Twachaa Pharmacy

Post Acne scars is the most predictable after effect if acne are not treated on time or if you have the habit of picking and repeatedly touching acne. Scars can be of various shapes and types. It is important to know type of scars as this helps us choose the best treatment modality.
Scars can be Atrophic or Hypertrophic:

 

Atrophic Scars:
Craters: These are deep scars whose width is equal to or greater than their depth.
Pits: These are scars whose width is less than depth.
Ice pick scars: These are V shaped scars
Box scars: These are deep U shaped scars
Rolled scars: These are W shaped scars.

Hypertrophic Scars:
These are raised scars associated with excessive fibrous tissue formation.

TREATMENT OPTIONS

Unlike Acne, medications are not very effective in treatment of acne.Various Physical treatment modalities are required for substantial improvement.

Microdermabrasion
Microdermabrasion is done for extremely superficial scars. The superficial layer of the skin is abraded with crystals of inert aluminum oxide which are ejected with force in a controlled manner. It needs to be repeated once in 3 weeks for about 6-12 sessions.

Chemical Peels
Chemical peels are done for superficial scars, pigmented scars & soft scars. Depending on the skin type and its sensitivity, the type of peeling agent and its concentration to be used is decided by the physician. It is a quick and simple procedure that involves application of a peeling agent on patients face for a brief time. During the procedure, the patient might experience warmth or stinging sensation. The peel is repeated every fortnight for 6-8 sessions. The different type of peels used are : alpha hydroxy peel such as glycolic acid- derived from sugarcane; lactic acid derived from milk ; kojic acid derived from a Japanese mushroom; mandelic acid derived from apples ; salicylic acid , a beta hydroxyl acid derived from willow birch.

Dermaroller
It is a fairly newer treatment which usage of a small rolling instrument which has multiple small needles of .5- 2 mm depth. This causes collagen remodeling in the next 2-3 months. It should be repeated once in a month for 4-8 sessions. The procedure is performed after application of a topical anaesthesia (anaesthetic cream) to make it relatively painless.The results are appreciable and permanent. The downtime is just 1-2 days.

Dermastamp
This is an instrument, which has five-six small micro needles in it. It works on same principle as dermaroller and is preferred to treat localized depressed scars.

LASER
Fractionated erbium yag laser (PIXEL laser) or Fractionated Co2 laser : The newest form of treatment for acne scarring is called fractional laser therapy. This type of treatment works at a deeper level & wounds the skin using microscopic pulses of light. Because fractional laser therapy doesn’t wound the top layer of tissue, healing time is shorter. It penetrates deep into the dermis, eliminating damaged cells and stimulating the growth of new collagen. Depending on the depth of the scars, some patients may require anywhere from 1 to 3 treatments for acne scar removal. It is best suited for treatment for deeper scars.It also improves the skin tone & texture.

PRP therapy
This is a relatively newer treatment modality that involves use of patients own blood. Special growth cells called “platelets” are separated from patients blood. These cells have an immense growth potential as they are responsible for release of various growth factors. These separated cells are activated and reinjected into scarred area. The released growth factors stimulate collagen formation. Apart from improving scars, theres an overall improvement in texture ang skin tightening.

Nothing is more envious than a clear skin. Our skin contains the dark pigment melanin. Patchy or uneven pigmentation occurs due to the over production of this pigment which in turn is triggered by many factors including Genetic Predisposition, Overexposure to sunlight, underlying hormonal imbalances and use of certain medications like Oral contraceptive pills.
Before running off and buying a fairness cream it is important to get to the root of the cause before formulating a treatment plan. Depth of pigmentation is assessed using a Woods lamp examination and depending on depth of pigmentation ,a customised treatment plan is made which will help you attain an even skin tone, texture and improve overall skin radiance.
Pigmentation may either be due to increased melanin deposition in the epidermis or dermis. Epidermal pigmentary disorders respond well to treatment while dermal pigmentation may take a long time to lighten.Pigmentation can present in various forms:

 

Melasma : Seen as brown patches on the face, it is more commonly seen in females. It occurs due to hormonal changes in the body. The pigmentation increases on sun exposure.

Peri-orbital melanosis : Also known as ‘dark circles’ may be heriditary, due to stress or eye strain

Freckles and Lentigenes : These are tiny black spots on the face and are genetic in origin.

