

Tiny growths

Many of us develop tiny elevations on the face, which are loosely called ‘warts’ or skin tags. These are harmless growths that make the skin appear dark and dull. Such growths can be removed easily by a painless procedure called electrocautery or using laser beams.

Likewise, other skin disorders too should be treated promptly to prevent permanent marks and scars.

Finally, it needs to be understood that there is no way to obstruct the course of nature. What is genetically predetermined and the over-arching effects of our environment cannot be totally arrested, in spite of the current pace of scientific development in the field of dermatology and cosmetology.

So don’t run behind the illusion of permanent youthful appearance and exercise caution while consulting doctors for treatment. Simply subjecting oneself to various procedures without any strong scientific evidence based methods is an invitation for disaster.

The post Be kind to your skin appeared first on Complete Wellbeing.

His parents took him from one doctor to another—first a paediatrician, then an orthopaedic surgeon, followed by neurologists. And to more doctors across the city they lived in. They spoke to counsellors, physiotherapists, occupational therapists and instructors of special children. They even sent his reports to relatives living abroad. Yet, no expert could predict the child’s future. Most experts rattled off statistics telling them how a majority of these boys ‘manage well’ as they grow up. Sadly, none answered their questions: Would my son be able to manage his personal hygiene? Would he be able to stand up, walk to school? Would he ever be independent? Would he remain bedridden for the rest of his life?

It was only after the child was about four years old and by then, limping around the house, that there was some breakthrough, which came with a simple question the father’s UK-based colleague asked, “Why don’t you approach a Support Group?” Now, what’s that supposed to mean?

What is a support group?

A support group is an assembly of individuals or families who come together to face similar problems/illnesses to which medical science may not be able to give definite answers. In all these cases, the therapy is not clearly defined and each patient responds differently at different stages of life. Typically, the treatment for these problems does not end with simple administration of medicines or performing exercises—it stretches for years or even decades. In some cases, the condition deteriorates over the years and the physician is not always available to guide on simple, day-to-day matters.

In cancers and other life-threatening conditions, coming to terms with the deterioration is traumatic—for the patient as well as for the family. People who have undergone similar situations are in a better position to guide other people in the same position.

The group of people [patients and relatives] meet regularly and share their experiences on the progress or deterioration of the person concerned and try to help each other manage it. These groups give emotional and practical support. By exchanging information, such groups help the patient and families develop coping strategies.

Deriving warmth

Human beings have evolved into species that functions best in groups. Groups allow for critical support mechanisms that increase the chances of survival of the members. Little wonder that we seek out friends, family, relatives, and colleagues all the time [except when we want to be left alone]. Being in a group stimulates thought, discussion and debate, which helps generate fresh ideas.

Just like children run to their parents for suggestions on a vexing problem, people suffering from illnesses having poor success rates or which are chronic and repetitive, try to seek out others tormented by a similar predicament.

Support groups provide a platform to patients and their families to express their personal experiences and comfort themselves with the experience of peers. While sympathising with others in the group, members gain courage to manage their own difficulties better. To reclusive families, it provides a forum for social networking.

Information about newer therapies is available from other members. Better techniques to help the patient negotiate critical areas of life can be obtained here and regular discussions help avoid the blunders committed by others.

Ketna Mehta, a Mumbai-based founder of Nina Foundation, a support group for spinal injury, says that the afflicted members overcome their rigid beliefs by observing how others in the group manage on their own. “A paraplegic member who was petrified of attending our support group meetings without her family and car for several months, managed to travel by taxi on her own by observing others. She is now so confident that she evens discards her crutches to walk at home. This is a huge leap towards independence,” says Ketna.

In the case of suffering children, such groups also guide parents on how to go about planning schooling and transportation. According to a parent, C Nandini, “An experienced parent could guide parents of another special child on how they could send her to a normal school with the help of an attendant. Just giving the child the requisite push will propel her to achieve greater heights, making her not only independent but also socially useful.”

