The most common form of eczema is known as atopic eczema or atopic dermatitis. Atopic refers to a group of diseases that are often inherited, like asthma or hay fever. Other types of eczema are:

• Scaly yellowish patches of skin that are usually oily, on the scalp and face [Seborrheic eczema]
• Blisters on the palms and soles
• Circular patches of irritated skin that are crusted, scaling and itchy
• A reaction caused when the skin comes in contact with a substance that it is allergic to, like nickel in jewellery [Allergic contact eczema]
• Usually related to circulatory problems, stasis dermatitis is a skin irritation on the lower legs
• Insect bites may also cause eczema. It causes localised itchiness and scaly patches of skin on the head, forearms, wrists and lower legs.

Causes and symptoms of eczema

The exact cause of eczema is not known, but experts believe that it is most likely caused by the body’s reaction to an irritant. It is also frequently found in people with a history of other skin problems, allergies or asthma. Here are some commonly known triggers:

• House-hold things like soap, detergent, animal dander and coarse materials
• Colds and respiratory infections
• Eggs, soy products, juices from fresh fruits, meat or vegetables, dairy products, nuts, wheat and seeds have been known to cause or worsen the condition. However it is recommended that you do not stop any food, unless there is a food sensitivity confirmed
• Hormonal changes in women during pregnancy or at a certain point in their cycle can bring out symptoms of eczema
• While stress cannot cause eczema, it can certainly exacerbate the condition.

Symptoms

The appearance of the eczema varies greatly from person to person and may include:

• Thick and leathery patches
• Scaly, red areas
• Small, rough bumps
• Bumps that leak fluid and crust over

Eczema is a great cause for embarrassment for those suffering from it because it affects the skin, and our self-image is often tied to how we look. The affected areas generally show up as thickened, scaly or excessively dry skin. In people who are fair-skinned the areas may initially appear reddish and slowly turn brown. Among those who are darker-skinned, eczema can make the affected area lighter or darker, thus changing the person’s pigmentation.

Eczema commonly appears on the face, hands, back of the knees, wrists and feet; though it can appear in other places. It is extremely itchy; sometimes the itchiness starts before the appearance of a rash. Because of the itchiness, sufferers might scratch anywhere from 500 to 1000 times a day! However, refrain from scratching as it worsens the condition and increases the risk of infection.

Diagnosis and cure

Treatment usually focusses on healing the damaged skin and alleviating the symptoms as opposed to ‘curing’ the disease.

There is no single test that can be used to diagnose eczema. However a patch test for allergies is the best way to find out if you have eczema. The outcome for people with this disease varies—for some the eczema will disappear completely, but for others it can remain for the rest of their life.

Let us look at ways to manage eczema.

Tips to manage eczema

• Bathing with warm water more than once a day alleviates symptoms
• Make sure that your soaps, shampoos, shower gels etc. do not contain harsh ingredients. Avoid perfumed products and refrain from using deodorants
• As soon as you finish your bath, apply an oil-based moisturiser to lock the moisture in
• After a bath do not rub your skin vigorously, instead gently pat it dry. Any harsh treatment of your skin will only worsen the condition
• Wear clothes made of soft, light fabrics; cotton clothes work best. Avoid tight-fitting attire and clothes made of rough fibres
• Keep your fingernails short so that you don’t cause further infection when you scratch
• Avoid rapid changes in weather and if possible avoid doing activities that make you sweat
• Adults with eczema need to adjust their lives and activities to manage their eczema. Jobs that require a lot of hand-washing or exposure to chemicals or other irritants, such as health care, house-cleaning, or hairdressing, may not be a good choice for someone with eczema.

Today, there are countless medications available to bring eczema under control. There are also specially formulated cosmetics to hide the unsightly rashes. So now you don’t need to let your scaly skin be in command of your life.

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What causes hyperhidrosis?

The cause is difficult to trace and sometimes it’s due to another medical condition. Some possible causes include:

• Drugs and drug poisoning
• Infections
• Diabetes or hyperthyroidism
• Anxiety disorders
• Cancer
• Menopause
• Parkinson’s disease
• Injury to the spinal cord

Hyperhidrosis is more common among those who have an anxious temperament or are suffering from depression or severe stress.

Signs and symptoms

Hyperhidrosis is hard to conceal since the sweat is almost dripping from the palms and soles. Often, the wetness makes the grip so slippery, that even everyday tasks such as writing, typing, or using the phone become tedious.

The sweat is especially bad for the feet as the water stays in the closed footwear. This invites bacterial or fungal infections that lead to itchy and foul-smelling feet.

How is it diagnosed?

Diagnosis constitutes detecting the cause of hyperhidrosis since that is what paves the way for treatment. Pinpointing the cause becomes easier for the doctor if the patient provides a detailed history about the onset and progress of his symptoms.

It is even better if he maintains a sweat diary, noting down the areas where he sweats the most and the time when the symptoms worsen.