Photomelanosis : This is increased pigmentation due to sun exposure. The pigmentation occurs on exposed skin, commonly on the face, neck and the back. The pigmentation may be patchy or as diffused darkening of the exposed skin.

Sun burn (tan) : A condition commonly encountered in fair skinned people due to excessive sun exposure.

Post inflammatory hyper pigmentation : It may be seen in the following cases Seen after healing has occured, like in acne, eczemas, contact dermatitis etc. Drug induced pigmentation. Pigmentation may also occur due to cosmetics especially those containing fragrance.

Melasma is a stubborn condition and requires combination of various treatment modalities. Usually multiple sessions of treatments are needed.
Topical Therapy :

 

• Sunscreens form the most essential part of treatment of melasma. A variety of
• Depigmenting agents : various depigmenting agents are available that includes Hydroquinone, Kojic acid, Glycolic acid, Retinoic acid etc can aid in the treatment of melasma.

Oral Therapy:

• Anti-oxidants form an integral adjuvant treatment. They help prevent oxidative stress caused to the body.
• Tranexemic acid:
• Hormonal therapy.

Physical Therapies

 

• Chemical Peels: Superficial peels such as Glycolic acid peels and Salicylic acid peels; moderately deep peels such as 50% glycolic acid and TCA, as well as deeper peels such as Cosmelan can be used to treat melasma.Usually 4-6 sessions are neede at an interval of 2-6 weeks. Deeper peels like COSMELAN peel may be neede at a much lesser interval, at times as less as 1 session every year.
• Lasers: Q switched NdYag and Light systems like the IPL are good treatment options.
• Meso therapy has also been successful in treating melasma depending upon the depth and intensity of pigment.Various cocktails of ready meso solutions containing varying proportion of depigmenting agents are available for use. Mesotherapy involves delivery of these agents directly into deeper layers of skin for better and quicker response.

Once the pigmentation has cleared, a maintenance treatment with sunscreens and skin lightening products must be continued to prevent recurrences. Maintenance treatments once in two or three months are advised in stubborn cases of Melasma.

Medically known as Peri-orbital hypermelanosis, this condition requires a separate mention as it is an extremely common condition in people of Indian origin. Under eye darkness gives an impression of tiredness all the time.

 

Dark circle appearance can be a combination of different factors such as :

• Genetic.
• Due to stress or even eye strain.
• Irregular sleeping pattern
• Thinner skin on the lower eyelids, allowing pigment and vessels to be more visible.
• Gravity, which causes under eye skin to move downward, inviting more stretching and thinning. This allows the blood vessels and pigment to become more visible.
• Cumulative sun damage plays a significant role. Sun damage exacerbates these characteristics by increasing skin thinning and melanin content.
• Sunken eyes: tear troughs tend to exacerbate appearance of dark circles.
• Excessive eye-rubbing.
• General poor health.

TREATMENT OPTIONS:

Chemical peeling:
Milder peeling agents like arginine , lactic acid or low concentration of glycolic acid peels helps to reduce dark circles in 8-10 sessions done at 2 weekly intervals. The peels are very safe procedure. There are no tell tale signs and the person can go back to work immediately after the peel.
Mesotherapy/Electroporation.

Dermaroller:
special eye rollers with a depth of .25 mm are available.
Dermal-Fillers:
Sunken eyes can also create an effect of dark circles due to a shadowing effect.In such cases, a hyaluronic acid filler can be used to fill the hollow under eyes thus getting rid of the shadow and the apparent dark circles.
PRP therapy:
It is a very effective treatment for dark circles as well as under eye rejuvenation.

As we age, our skin ages too!! With the time there are natural skin changes that are inevitable. However early recognition of these and timely intervention goes a long way in preserving the youthfulness and charm of your skin.
Our Skins are of different varieties- Oily, dry, Combination, Mature or Acne prone
It is important that you know your skin type as this helps you choose your routine skin care regimens and treatments better.
In your 20s:
Your skin is at its best at this age. The skin is soft, supple and radiant. Hence essential products are recommended such as an appropriate cleanser, sunscreen and moisturizer. Any other issues such as acne need to be treated alongside with appropriate medicated preparations.In your 30s:
Dryness sets in and one notices the appearance of fine lines and wrinkles. There is a decrease in the overall radiance of the skin of the face and eyes. This is the time your skin needs your attention. To improve the texture and quality of the skin and prevent accelerated ageing of the skin, appropriate formulations are advised. Procedures that can restore your skin’s youthfulness are suggested too.
In your 40s:
The dryness and dehydration of the skin increases. Skin Lines increase and wrinkles deepen. There is loss of skin elasticity and muscle tone. Pigmentation in the form of freckles , sun spots , melasma appear .Hormonal changes show up as dullness of skin and loss of tone.Heavier moisturizing agents with active ingredients are introduced along with treatments.
In your 50s and 60s:
The skin changes worsen and sagging of skin around the lower face and jawline leading to jowls begins.The Wrinkles deepen into folds.At this stage any skin products are of limited value and treatments are almost always necessary.
In your 70s and beyond:
All the above mentioned changes may be present in different degrees depending on your genetics, hormonal changes or illnesses .Once again our approach is to suggest anti-ageing solutions which would combine stronger cosmeceutical agents and procedures.