Conditions for which support groups exist

In the developed countries, support groups exist not only for serious illnesses but also for specific categories of people, for example, gays. Check out this online list of support groups. In India, it is not yet a common phenomenon outside metropolitan cities. Some of the common conditions for which support groups exist globally are:

• Addictions like alcoholism, drug addiction, tobacco chewing and smoking.
• Adult brain disorders like epilepsy, stroke, multiple sclerosis, Parkinsonism, Alzheimer’s disease, motor neuron disease and dementia.
• Developmental disorders like cerebral palsy, Down’s syndrome, dwarfism, dyslexia, dyscalculia, dysgraphia, autism and Attention Deficit Hyperactivity Disorder [ADHD].
• Chronic illnesses like rheumatoid arthritis, atopic eczema, psoriasis, kidney failure, mental illnesses and juvenile diabetes.
• Blood disorders like haemophilia and thalassaemia.
• Skin disorders like atopic eczema, ichthyosis, vitiligo, psoriasis, scleroderma, neurofibroma, pemphigus and acne scars.
• Sex-related issues like sexual abuse, homosexualism, porn addiction, erectile dysfunction, herpes infection and AIDS/HIV.
• Orthopaedic: Amputees, paraplegics, quadriplegics, and physically disabled.
• Cancers.
• Visually challenged and hearing impaired.
• Infertility and adoption.

What support groups do

Support groups disseminate information through various means. They hold regular meetings on medical treatment, surgeries, mobility, rehabilitation and emotional support. Those who have managed to overcome their limitations provide guidance to new members.

Sometimes experts are invited to speak on specific topics. A question-answer session follows the talk, which allows members to get their doubts cleared. Some groups also publish newsletters for members.

Support groups that are financially sound or that receive sponsorships also fund part of the treatment costs. They even provide wheelchairs, callipers, crutches, hearing aids, spectacles and water beds to those who can’t afford them. Some groups even celebrate birthdays/anniversaries of members. Members are also encouraged to participate in events such as marathons. Such initiatives provide an occasion to celebrate and participate in social activities.

Types of support groups

Self-help groups: Such a group is actively promoted by members that include patients, relatives and care-givers. They allow frequent meetings between members, either at a member’s residence or at a prearranged venue, usually a hospital or school premises.

Professionally-supported groups: Unlike the above, these are run by doctors, social workers, psychologists, counsellors or religious bodies. Meetings of such groups are usually conducted in hospitals, medical colleges, research institutes and charitable health centres.

Online groups: These are run either by members or professionals. They provide online guidance to their members and usually do not have personal meetings as their membership is usually across the globe. These groups hold regular chat sessions, bulletin board messaging and web-based discussions.

India has a long way to go

India still lags behind in having active support groups. They are present only in major cities. One way forward is to ask your physician for details of an support group in the vicinity and join the group. Even if the meetings are held far away, it is worthwhile to attend a few sessions to understand how they function. You can then set up another chapter in your locality so that more people can benefit. The parent group or your doctor may even help to get things started. It helps you as much as it helps others. As Dr Mehta says, “The one giving a tip in the support group also gains confidence for helping another”. It’s like what Gautam Buddha said, “If you light a lamp for someone else, it will also brighten your path”.

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Psoriasis is one such condition, which distorts the appearance of the normal skin. The patches of psoriasis appear bright, salmon pink and the surface shows layers of mica-like silvery scales. Fortunately, there is no associated itching or oozing from the patch. The most commonly affected areas include the scalp; the skin overlying joints such as knees, elbows, ankles and knuckles; palms and soles. In severe cases, the patches appear on any part of the body.

Psoriasis can develop at any age but is often seen in young adults. In women, there is a spurt in its frequency during puberty and menopause. Although psoriasis is rarely seen from birth, some infants may develop it in the areas associated with diapers.

Mysterious cause of psoriasis

Despite decades of scientific research, the exact cause of psoriasis has not been identified. It is thought to be genetically inherited although dermatologists come across many individuals without such family history. Researchers suggest that it could be due to an immune system malfunction.

What worsens psoriasis?

Psoriasis occurs more often during winter when the skin becomes dry; it also flares up during episodes of intense mental stress. Another peculiar behaviour of this disease is that new areas of psoriasis can occur anywhere if the skin gets scraped or scratched. Friction-prone areas like hands and feet frequently keep developing psoriasis despite proper treatment.

Complicated types of psoriasis

If left untreated, psoriasis may progress to one of the three complicated forms.