A doctor may order the following:

Starch-iodine test: An iodine solution is applied to the sweaty area and left to dry. After it dries, starch is sprinkled that makes parts that are prone to excessive sweating, turn dark blue.

Paper test: Special absorbent paper is placed on the affected area. This paper is weighed later to check the increase in weight of the paper, indicating the amount of sweat absorbed.

Depending on other symptoms and suspected underlying condition, your doctor may advise you some specific tests such as a thyroid function tests if hyperthyroidism is suspected.

Complications of hyperhidrosis

Excessive sweating, specially on the palms, soles and under arms, may predispose a person to contact dermatitis, pompholyx [eczema with blisters], fungal infections and bacterial infections like pitted keratolysis [crater like pits on hands and feet].

Apart from this, hyperhidrosis may cause severe psychological disturbance, stress, anxiety and depression. Some patients feel embarrassed to socialise and hence restrict social interaction.

What brings relief?

Antiperspirants: Products containing 10 – 20 per cent aluminium chloride or products with 2 per cent formaldehyde, 10 per cent glutaraldehyde or 10 per cent tannic acid help. Avoid using aluminium zirconium based products.

Also, refrain from excess use of antiperspirants as it irritates the skin and can even damage clothes.

Medicines: This includes medications specifically indicated for hyperhidrosis or those meant to reduce anxiety.

Iontophoresis: In this procedure, the affected person’s hands or feet are placed in water and a mild current is passed through the water. The intensity is then increased slowly till the patient feels a mild tingling sensation. A typical session lasts for 10 – 20 minutes and a person may require many sessions.

Botox: This involves injecting small doses of Botox into the affected area to block the nerves that stimulate sweating. However, the effects last only six months. Side-effects include pain on the site of injection and flu-like symptoms.

Sympathectomy: This treatment is suggested as a last resort for severe cases that are resistant to other forms of treatment. It involves removing part of the nerves in the affected area.

Adjuvant treatments such as behaviour therapy and biofeedback may provide some benefit.

This was first published in the June 2012 issue of Complete Wellbeing

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Though there are not many studies investigating the technique many dermatologists are using it for various skin conditions and are finding it effective without significant side effects, provided it is done by a well-trained expert. But there is need for more research and well-designed controlled scientific studies to substantiate the claims of benefit of this mode of therapy. So if you are considering mesotherapy, familiarise yourself with the basics and make an informed decision.

What is mesotherapy?

In mesotherapy, [also known as intradermotherapy] injections containing a mixture of compounds are given directly at the site to be treated. The compounds are a mixture of pharmaceutical, homoeopathic medications, plant extracts, vitamins, hormones and other ingredients. Since the compounds are introduced into the skin with tiny injections and not open cuts, mesotherapy is classified as a minimally invasive therapy.

It is used to treat a vast number of medical and cosmetic conditions.

What are its applications?

The technique was originally invented for pain relief. However, its cosmetic applications including fat and cellulite removal, facial rejuvenation and treatment of hair loss have received attention. It has been found beneficial in several dermatological and medical conditions.

Dermatological conditions: Cellulite, local fat deposits and body sculpting, acne, baldness, weight loss, expanded blood vessels, facial rejuvenation, skin tightening, stretch marks and pigmentation.

Medical conditions: Arthritis, asthma, lower backache, headache, sport injuries, gout, varicose veins, carpal tunnel syndrome, muscle pain, herpes, ringing sound in the ears and vertigo.

However, mesotherapy is more commonly used for skin and hair rejuvenation than for treating medical conditions.

How effective is mesotherapy for skin rejuvenation and hair loss?

Mesotherapy using multi vitamin injections as an anti-aging skin treatment has been used by many medical and non-medical practitioners, despite the existence of only anecdotal reports of its effectiveness. Also, many patients have experienced temporary redness, pinpoint bleeding, and pain despite topical anaesthesia.

Regarding its use in hair loss, currently there is no data on its safety and efficacy that has been adequately and critically evaluated and documented in proper, peer-reviewed clinical trials. However, if done by a trained person, who can judge the type of hair loss, its severity and with other additional treatments as needed then mesotherapy is one of the promising upcoming treatment for hair loss and its use for the same needs to be explored further with better scientific studies. Further, mesotherapy is not entirely a safe technique as publicised in lay media and can give rise to complications if not done by a properly trained and qualified person with proper aseptic precautions.

How long does the procedure take?

On an average a procedure takes 30 – 45 minutes. It depends on the age of the person and the damage to the skin or hair. After treatment, hot water bath should be avoided for 12 hours and no make-up should be used on the area of injections for about eight hours.

What are the side effects of mesotherapy?

This is minimally invasive procedure and found to be safe. However, some patients may experience minimal bruising and swelling, infections, inflammation, fat redistribution, formation of bumps, facial and scalp ulcers and scarring, allergic reactions due to various chemicals/drugs, pigmentation and increased hair loss.