 

Genetics also determine the quality of the skin but what you have inherited needs to be maintained. A soft, supple radiant skin implies good health .Your lifestyle can also play a major role in determining the health of your skin. A balanced diet and exercise in moderation would go a long way in giving your skin that luminous glow. Smoking, can add years to the face and is an independent risk factor for premature ageing of skin.

Virtually your entire body is covered with hair. Because most of this hair is fine and pale, it usually isn’t viable to the naked eye. But, when darker, coarser hair appears in places which may make you uncomfortable,it may be time to consider hair removal with the LASER. Now men and women alike are making unwanted facial hair and body hair a thing of the past .No more painful waxing, electrolysis or razors!

 

Principle of LASER for hair reduction:
The laser has a wavelength that specifically targets the pigment ‘melanin’ contained in the hair follicle & shaft. It penetrates the skin to the depth of 1.5mm which is where the hair bulb is located. Thus it works on the principle of selective ‘photothermolysis’.The laser pulses for a fraction of a second, penetrates the hair bulb without destroying the surrounding skin & vaporizes the pigment in the hair follicle.Thus the follicle is either destroyed or its re-growth is impeded. This is a non- invasive procedure & a large number of hairs are targeted in a single flash of light .

When the LASER pulse is delivered, some patients experience a mild pinching or stinging sensation but no local anesthesia or pain medication is typically required; however, some patients may prefer to use a topical anesthetic when sensitive areas are treated.

 

Commonly Treated areas:

• Chin
• Underarm
• Upperlip
• Chest
• Back
• Legs
• Hands
• Bikini Line
• Buttocks
• Full body

Side Effects:
Most commonly noticed are slight reddening and local swelling of the skin.These effects typically last for several hours or less. In rare instances, blistering may occur.

 

LASER at our clinic is performed only under strict guidelines and presence of a Dermatologist. We use US-FDA approved Diode technology , which is a gold standard for LASER hair reduction treatment.
Pre- and Post- Procedure Instructions

• Stop bleaching / threading / waxing of hair atleast a week prior to your session,
• After the laser session, avoid excessive exposure to the sun.Use SPF 15-30 sunscreen lotion regularly.
• Do not scrub the treated area too hard.
• Do not swim for 2 days after the procedure.
• Do not bleach / thread / wax the treated area in between the treatment. You could, however, shave the hair 2-3 times

Tattoos can be effectively removed by the Q switched NdYAG laser. It works best on black, blue black and green tattoos. A numbing cream is applied 45 mins before the procedure to reduce discomfort. It usually takes 4-8 sessions before the tattoo is satisfactorily or completely removed and are spaced at 6 week intervals.
Side Effects

 

• Hyper pigmentation (dark spots) or hypo pigmentation (white spots) may sometimes occur; however these are more common in darker skin.
• ‘Paradoxal darkening’ of a tattoo may occur when a treated tattoo becomes darker instead of lighter. This occurs more often with flesh tones and lighter colored tattoos and maybe avoided by doing a ‘patch test’; where the laser is applied to one or two test sites prior to a decision to treat a full tattoo.
• Scarring may occur when inappropriate laser energy is used.
• Transient textural changes are occasionally noted but often resolve soon.
• Local allergic responses to many tattoo pigments have been reported, and allergic reactions to tattoo pigment after Q-switched laser treatment are also possible.

Contraindications
Patients with hypertrophic or keloidal tendencies or hypertrophic scarring tendencies.
Active inflammation at the tattoo site.
History of Vitiligo, Psoriasis.