• Exfoliative dermatitis: The entire skin of the person is shed off in flakes and the body appears flushed. The person appears weak due to loss of protein from the skin.
• Pustular psoriasis: The chest, abdomen or the limbs show large ‘lakes’ of pus-filled areas. The underlying skin is bright red and the patient appears to be in a state of exhaustion.
• Arthropathic psoriasis: This type of psoriasis is accompanied or preceded by swelling and pain in major joints of the body, for instance, knees, ankles, lower back, fingers and toes. The patient becomes virtually immobile and may require to be hospitalised. Over a period of time, the joints may get deformed and mobility is compromised.

Special types of psoriasis

• Flexural psoriasis: This type affects the groins, underarms, area below the breasts and other body folds. The skin appears red and raised with minimal scaling.
• Palmo-plantar psoriasis: It appears as thick, dry, scaly patches. In some cases, the scales lose their silvery character.
• Sebopsoriasis: The co-existence of seborrheic dermatitis [dandruff] in psoriasis is termed as sebopsoriasis. In this type, the scalp, eyebrows and areas behind the ears are affected.
• Nail psoriasis: Nail damage may precede skin lesions. The nails have pits, linear ridges, and discolouration.
• Oral psoriasis: Psoriasis rarely affects the mouth. It is a feature of pustular psoriasis and exfoliative dermatitis. Grey, yellow or whitish plaques or ring-like lesions are found in the mouth, palate and tongue. The lips may have silvery scales.

Uncomplicated psoriasis is never fatal. Even with complications, the currently available treatment methods ensure that the patient improves and resumes normal life.

How is psoriasis treated?

The unfortunate part of psoriasis is that the perfect treatment is yet elusive. Treatment of psoriasis yields good results but the response may not be long-standing. The disease has many cycles of remissions and relapses—the disease disappears and reappears periodically. Due to its embarrassing appearance, it affects people in their day-to-day lives.

Creams and ointments containing corticosteroids, tar, calcipotriol, calcipotriene, tazarotene, tacrolimus and moisturisers are prescribed in sequence till the lesions disappear. Tablets containing vitamins, fish oils, steroids, psoralens, acitretin, methotrexate and cyclosporine are given orally depending on the severity of the condition. Most patients respond to these drugs and remain free of symptoms for months together.

Combining oral tablets with exposure to specific rays of ultraviolet light [PUVA therapy] helps patients who do not respond to the above treatment.

One of the recent developments is the availability of special compounds known as ‘biologicals’, which are injected weekly for several months for clearing complicated forms of psoriasis. Etanercept is one such drug now available in our country, but its prohibitive cost prevents it from being prescribed to most patients who do not have health insurance.

There are also some reports of a specialised type of laser—Excimer laser—being useful in treating psoriasis although more studies are required before it can be recommended as an effective therapy.

Exfoliative, pustular and arthropathic psoriasis need to be treated by skin specialists [dermatologists] as the patient may require hospitalisation and high intensity medications.

Don’t self-medicate, please! It must be clearly understood that certain medicines are prescribed only by specialists for short periods of time, after confirming that the patient is not planning a family in the near future.

There is a high likelihood of abnormal pregnancy, if women of child-bearing age consume this drug.

Drugs like methotrexate and cyclosporine too are prescribed by dermatologists cautiously as self-medication could lead to major complications.

How to prevent relapse of psoriasis

People suffering from psoriasis can prevent repeated attacks by observing some precautions. Most doctors who treat psoriasis patients explain to them the ointments that are to be restarted if the patch reappears. Applying the appropriate medication for the prescribed duration helps clear the skin. Once the skin has cleared, it must be kept regularly protected with a medicated moisturiser recommended by the physician.

Elderly individuals have reduced activity of oil glands in the skin, which leads to dryness even in the absence of skin disease. If such people suffer from psoriasis, the need for moisturisers becomes vital.

Friction with household utensils, briefcases, steering wheels, and badminton racquets or cricket bats are reasons for relapse of the disease. People who regularly handle these objects are advised to minimise the contact as far as possible. If friction actually occurs, the appropriate ointment should be applied on the area before retiring every night.

Stress and emotion

While attention to the patient’s general, physical and psychological health is always worthwhile, the emotional state plays a major role in keeping psoriasis under control. Many patients themselves observe that their condition relapses before major examinations or if there is a change in their job profile—situations of emotional upheaval.

