Summertime blues


Summer is a much awaited season as it denotes vacations, travel and leisure. Yet, it also comes with its own set of health risks. Dr. T.D. Rajan provides guidelines to stay healthy this summer.

SUMMER is the time when days are long and the warmth of the sun heats up the environment. In the northern hemisphere summer arrives during the middle of the year, whereas in the southern half, itbegins from December. While it is the time for school vacation in most parts of the country, it is also the time for several health related problems. It is important to be aware of these conditions, so that some of them can be minimised. Children often play long hours in the sun and may forget the rules of hygiene. Also, recreational activities like sports, swimming and physically grueling outdoor activities undertaken during the summer help the spread of germs. During intense summers, food poisoning, heat stroke, sunburn and prickly heat are common. Viral infections like jaundice, conjunctivitis (sore eyes) and chicken pox are also seen in summer. Some of the conditions have been elaborated here.

Normal skin has got enough capacity to withstand moderate degrees of heat and sunlight. This ability varies with skin colour and sensitivity. Due to prolonged exposure to ultraviolet rays from the afternoon sun, people may suffer intense burns, making the exposed areas of the body red, dry, itchy, and it starts peeling after a few days. In some cases, fine, fluid filled eruptions or frank blisters may appear. In toxic sunburn, the person may feel feverish and may develop chills.
The best way to prevent sunburn is to cover oneself with long-sleeved clothes and by using sunscreen with SPF 30 or higher twenty minutes before venturing outside. People who are prone to sunlight induced allergic skin rash should wear clothes which have close-knit weave. Using an umbrella or a broad brimmed hat when you are on a holiday is essential for people who feel the heat strongly. Drinking sufficient water to keep the moisture of the skin intact is equally important. The peeling skin can be protected by Vaseline or coconut oil. Creams containing betamethasone will help to heal the burnt skin. Although bathing with normal water will be helpful, soaps should be avoided.

Heat stroke
Our temperature regulatory system helps to maintain body temperature within a specific range that allows the brain, heart and the major organs to work efficiently. However, in certain extremely hot conditions, the temperature may soar excessively, leading to ‘heat stroke.’ Intense headache, drying of skin, cramps, weakness, vomit, increased heart rate or shallow breathing are signs of a heat stroke. The skin appears flushed and the person becomes disoriented and confused. If not promptly attended, the patient may slip into coma. One must not leave such a person alone.
Put him under the shade or shift him to a cool place or switch on the air-conditioner, if available. Spray water on his body and keep wet towels on his body.

Prickly heat
One of the purposes of sweat production from our skin is to allow the skin to release heat and this happens silently without us being aware most of the time. The sweat glands go on overdrive during summer to expel excess heat. Sometimes due to copious production of sweat, the pores that bring sweat to the surface of the skin gets clogged, giving rise to a red rash of fine eruptions with a pointed tip containing clear fluid, which ruptures on scratching. This is called prickly heat. It may also appear as wide areas of intense redness accompanied by itching. The trunk, groin and underarm are the commonly implicated areas.
Taking cool baths and remaining in a cool room helps to soothe the rash. Calamine lotion can be applied two or three times a day to cool the surface and give relief from itching. Tablets containing cetirizine or fexofenadine can be given once or twice daily. Avoiding use of soaps during bath helps to relieve itching. Gently pat the body with a dry towel after bath as vigorous rubbing will bring back the itchy feeling. Loose cotton clothes should be worn till the weather improves.

Germs are normal ‘residents’ of our skin, as we all know. However, their numbers are never too large to allow them to produce infection and cause damage to the skin.
When there is profuse sweating, the skin is teeming with bacteria which set up inflammation. The bacterial enzymes cause intense redness, swelling and pain. Pus may form deep within the skin, and the area becomes painful and cannot be touched. Sometimes, they develop into abscesses, which rupture releasing yellowish discharge. Fever sets in if the bacterial load in the body is heavy. Rest is an important part of treatment if boils are on the lower limb. Hot fomentation will help to soothe the area and also to help in the healing process. Antibiotics and pain-killers are necessary in these cases, and hence it is better to visit the physician for accurate advice. Large abscesses may need to be drained by a needle or by surgery.