 

Vitiligo is a disorder in which depigmented(white) patches of skin appear on different parts of the body.In vitiligo the pigment cells of the skin, melanocytes, are destroyed.Vitiligo can be focal and localized to one area, or it may affect several different areas on the body. Vitiligo can also affect the mucous membranes (such as the tissue inside the mouth and nose) or the genitals.
The exact cause of vitiligo is unknown, although it is believed that it is an autoimmune condition in which the body’s immune system mistakenly attacks and destroys certain cells within the body.

What causes vitiligo?
The cause is not known. Vitiligo may be an autoimmune disease. These diseases happen when your immune system mistakenly attacks some part of your own body. In vitiligo, the immune system may destroy the melanocytes in the skin. It is also possible that one or more genes may make a person more likely to get the disorder.

Will the white patches spread?
There is no way to tell if vitiligo will spread, its prognosis is unpredictable. For some people, the white patches do not spread. But often the white patches will spread to other areas of the body. For some people, vitiligo spreads slowly, over many years. For other people, spreading occurs quickly. Some people have reported more white patches after physical or emotional stress.

 

How is vitiligo diagnosed?
The doctor will use a family and medical history, physical examination and few clinical tests to diagnose vitiligo.

Can my kids develop these patches?
Vitiligo does have a genetic transmissible potential. However risk is higher if the disease is present in more than one generation or if both parents have vitiligo.

Is this contagious?
No, vitiligo is not contagious and does not spread even from close contact.

Is it Treatable?
Yes, you need to be patient. Treatments may at times be neede for a longer period of time. Results are best obtained when the disease is limited to few patches and treatment is sought early.

TREATMENT OPTIONS

Current treatment options for vitiligo include medical, surgical, and Phototherapy. Most treatments are aimed at restoring color of the white patches of skin.
The choice of treatment depends on:

• The number of white patches
• Disease stability
• The personal patient profile like age, social circumstances etc.

Same treatment is not right for everyone. Many treatments can have unwanted side effects. Treatments can take a long time, and sometimes they don’t work.

Medical treatments

Topical preparations:

• A topical steroid preparation is often chosen first to treat localized vitiligo. The results of therapy have been reported as moderately successful, particularly in patients with localized vitiligo.
• Topical calcineurin inhibitors (such as tacrolimus or pimecrolimus) (0.03% or 0.1%) are an effective alternative therapy for vitiligo, particularly when the disease involves the head and neck.
• Vitamin D analogs, particularly calcipotriol and tacalcitol, have also been used. They target the local immune response and act on specific T-cell activation.

Systemic therapy

• Steroids have been reported anecdotally to achieve success when given in pulse doses or low doses to minimize its adverse effects. The benefits versus the toxicity of this therapy must be weighed carefully. More research is necessary to establish the safety and effectiveness of this therapy for vitiligo.

COMMON HAIR TROUBLES

Split ends or Trichoptilosis is the splitting or fraying of the hair-shaft due to excessive heat and mechanical stress. Thermal, chemical or mechanical stress can cause split ends. For example, the use of curling irons and other heat treatments may cause split ends. Excessive application of hair products such as perms and hair coloring may strip protective layering off the outside of the hair’s shaft and weaken the hair, making the hair prone to split ends. Mechanical stresses include pulling a comb forcefully through tangled hair and repeated combing.
There is no remedy for split ends beyond trimming the affected hair.Some shampoos claim to heal split ends by sealing the ends back together.An easy way how to remove split ends is by cutting the hair ends.

Other common problems could be

• Abnormal odor
• Early greying of hair
• Clumps of hair falling out
• Clumpy flakes that do not easily slough off the scalp skin
• Excessive itchiness that doesn’t go away with a few hair wash, redness of scalp skin
• Patches of thinning

Any of these symptoms may indicate a need for professional assistance from a dermatologist or trichologist for diagnosis.

 

Dandruff
Dandruff is the shedding of dead skin cells from the scalp. It is a common scalp disorder affecting almost half of the population at the post-pubertal age and of any gender and ethnicity. It often causes itching. The severity of dandruff may fluctuate with season as it often worsens in winter[ Most cases of dandruff can be easily treated with specialized shampoos. There is, however, no true cure.
Dandruff has been shown to possibly be the result of three factors

• Skin oil commonly referred to as sebum or sebaceous secretions
• The metabolic by-products of skin micro-organisms (most specifically Malassezia yeasts)
• Individual susceptibility and allergy sensitivity.