Sleep disturbances and sustained anxiety leads to certain chemical changes in the body, and interference with the smooth functioning of the immune system, which is responsible for all repair processes of the human body. This in turn, exacerbates instances of psoriasis.

So, the affected person should be provided emotional support. Remember, though the disease looks bad, it is not contagious. And with love and support, it will be under control.

You may eat everything!

In the complicated and extensive forms of psoriasis, taking adequate rest and giving proper attention to meals helps speed up recovery. Diet has no specific role in the disease and hence the patient is free to eat whatever she likes.

Sex and intimacy

Young men and women suffering from extensive psoriasis suffer from deep anguish when the lesions are present on the trunk.

The shedding of scales in large amounts affects their marital life. It gives a creepy feeling not only to the person, but also her partner. Scaling in the genital areas makes intercourse embarrassing as there is intense anxiety of spreading the disease to the sexual partner. It would be worthwhile to repeat that the disease does not spread, even through sexual contact.

Using moisturisers or lubricants can help minimise the scaly appearance of the skin in these parts of the body.

Social issues

Most individuals suffering from chronic psoriasis would have already sought medical assistance from several doctors. The realisation of the fact that the disorder is chronic and recurrent, produces a lot of strain on the person’s mind.

Patients having extensive disease are often at the receiving end of dirty stares and comments from the public. When it affects the poorer sections of society, especially women, the social overtones can be extremely depressing.

When it comes to getting married, psoriasis patients find it difficult to find a life-partner even though the disease has no impact on reproduction or life expectancy because of the way the skin looks. The patches put off prospective mates.

Often, women find it difficult to select dresses that can conceal their patches on the skin. Going for a swim, visiting a beach or attending a party wearing sphagetti straps and shorts become impossible for women sufferers.

Brighter side

Psoriasis, with all its drawbacks, is a safe disease. Barring the small percentage of complicated cases, the internal organs are not affected, making life expectancy normal. The disease is not contagious and does not require repeated bandaging or dressing.

Even though psoriasis cannot be cured, with appropriate care, most patients have a disease-free interval of several years. The newer drugs help the patient lead a near-normal life and keep her gainfully employed and socially useful.

Maintaining adequate lubrication of the skin by using appropriate moisturisers is the mainstay of psoriasis treatment. When in doubt, moisturise!

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Punching a few keys, he secured a list of “best” doctors on Google for stomach ache. In 0.14 seconds, he got 218,000 results! That’s when it got confusing. Is the first listed name really the best? Or are the names at the top, listed based on the payments made to the search engine? Now how does Raymond sift through those names and make sure that his wife reaches a genuine doctor?

The explosive growth of information technology has been a blessing in many ways. With the easy availability of personal computers, affordable mobile phones and ready internet access, the world is at one’s fingertips [well, literally]. It’s now possible to get a plumber, order a bouquet, buy a gizmo or learn the intricacies of an ugly skin disease instantly, without stepping out of the house .

A person suffering from an incurable illness can easily get information of the latest treatment. You can even get details of a hospital or a clinic, including directions to the place, equipped with nothing more than its name. “So, what’s the problem?” you may ask. The difficulty is that the information available on the worldwide web is not complete. Moreover, since there is no system to monitor whether the facts stated on websites are accurate, not everything that is listed is 100 per cent authentic. Even if it is, it becomes difficult to zero down on the right choice for you when you are faced with an explosion of options. Allow me to help you make an informed choice…

A word about websites

There are different kinds of websites on the internet. Private or ‘promotional’ websites put up by individuals and organisations primarily to serve two purposes: provide details of the services and serve as a medium to advertise their business. In addition, there are independent ‘service’ websites, which simply list various categories of products and services available globally. Search engines too display list of websites based on their own tracking and rating system. They provide prominent slots to paid advertisers, which are placed higher in the list for easy access by the user.

Unlike browsing health-related information, finding the specific doctor through the internet is not without its dangers. Therefore, one should have a clear idea of how the listing system works on the internet.

