THE MYSTERY OF THE DISAPPEARING WHITE SPOTS

A 27 years old young healthy male reported to the skin OPD with complaints of white patches over his arms and thighs since 8 months. On examination the spots were flat white spots & were numerous and distributed over the arms and legs most of them measuring less than a cm in diameter. the spots were quite subtle almost playing hide and seek looking prominent at sometime and then not so obvious at other times It didn’t fit in clinically with the most common skin issues of similar look ie fungus, allergy, sun sensitivity etc. Routine blood tests Complete blood counts , liver , kidney function tests, thyroid , blood sugars were within normal limits and gave no further insight whatsoever The patient had visited couple of doctors who just like us couldn’t really come to a final diagnosis and he was treated as a case of fungus, allergy white patches with no improvement at all; the case was turning to be most eluding yet teasing,it was like the spots were taunting us having a secret laugh at our ignorance. With nothing more to offer to the patient we admitted to the patient yes even though we are supposed to be specialists we had no clue as to what we were dealing with and we thought let us sleep over this and rake our brains at a later date

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image 1

Thankfully the patient was patient and persistent, and he had more trust in our abilities to help him than what we had frankly and were all about to throw our hands in the air when we noticed that his arms appeared slightly red kinda flushed. So we had a new clue and we started to prod deeper into that and the patient revealed that the redness is very much there on and off but it doesn’t bother him like pain or itch so he choose not to discuss that We then started a cross reference transient redness, flushing we dug into our books and online research ( Dr Google ) threw up a picture akin to our patients condition and we had the diagnosis it was BIER spots, a rare entity but nevertheless reported and published.

So this is how it goes when the patient raises his hands as shown in image 1 they disappear and when the patient puts his arms down the blood gushes down, the flush increase and the white spots reappear magically shining like stars in a dark moonless night (image 2).

In the image 3 we can see both the arms the right is red and beefy and left pale as it had been just raised for a few seconds a moment ago which had emptied the veins ; the contrast is startling and was staring in our face  Like a kid who has been give a free access to a video game parlor we were grinning and asking the patient to raise one arm and then the other and get them down and so on, even he was mesmerized to see the changes in his body happening with a bit of help from gravity The white patches would crop up the moment his arms were hanging

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image 2 & 3

down in the dependent position and disappear in a jiffy the moment he raised them and even though I’m considered a specialist in treating vitiligo ( White Patches ) I swear I have never seen any white patch getting cured at this speed. Medical literature dispels the mystery behind this phenomenon as abnormal Vascular response to venous hypertension and tissue hypoxia so if u see that’s what was happening But the thrill of making this rare diagnosis was a eureka moment for me and my colleague Dr Nupur, the sweet pleasure of arriving at a diagnosis was just divine . We literally patted each other on the back Good job and after a long slog in the OPD we raised a toast ( with tea In thermacol glasses) and exclaimed Elementary Dr Watson Elementary I know some of u must be wondering why I’m so excited to sit down and write a article about this simple condition but it’s something u really go to experience yourself , and in the end it’s the small pleasures that really count in this beautiful journey of life, for these are the drops that become the ocean, and is it not that the entire ocean is in the drop……

― Dr Paul

Take Care of Dry Skin in Winter | Few Tips

The magic of winter’s cold breeze, snowflakes, and bonfire often fade away by the unpleasant dry skin issues. The onslaught of the long haul of itchy, dry and flaky dry skin just turns the winter experience to a bitter one. A good moisturizer is not always a solution and as dry the winter is, more care you need. Your skin may need a bigger toll to stay alive in this dry weather. Here are some tips and bits of advice which can help you maintain a glowing skin in winters.

Hot Shower? A BIG NO!

The hot shower may feel good at that time, but it actually, damages skin surface and accelerate dry-skin related irritation. Excessive dry skin may lead to eczema or serious skin inflammation such as redness, scaling of the skin or itching. Moreover, you must not rub your skin excessively during the shower as that can worsen the condition.

Mild Soap or Gels Only!

Surveys show that almost 85% of women are not aware of the products that are suitable for their skin. If you are the one with dry skin, always go for a natural product oriented mild soap. It’s very essential for us to realize the need for small products that can make a big difference; a glycerine enriched soap or sandal or honey or natural ingredients made soap.

Avoid Air Heaters

Having some hot air around definitely sounds mesmerizing but is not recommended for the dry skin peeps. Using central heating unit or air heaters can be the big reason for skin damage such as blotchy, chapped and painful skin in winter.

Woollen Fabric Should Not Touch Your Skin!

The woolen fabric may seem a blessing for winter days but in reality, it moves moisture away. Woolens often lead to dry itchy skin and continuous rubbing worsens the condition. Always wear cotton under the woolen clothes to avoid any further skin damage in winter.

Switch to Heavy Creams!

Finally, dry skin needs a lot of; and you must provide a good amount of nourishment to your dry skin. Use heavy creams made with glycerine or aloe vera or honey to add the extra moisture lock, your skin wants in the freezing weather.

Do You Need More Care?

Visit a dermatologist if the above tips do not help your dried skin to rejoice. You may require a prescription ointment or cream or treatment to reduce the discomfort.