Dandruff is also associated with some skin disorders , including dry skin, seborrhoeic dermatitis, psoriasis, eczema or sensitivity to hair care products.
Shampoos containing one of the following ingredients are commonly used to control dandruff.

• ketoconazole
• selenium disulfide
• Ciclopirox
• Coal tar

Very rarely, oral therapies are needed for Dandruff.

Hair Loss
While it is a common problem faced these days, hair loss can have a tremendous impact on facial aesthetics and self-esteem. A head full of hair serves as a symbol of youth, health, fertility and  potency. This is why hair loss, hair thinning and baldness often cause great embarrassment and concern and hair restoration treatments are so highly desirable.
Our hair goes through a natural growth cycle that allows replacement of old hairs with younger healthy ones, so your hair sheds the old in favour of the new. Most young adults lose between 70-100 hairs from their scalps every day, which are then replaced by new hairs.
The problem occurs when this natural growth cycle is interrupted. Instead of your head maintaining a balance of hair (as old falls out, new hair takes its place) you see a persistent thinning and eventual baldness. After the completion of puberty the hair cycle slows down, causing the process of hair thinning to accelerate while regeneration is progressively delayed. This is the beginning of the balding phenomenon affecting around 60% of males above the age of 40 years old.

 

Acne & Acne Scars are a commonly seen skin problem. They impact a person’s self confidence and psyche negatively. However do not lose hope, the best part about this much dreaded skin condition is that it is completely curable!
Acne, medically known as Acne Vulgaris, is a skin condition that involves the oil glands at the base of hair follicles. It commonly occurs during puberty when the sebaceous (oil) glands become more active. These glands are stimulated by male hormones produced by the adrenal glands of both males and females. Acne can present itself in varying forms as common whiteheads, blackheads and papules or more serious pustules, nodules and cysts. Acne is a condition which should not be ignored.Though they themselves do not pose a health hazard, but can leave permanent marks and scars on patients face.What are the factors that precipitate or aggravate acne?

 

• Hormonal imbalance
• Polycystic ovarian disease
• genetic predisposition.
• Stress
• Use of cosmetics such as creams, oil based moisturizers, oil based foundations, etc
• Application of heavy oil or gel on the scalp leads to pimples on the back and forehead.
• People who work in chemical or oil industries and come in contact with hydrocarbons, heavy oils, cutting oil, wax, grease and coal tar derivatives can develop acne.
• Hot and humid climate.
• Diet- High glycemic load foods (sugar loaded and starchy foods), oily foods may aggravate acne
• Drugs such as oral contraceptives, steroids, isoniazid, lithium, phenytoin, iodides etc. can cause pimples.
• Sweat- sweating in a hot and humid environment causes deterioration in 15% of acne patients.
• Menstruation- Pre menstrual flare of acne occurs in 70% of female acne patients.
• Friction and pressure- Friction and pressure from helmets, backpacks and tight collars can induce blackheads and papules. Pressure from face massages or facials can aggravate acne.
• Pregnancy- Pregnancy has an unpredictable effect on acne. Pre-existing acne may aggravate or remit during pregnancy.

Do acne occur only in teenage?
Acne is more common in the age group of 13 – 30 years but it may occur or persist even beyond this age limit. Males are more frequently affected than females due to androgen activity. Females may get a pre-menstrual flare due to the increase in level of a hormone called Progesterone.

‘Do’s and Dont’s in acne?

• Wash your face with an anti-bacterial face wash at least 2-3 times a day.
• Increase the intake of citrus fruits such as oranges, grapes, lime and lemon and other food stuff which are high in vitamin C and zinc.
• Drink plenty of water.
• Do not pick or squeeze the pimples as this causes infection, pigmentation and scarring.
• Avoid the use of oily cosmetics, cleansing milk and gels.
• Avoid any parlour/Spa therapies.
• Do not apply excessive hair oil if you have acne over the forehead.
• Avoid stress factors.
• Be patient and give medicines some time to act. You may have to take medications for 8 – 10 weeks.
• You may require medical intervention in the form of comedone extraction, superficial chemical peel, MDA. These are best performed by a dermatologist.

TREATMENT OPTIONS

A combination of oral and topical treatment may be prescribed depending on the degree and severity of the condition.

Topical therapy (medicated creams)

• Benzoyl Peroxide
• Topical Antibiotics.
• Retinoids.
• Azelaic acid