Ask the Doc...
Patches on the skin
Dr. R. Murlidhar, Consultant Dermatologist, Apollo Hospitals, Chennai, replies to this week's questions.
A 12-year-old tiny spot by the lower lip was diagnosed as vitiligous. I was prescribed application of Melanocyl solution followed by Flutivate ointment (after 1/2 hour) at night, Mazoica after breakfast, application of Tacroz (Tacrolimus) during the day, Psoralen tablet and exposure of the affected skin to sunlight twice a week. After one month, Psoralen was changed to Melanocyl tablets followed by exposure to sunlight every alternate day. Mazoica was changed to Recharge plus; Whitcare ointment in the morning and Tacroz in the evening. Melanocyl solution and Flutivate were continued. After one and a half months, the spots disappeared. Is there a possibility of relapse? Can vitiligo be distinguished from other spots? PVSR Sharma
Answer: There are many misconceptions about vitiligo, especially its treatment. Psoralen and melanocyl contain the same active principle. So there is no logic in changing one for the other. Flutivate is quite a potent steroid. Though all steroids used externally do have some role in treating vitiligo, I usually advice patients not to use them continuously as they would damage the very skin we are supposed to treat. The other issue is that melanocyl solution is used in the day as it is activated by sunlight. There is no point in using it at night. Recharge and Whitcare are not proven in the management of vitiligo. Having said that, one should never combine melanocyl lotion and melanocyl tablets in the same patient, as this may burn the skin. Tacroz is a new drug useful in the treatment of vitiligo. By and large, localised vitiligo confined to a single anatomical area can be treated and there are plenty of options. Please talk to your skin specialist and streamline your prescription for best results. As for relapse, it is possible, so you will have to be under supervision for a year at least. There are several other causes for white spots, so do not panic every time you see a white spot. Even fungus or marks of inflammation can leave behind white spots. Discuss a symptom with a dermatologist before labelling it as vitiligo.
I AM suffering from eczema for five years. It started when I used a new leather slipper. Medicines prescribed by a skin specialist were of no use. Is there any cure? S. Prakash
Answer: Eczema is only an inflammation of the skin. If the inflammation is recurrent, maybe you have contact eczema to some component, which makes your skin sensitive to the footwear. This can happen due to chromates or nickel in leather footwear. Ill-fitting footwear can also inflame your skin. Dry skin can result in eczema, which can also get infected. You must treat it continuously and get rid of it, which is certainly possible. Often eczema is perpetuated by the patient who goes on scratching. This has to be identified by the doctor and treated or else the eczema will not disappear.
I AM now 18. Six years ago, the colour of my face started becoming relatively darker than the rest of my body. The area below my eyes and near the corners of my nose (above the mouth) is not so dark and the rest of my body is even fairer. Why? Y. Rakesh
Answer: The common reason for this problem is exposure to sunlight, which contains ultraviolet light. Going out a lot can expose you to this light and your skin can react adversely to it, and produce a dark pigmentation. Avoid sunlight, ultraviolet light and cosmetics that sensitise your skin to light. Perfumes are a major hazard in this connection. You may use a sun block to help you along, specific medicines are also available which your dermatologist will able to prescribe.
MY husband is 40 yrs old and has been suffering from psoriasis, which started three years ago. Nothing seems to help control it. He has used creams, UV rays, medication, natural remedies etc., Can you please advise the best methods for controlling psoriasis: what to eat and what not to? Name withheld
Answer: Psoriasis is considered a systemic disease. The immune cells interact with your skin in such a way that the skin cells divide faster than they should and so appear as thick patches on different areas. Various treatments are available. As for diet, alcohol affects the disease adversely; smoking worsens it. Several drugs are available and have to be chosen depending on the extent of disease and ability of the patient to tolerate it and affordability too, as some drugs are quite expensive. There is a wide array of therapies that a good dermatologist can tailor for the patient. The patient's personality is also taken into account when treating psoriasis as the quality of life index is an important factor in deciding treatment. Besides, this may also affect the response to treatment. A full discussion of the modalities available is not possible here, especially in the absence of more clinical information about your patient.
I AM 71 years and have found white dots on my hands and legs. This was diagnosed as leucoderma. The skin specialist says it cannot be cured completely but prescribed medicines such as Beijnot incolnate lotion, trioxal and Minujal. But I have found the white dots seem to be increasing. Now the specialist says not to eat tomato, lime and curd. Will this restriction help? Is there no cure for leucoderma? R. Kandan
Answer: I think there is no logic at all in the diet you have been prescribed. Dermatologists all over India have been prescribing various diets for vitiligo patients with no scientific basis. As it is, at the age of 71, you need vegetable vitamins. You also need to understand that vitiligo at 71 responds very slowly, if at all, to treatment. You need to confirm whether you really have vitiligo or some other cause of leucoderma, as all leucoderma is not vitiligo. At your age, people normally lose colour on the arms and legs due to age factors called idiopathic guttate hypomelanosis, a condition which requires only reassurance. Vitiligo is a cosmetic encumbrance. Before putting a patient on treatment, the doctor has to decide whether it is indeed worthwhile to expose the patient to the hazards and nuisance of treatment.
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