Melanocyte Cell Transplantation or MCT as Vitiligo Treatment

This surgical approach is now being considered as “may be a cure”. Unfortunately, science is still not able to find a permanent cure for this condition but there are many cases where Melanocyte Cell Transplantation (MCT) Melanocyte Keratinocyte Transplant Procedure (MKTP) as Vitiligo Treatment has made wonders.

The new approach to treat vitiligo is cellular grafting. This surgical approach is now being considered as “may be a cure”. Unfortunately, science is still not able to find a permanent cure for this condition but there are many cases where Melanocyte Cell Transplantation (MCT) Melanocyte Keratinocyte Transplant Procedure (MKTP) as Vitiligo Treatment has made wonders. The idea of MCT is to remove the top layer of pigmented skin and replace it with healthy pigment cells (melanocytes) taken from another part of the body. Within a few months, the transplanted melanocytes start making pigment and deposit it to the surrounding areas. The success of this treatment wipes away the white spots and, in many cases, it has worked like magic. Patients with successful results don’t need any standard vitiligo treatments after that. However, not everyone is the right candidate for this Treatment of Vitiligo.

A Deep Insight into Melanocyte Cell Transplantation:

Vitiligo or white spots start appearing on the skin when immune cells sneak into the skin to find melanocytes and kill them. Melanocytes are the cells that produce pigment in our skin. So killing melanocytes stops the pigment production process and skin starts to lose its color.

In this Melanocyte Cell Transplantation (MCT) treatment, new melanocytes are transferred to the affected area. But, the immune cells active in that area kill the new melanocytes too which drives failure of this Vitiligo Treatment. This treatment shows higher success rate only if the disease is stable where the immune cells are quiet and no longer destroying the melanocytes. In such condition, the new melanocytes start working and bring the original skin color back. Now, the problem is, it is very difficult to know when the disease is stable. In common practice, the Dermatologist carries out this treatment only if the patient has no lesions from last 1-2 years.

This Vitiligo Treatment appears to be excellent for, segmental vitiligo patients. As in the segmental vitiligo, the disease is limited to one portion of the body, chances of success rates appear to be higher. 80-90% of such cases have seen success and may never require further vitiligo treatment. That’s the reason why this treatment is addressed as “may be a cure” which is normally never used for any other vitiligo treatment.

In Cellular grafting or Melanocyte Cell Transplantation (MCT), the top layer of the affected area’s skin is removed and melanocytes & other skin cells from normal skin is transplanted into that area. Among all other Vitiligo Treatment procedures, cellular grafting has appeared to be the most successful one until now. In medical terms, this process is also called as Melanocyte-Keratinocyte Transplant Procedure or MKTP.

But, I know only a few centers around the world that offer this treatment. This was the biggest reason I have started offering this treatment into my own SKIN LASER CENTRE. Here, we not only offer treatment but also provide post-treatment care to ensure the complete success of this process. This procedure requires special equipment and professional training. At our center, we have experienced excellent success rate for MKTP so far. As per my opinion and experience, it is the best Vitiligo Treatment for right patients, whom we decide after a careful series of examination. This procedure is a bit costly than others and thus I suggest the treatment only to the patients who fulfill the prerequisite health conditions.

Cleanliness is a Bad Habit

Of late I have been seeing so many patients in our Dermatology OPD with hands which are dry, parched, itchy, irritated and have got cuts. Their history points out to a peculiar habit of washing their hands frequently and as I dig deep into the number of times their hands are subjected to scrubbing, soaps, hand washes, sanitizers, wet tissues etc.

Ok, let me rephrase. Over cleanliness is a very BAD habit!

Of late I have been seeing so many patients in our Dermatology OPD with hands which are dry, parched, itchy, irritated and have got cuts. Their history points out to a peculiar habit of washing their hands frequently and as I dig deep into the number of times their hands are subjected to scrubbing, soaps, hand washes, sanitizers, wet tissues etc., it is mind-boggling. Most of these patients wash their hands at least 10-15 times a day, some sheepishly admit it to be 30 and sometimes the accompanying attendant will point it out to be even more!

Most of these patients are highly intelligent or shall I say too intelligent and are perfectionists, highly successful men, and women and somehow the cleanliness bug has bitten them. Even though they do understand the issue they somehow don’t and even on explaining the problem to them, they very reluctantly nod their heads in affirmation.

Now we all see beggars on the road, children running around bare feet, we see Rickshaw pullers, laborers and many more, but, how many times do they wash hands with all these fancy soaps & sanitizers? We all know the answer-hardly…Still, they maintain good health, may be better than what most of us do.

So the logic lies in the fact that God has given us a superb Defense System; what we Doctors have given a fancy name to, ‘Immune System. So we have to get EXPOSED so that our defense, our Army stays on its toes else it gets lethargic or worse, misdirected leading to the “problems of the clean”.

So, friends, cleanliness is good, over cleanliness is very bad, and the next time you want to reach out to that sanitizer bottle which for your information contains 66% alcohol, think twice. You really don’t need it, let your inner immune system take care of the small stuff and as I always quote have ‘Faith in the Lord’.

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