“Over the counter skin products are dangerous, especially if they contain steroids.”

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Pune-based dermatologist Dr. Anita Viegas speaks to A. Radhakrishnan on a wide range of issues related to skin, skin care, latest treatments available for skin ailments and the do’s and don’ts for a healthy, glowing skin.

Briefly describe yourself.
 
I am meticulous, paying attention to detail and give of my total self to anything I undertake. Taking the more difficult path somehow comes easily to me. With an organiser personality, I like it when things go as per plan.

Your educational achievements?

I am blessed to have studied in two great institutions – MBBS from St John’s Medical College, Bangalore and MD from CMC Vellore, where the focus is not just on teaching medicine in all its intriguing intricacies, but on looking at the patient as a precious human being and serving that person.  
Hard work and academic achievement they say, go hand in hand, especially in the medical field. I won several prizes and stood 1st in my college at the final MBBS examination. My post graduate thesis was the largest study from India on Neurocutaneous syndromes. Karoytypic abnormalities in pigmentary mosaicism were studied for the first time. This series was presented at the World Congress of Dermatologists in Rome, in July 2004.

Why did you choose to specialise in dermatology? 

To start with, the excellent teachers I had at St John’s – Drs.Elizabeth Jayaseelan, Anil Abraham, Sujata Harshad and others kindled the interest. My internship posting in dermatology was marked with having to look after several dermatological emergencies and ill patients with challenging co-morbidities. 
I later worked at a rural hospital, village Palamner, of Chitoor district. There too, I had to treat a lot of patients who had skin issues (the hospital was known as a leprosy hospital). With this background, dermatology somehow emerged as a natural choice!
At CMC Vellore, the unforgettable learning experience, thanks to Drs. Mary Jacob, Renu George, Susanne Abraham and Pushpa Eapen enabled me to be a learner for life. 

What is your personal skincare routine like?

Very simple. I apply a retinoid based cream at night, an oil- free moisturiser in the morning and regularly apply sunscreen. 

What are the common skin complaints in India? 
 
One study from rural central India found eczema to be the commonest at 22%, fungal infections 13%, benign skin tumours 6% and pigmentary disorders 4.5%. Various studies show different figures depending on the age of the population.

Have you ever misdiagnosed a skin disease? What steps did you take to rectify it?

Yes and on more than one occasion!
One situation that leads to this is when one sees a patient before he or she has developed all the manifestations of a particular condition…so the early signs may look like quite something else! Diseases do not read books! And so the uncommon manifestation of a common disease can be tricky. So also, the common manifestation of an uncommon disease. 
I recall one instance when I had gone down to examine a patient in her car, as she was elderly and unable to come to my clinic on the first floor…the restricted visibility was not in my favour. When the condition continued to deteriorate, I was forced to reconsider my initial diagnosis and search for other possibilities….I suggested a skin biopsy and today she is on the right treatment and doing well.
That is the humbling and exhilarating part of practising medicine…that one can’t always be right…that just when everything seems to be working right, something unusual poses a challenge that forces one to reconsider and research.

What causes skin cancer? Is it common?

Exposure to ultraviolet radiation, smoking, certain chemicals, immunosuppression due to certain viruses or medications, having an affected family member, certain kinds of nevi ( birth marks), Caucasian race…are all risk factors for skin cancer.
Conventional wisdom was that skin cancer incidence is lower in Indians due to the protective benefit of melanin. There are indirect indicators of perhaps increasing numbers, compared to the 1980s although nation-wide cross-sectional studies are not available. 

What causes acne? What is the difference between acne and rosacea?

The cause of acne needs to be addressed. Adolescent age; hormonal imbalance triggered by medication given for another condition (some anti-TB and epilepsy medicines can cause acne); diet (junk food, sweets, high intake of dairy products, oily cosmetics), etc., and over-the-counter steroid creams, often misused for fairness are causes.
The severity needs to be assessed. Severe forms with pus need internal medications. Mild forms need certain topical (application) medications, so that the process of blackhead and whitehead formation is reduced to a minimum. 
Acne is mainly characterised by pimples of varying grades (blackheads, white heads, reddish bumps, yellow pus filled ones). Rosacea may have bumps, but has predominant redness, which is easily triggered off by a number of factors, especially by UV rays. 

What’s the best way to exfoliate if I have acne?