There is a risk of transmission of blood-borne infections such as hepatitis if proper precautions are not taken. Also if you are on medication for insulin dependant diabetes, cancer, heart diseases, stroke, organ transplant or you are pregnant please take extra precautions.

How long do the results last?

Although the results of a mesotherapy procedure are encouraging for most people, periodic repetition is required to maintain the outcome—usually after every 6 – 8 months. Also, the results vary from person to person and depend on the area worked on. A trained physician is able to give an idea about that depending on one’s response.

This was first published in the August 2012 issue of Complete Wellbeing

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Xerostomia is not a disease in itself but can be a symptom of a variety of conditions.

What causes it?

Temporary xerostomia may occur due to stress, anxiety, depression, viral fever, dehydration due to diarrhoea or heavy exercise on a hot day, decreased water intake or short-term use of drugs affecting salivation. This condition lasts for a short while and is reversible. However, in some people, the symptoms are for a prolonged period and the condition may become chronic.

Medications: Long-term use of medications including anti-depressants, anti-hypertensives, opiates, broncho-dilators, proton pump inhibitors, anti-psychotics, antihistamines, diuretics and anti-cancer drugs.

Infections: Viral infections like mumps, hepatitis C, HTLV and HIV/ AIDS can cause a related salivary gland disease known as diffuse infiltrative lymphocytosis syndrome [DILS].

Autoimmune diseases: SjÖgren’s syndrome is an autoimmune condition with many associated symptoms including fatigue, muscle pain and joint pain. It is characterised by destruction of the moisture-producing glands throughout the body, leading to xerostomia, xerophthalmia [dry eyes], and in case of women, dry vagina.

Endocrine diseases: Hypothyroidism and diabetes are common causes of xerostomia.

Radiation therapy: Radiation therapy for cancers in which the salivary glands are close to or within the field of radiation can damage salivary glands with resultant xerostomia.

Nutritional deficiency: Deficiency of certain vitamins needed to maintain mucosal health like vitamins A , B and C can cause dry mouth even with normal salivary secretion.

Traumatic: Any trauma to the salivary glands itself or to the nerves around them can cause xerostomia.

Others: Bone marrow transplantation, patients with kidney failure on haemodialysis, Alzheimer’s disease, Parkinson’s disease, scleroderma, stroke and rare diseases like sarcoidosis too may develop xerostomia.

What are its symptoms?

• Feeling of stickiness or dryness in the mouth and throat
• Trouble in chewing and swallowing
• Altered sense of taste and foul odour from the mouth
• Difficulty in speaking
• Cracked, dry lips that may stick to each other
• Burning sensation in the mouth
• Recurrent mouth infections
• Dental caries
• Psychological distress and depression
• Absence of a pool of saliva in the floor of mouth. The consistency of saliva may appear frothy
• Abnormally red, fissured and dry tongue with a pebbled, cobblestone appearance.

How it is diagnosed?

Detail history of the patient’s health conditions and a thorough examination provides a clue to the probable underlying cause/causes of xerostomia. This is followed by a review of all the medications the patient is taking. Further blood investigations and biochemical tests may be requested to help accurately pinpoint the cause. Immunological tests for auto-antibodies like rheumatoid factor may be needed to rule out autoimmune diseases like Sjögren’s syndrome. In rare cases, imaging studies like radioisotope salivary function test, MR sialography and ultrasound examination of glands may be required. Most doctors also screen for infections such as HIV and hepatitis C. Sometimes salivary flow rate measurement is done to document hypo-salivation.

How is it treated?

The cornerstones of treatment are the prevention and treatment of complications, control of the underlying problems that may cause or contribute to xerostomia and symptom control.

In case of drug-induced xerostomia, stopping or changing the drug or reducing dosage helps. Following good oral hygiene minimises the severity of the condition. Also, chewing gum, eating candies and mints help stimulate salivary secretion. In people who have partly functioning salivary glands, using lubricants or artificial saliva diminishes the sensation of oral dryness and improve oral functioning. Some patients are prescribed medications for management of their condition. Others simply drink more water.

Some patients have also experienced good results using alternative therapies like acupuncture.

How are complications prevented?

Daily use of topical fluoride and antimicrobial mouth rinses helps prevent caries in patients with reduced salivary flow. The mouth rinses can be used twice daily to prevent demineralisation and induce re-mineralisation. Regular dental check ups help detect and treat lesions and decay. If saliva is sparingly secreted, you could be treated with fluoride applications [gel or foam formulations], varnishes, and pit and fissure sealants to prevent rapid decay of tooth structure.

Dry mouth-induced oral lesions are susceptible to developing secondary infections. One such common infection is oral candidiasis that is treated with topical anti-fungal agents.

Sipping on fluids during eating and avoiding eating dry foods helps losing sensation of taste. Patients suffering from xerostomia who use dentures can soak the dentures in a special solution that prevents germs from growing on the dentures.

This was first published in the May 2012 issue of Complete Wellbeing.

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