It starts as a troublesome itch somewhere on the body where sweating is in abundance. In areas like the groin, armpits, under the breasts and buttock folds, the presence of sweat makes the skin soft and porous. This spongy skin mops up fungi waiting outside, and welcomes it inside! The eruptions take the pattern of a ring and hence it has the name. The itch produced by the ringworm is one of the most intractable types, and people cannot resist scratching, irrespective of the time of the day or where they are seated. Unlike in the past, ringworm is not only spreading rapidly but is also becoming resistant to most of the commonly available medicines and creams.
One must avoid wearing denims and tight fitting garments. It is necessary to take shower twice daily and wear only loose clothes at bedtime. Treatment should be sought quickly by consulting a skin specialist, and the entire course should be completed to prevent relapse. It is important to avoid using cheap, over-the-counter creams which may only give relief without permanent cure.

Creams to be avoided
Candid Total, Quadriderm, Panderm + , Panderm Super, Panderm – NM , Terbinaforce Plus, Orkid – 4, Dermi- 5 , Cosvate – GM, Lobate – GM , Clobet – GM, Betamil – GM, Tenovate -M, Clozema – GM, Cloderm – GM, Clop – GM, Gracederm, Topifort – MX, Sonaderm – GM, Surfaz – Sn, Betno- vate – GM, Qualiderm Plus, Fourderm, Nadimix, Triben XT, Triben Plus, 3 Mix,Tetmosol Total, Keto 4s, Ringout+

Food poisoning
As people go outstation on vacation and eating outside is a regular feature, the chances of food poisoning is on the rise during summer. The environmental condi- tions are perfect for bacteria, virus and parasites to thrive on uncovered food.
Fever, nausea, vomiting and profuse diarrhoea are the common symptoms. The patient develops numerous watery, loose stools, and feels very drained out and weak. Rest is important and the person should drink fruit juices and water frequently. Eating just curd and rice will help to provide energy for the healing process, till appetite returns.
Drinking a glass of boiled water with a pinch of salt and little more than a teaspoon of sugar (known as Oral Rehydration Solution or ORS) will replace the salts and water lost from motions. ORS needs to repeated after every loose motion if the patient is unable to consume soups and juices or food.

Typhoid fever
Contaminated food and water is responsible for this type of bacterial infection which appears as a high-grade fever, headache, weakness, indigestion, abdominal pain and loose motions. In severe cases, it may cause ulcers in the intestine.
It may take a few days to understand that the fever is due to typhoid since blood tests are not confirmatory within the first week. Rest, simple, non-spicy food, boiled vegetables, plenty of fruit juices and water or ORS is important to treat typhoid, which is also called enteric fever. Antibiotics are necessary and should be taken for as long as suggested by the physician.

One of the most dramatically visible conditions which can be suspected without any tests is jaundice or (viral) hepatitis A. The skin as well as the whites of the eyes appear yellow. Urine colour also is a deep yellow. Fever, nausea, vomiting and itching all over the body are common complaints. Treatment involves giving rest to the bowels by consuming soups, boiled vegetables and fruit juices. Like typhoid, this condition is also caused by contaminated food and water.
Both these infections can be prevented by ensuring that one drinks boiled water, and by eating only well cooked food. Avoid street food. Vegetables need to be washed well before cooking.
Thus, summer is vacation-and-fun-time only if proper care is taken without falling ill. Opting for well-cooked food and bathing frequently helps to remain fresh and fit. Remember to pack your bags with loose fitting, cotton clothes, sunscreens, moisturisers, calamine lotion, and don’t forget to carry a bottle of mineral/boiled water.

Dr. Rajan

The writer is a senior skin and sexually transmitted diseases specialist, practising in Mumbai. He advises pharmaceutical companies on drug branding, promotion and marketing. He is a writer on social topics in the print and electronic media, as well as in pharmaceutical magazines. Dr. Rajan is also an hon. consultant to ONGC, Larsen & Toubro and Air India.