Exfoliation has a very minor / supportive role in acne. Otherwise one could just scrub the problem away! One needs to assess the entire situation and work out a regime.

Does stress and depression lead to skin ailment?

Yes! The converse is also true where skin ailments that are longstanding cause stress and depression. 

Which foods should one avoid?

There cannot be blanket restrictions, as it depends on the skin condition of an individual.
A diet rich in anti-oxidants helps in maintaining a healthy skin.

What to do about skin discolouration?

That is challenging! Sunscreen helps to some extent; it may perhaps prevent worsening. 

What are these stubborn rash, warts and other marks that won’t go away? Are they harmless?

Difficult to generalise. Warts may be viral. Some people refer to skin tags also, as warts, which indicate a slightly greater risk of developing lifestyle diseases.
 
What are Brown spots?

That is again a description. Not a diagnosis…some types of fungus and freckles and age related spots may also be brown. 

Any cure for the dreaded keloids?

Treating keloids is extremely challenging as some patients respond better than others. The centre of the chest is usually the most difficult to treat. Most often we are able to give some relief; total cure is elusive. 

Is it okay to pop a pimple? Or should it be treated right away?

Popping pimples is the surest way to get scars and marks on the face. Treatment helps, although it may be six to seven weeks before the onset of results. Pimples often affect self-esteem. Hence treatment makes sense.

What are the latest treatments for the skin? Is laser treatment advisable? 

There are huge map like birthmarks on the skin that are perceived as disfiguring and affect self-esteem, relationships, etc.In such cases, lasers are a big boon. If done for the right indication and with adequate precautions, they do help in reduction of unwanted hair, rejuvenation, scar treatments and even in pigmentation and certain birthmarks.
Is it advisable? The person has to decide how important/ distressing the problem is. Yes, every procedure has a possible chance of side effects, like medications. These are discussed to enable decision making.

What is cosmetic dermatology?

It is the application of dermatology for look – enhancement and is also called Aesthetic dermatology.  We do have an increasing number of people who do not have a skin disease, but would like to have the best version of their skin and there are numerous options from peels to botox and fillers. 

Do facials at beauty parlours increase chances of skin ailments?

That is a tricky one! For those who have no tendency to acne, there may not be much of a risk, if relaxation or the pamper factor is what they are looking for.  

What are the do’s and don’ts for glowing clear skin?

Do eat brightly coloured fruits and vegetables like broccoli, bell peppers, tomato, nuts, dry fruits like walnut, flax seeds sunflower seeds, fish, citrus fruits, legumes. Do use a sunscreen. Do use a gentle cleanser and moisturize skin when dry. 
Don’t eat junk, don’t smoke and drink; handle stress and get adequate sleep. 

How useful is Botox?

Botox when used for the right indication is one of the most gratifying of procedures. Definitely useful in dynamic wrinkles (lines seen when we use our muscles of expression); not helpful in static lines (lines present at rest).

How important are biopsies?

Biopsy is extremely useful in evaluating chronic skin conditions. It is not (as is often feared), just to diagnose cancer.

Can lemon juice and baking soda harm my skin?

Yes both are not risk free. Although lemon is a popular home remedy, it can cause dryness, redness and phytophotodermatitis. Baking soda too can irritate the skin. 

Does one have to use sunscreen everyday in India?

Preferably. Especially if one is concerned about tanning and skin rejuvenation. 

How much can one depend on over-the-counter products and home remedies and any DIY skin treatments, without help of a dermatologist?

Over the counter skin products are dangerous, especially if they contain steroids.  Dermatologists often see patients with a condition called Topical Steriod Damaged Face, due to the inadvertent use of steroids, for fairness and glow.
Several conditions require the judicious use of steroid creams.
These have to be used under medical supervision. Our association, the IADVL (Indian Association of Dermatologists Venereologists & Leprologists) is working hard to educate the public as well as to bring about appropriate legislation to curb this menace.
 
How can I slow down the signs of aging?

Following a healthy lifestyle, using sunscreen to protect the skin, retinoid or alpha hydroxy acid cream and procedures depending on specific conditions help to slowdown the aging process. 

Finally, what would be your advice for an issue- free skin? 

One can follow the dos & don’ts discussed. However genetic or constitutional tendencies or infections may sometimes still cause concerns. Despite best efforts, it may not be possible to totally avoid skin issues.


A. Radhakrishnan

A. Radhakrishnan is a Pune based freelance writer, poet and short story writer.

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