The logic behind listings

All search engines produce lists of items searched in a particular order, which is decided by their software protocol. The number of visits [or ‘hits’] a website receives in a specific period of time determines the popularity of that site. The search engine scans the contents of the site as well as the amount of time the user lingers on the page. As the number of hits increases, the search engine pushes the site upward in the list. Therefore, the first name in the list is the most searched site and is probably the most accurate one for the user.

Making the decision

Remember that not all doctors are listed on the web. Many senior and sought-after doctors don’t have websites. On the contrary, novices who have recently set up plush clinics may have sophisticated websites. Looking at the layout of the site does not always give a clue to the abilities of the physician. For that, you need to do a little more—make telephonic enquiries after you have short-listed your options from the internet. It would be foolish to make a quick search and rush to the first virtual doctor available. The following points should help:

1. Check the physician’s qualifications: Is he a general physician or a specialist? Is the doctor an allopath/MBBS, homoeopath [BHMS], ayurvedic [BAMS] doctor or simply a beautician practising under the guise of a ‘cosmetologist’? Is he a diplomate for example Dip. Child Health [DCH], a postgraduate [MD, MS, PhD] or a super specialist [DM, M.Ch]? Is he also stating from where he has procured the degrees? For instance, medical college or university name.
2. Check for affiliations: Is the doctor practising solo or is he also attached with some government bodies? Government hospitals employ only qualified personnel. Hence, someone who is a consultant at a hospital run by the local body would be one with some degree of experience and authenticity. Is he a professor too, teaching at a medical college? A teacher at a medical college is usually one with vast experience in his field. Besides, teaching doctors have better skills of communication than those who are only into private practice. Is he a member of a recognised medical speciality association? Is the association a broad-based national or international body? Is the physician listed in the members’ directory? Does he consult at any private hospital or a well-known industrial group? Large corporations appoint senior and highly skilled consultants on their panel to take care of their employees. Therefore, a physician who is attached to a large organisation is someone whose bio-data is vetted by a team of eminent people.
3. Check for internet presence: Does the physician have his website or a blog? Are his articles constantly updated? Are the articles simple to understand or are they full of confusing jargon? Does he participate in online forums and provide credible solutions or simply promotes his practice? Does his personal website state his experience in practice? Are his qualifications and institutional attachments mentioned clearly? Perhaps you could call up one of the organisations and verify the attachment. Does the physician contribute to reputed online journals published globally? Is he mentioned in, say the British Medical Journal or Archives of Dermatology? Is he quoted by other authors in medical journals or websites or newspapers/magazines? Are the physician’s works elicited in an internet search? Some of these articles will quote his qualification or his hospital attachment. This data helps ratify the claim made by the physician on his personal website. If the physician is easy to find on the internet and his name appears in prominent journals and sites, run an internet search and check if you can get more information about him.
4. Read reviews: Are there reviews about him? Read them. Where are the reviews, in forums or on his website? There is a difference between testimonials and reviews. Testimonials are provided by doctors on their own website and they may not be authentic. Rely more on reviews rather than testimonials. If the testimonial provides a contact, call up and talk to the person who’s provided the testimonial.
5. Call the clinic: Call the clinic/hospital and talk to the receptionist. Verify the qualifications mentioned. Ask questions about the type of work done by the doctor and whether he is attached to major institutions. A simple talk with the person will clarify if there is something erratic.Speak to the physician and get a feel of how she sounds over the phone. Does she appear warm and friendly or was she in a hurry to end the call? Remember, though, that doctors obviously do not provide consultation over the telephone to strangers. Therefore, avoid asking queries. It might even put off a well-meaning physician.

Armed with this knowledge you can be fairly certain whether the physician being located is qualified, reputed and responsive. However, the proof of the pudding is in the eating. Therefore, the final step before surrendering oneself to an unknown doctor is to actually visit the clinic and look at its upkeep. Check whether the clinic is reasonably well-maintained and whether there is a crowd of patients waiting for their turn. You can even talk to the receptionist or other patients in the waiting room for a first-hand feel of the place. Most clinics have notice boards displayed in the waiting rooms. Give it a good look to see if the physician provides up-to-date information about current illnesses or it has an old collection of newspaper clippings. This may give a clue to the doctor’s interest and attitude towards the waiting patients.

In the final analysis, if one gets the feeling that the physician is not the one you had in mind, flee from the waiting room itself…. And start another online search!

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