Medical Problems : Common Skin Conditions Treated ...

Acne
What is acne?
It's also called Pimples and affects 90% of teenager, 50% of adult women, and 25% of all adult. It usually causes social embarrassment because of pigmentary changes and scarring.
What causes acne?
There are glands called sebaceous glands on face which produces excess sebum that gets blocked on the skin surface causing acne. There are lot of myths regarding acne which includes blood impurities or that food cause's acne which is not true.
What is the treatment of acne?
Acne is treated based on its severity. It is treated with derivatives of vitamin -A called retinoic acid and the severe ones requires oral antibiotics and the oral form of vitamin A called isotretinoin. The best thing to do in acne is to start treatment with topical cream as early as possible so as to limit damage to skin. These medicines needs to be applied till the period of active acne formation is present.
What is the treatment of acne scar?
The scars generally improve over a period of time with applications of medicine. However, there are certain types which require treatment with chemical peeling (Like TCA CROSS), surgery and fractional co2 lasers.

Discoloration of skin

Melasma
What is Melasma?
Melasma (commonly called kalo poto or Chaya in Nepali) is a very common, patchy, discoloration of face, commonly seen in females of reproductive age group. Though a benign condition, it causes social distress and impairs quality of life.
It is supposed to be caused by multiple factors including sun exposure, oral contraceptive pills, and drugs and sometimes believed to be of hormonal origin.
What is the treatment of Melasma?
Sun protection remains central to the management of Melasma. The main treatment includes topical creams and sunscreens followed by peeling, lasers, light treatment and oral drugs for refractory cases.
The treatment needs to be supervised time and again in order to prevent relapse and look skin glowing for ever.

Vitiligo
What is Vitiligo?
Vitiligo (also called seto dubi in Nepali) is one of the most important cause of skin discoloration in which there are patches of white skin on the body and can involve oral mucosa, tips of fingers/toes/penis /vulva and even hairs can becomes white.
What is the cause of Vitiligo?
There are pigment producing cells on the body which gets destroyed in this condition for some reasons which is yet to be defined precisely. There may be genetic predisposition for getting vitiligo in around 30% of individuals.
What is treatment of Vitiligo?
The treatment of Vitiligo depends on the stability of white patches. If the white patches are increasing in number and size than topical treatments, oral therapy and phototherapy are used. In case there is no re- pigmentation despite these treatments, grafting of stable lesions can be done with variety of re pigmenting techniques such as miniature punch grafting, blister-grafting, and autologous melanocyte cell suspension transfer surgeries.

Eczemas
What is eczemas?
Eczemas (commonly called Daad in Nepali) presents with itchy, scaly skin and may be associated with oozing or thickening and increased pigmentation of localized part of skin. There are different types of eczemas and Atopic dermatitis is one of the common amongst them. Atopic Dermatitis presents with small, red bumps that might be associated with oozing and crusting. They are extremely itchy and involves hands, feet, neck, behind the knees, elbows, elbows, upper torso of body and face.
What are causes of eczemas?
The exact cause of eczema is not known and may be related to genetic or environmental factors and stress.
What are treatment of eczemas?
The goal of treatment of eczema includes immediate relief of itching and prevention of flare-ups in future. Generally, they are treated with corticosteroids, anti-histamines, and moisturisers. Severe and refractory types of eczemas might need to be treated with injectable.

Moles
What are Moles?
Moles or naevi (called kalo Kothi in Nepali) are common and everyone can recognize it easily. They are basically group of pigment producing cells called melanocytes. Large moles when present at birth are more likely go into melanoma (a life threatening disease). Other moles are acquired, and needs removal only when required. This can be judged only by examination of these naevi�s and you need to consult us for this reason.
What are treatment of Moles?
The treatment options varies ranging from leave-as-it- is for benign moles to excision followed by biopsy of suspected melanomas. Moles which are different in color than other moles, dark in centre and lighter in edges, size is more than 0.5 cm, more than 20 in number and are associated with bleeding or ulceration need urgent consultation. Lasers can be recommended only for selected moles decided by us.

Keloids
What are Keloids?
Keloids are a type of scar which is raised above the surface and results usually from trauma of any kind in susceptible person. They extend beyond the original site of injury.
What are causes of keloids?
The exact cause of Keloid is not known but it is believed to be due to excess collagen production because of unknown reasons.
What is treatment of keloid?
Keloids are difficult- to- treat conditions. When there is itching or pain, it indicates that the Keloid might increase in size and needs treatment. Most of the treatments available leaves a flat scar. Most common treatment of keloid includes injecting corticosteroids, which might be painful while injecting. You can discuss with us regarding the best treatment available which suits to your keloid.

Warts
What are warts?
Warts (called musa in Nepali) also called verrucae are caused by Human Papilloma Virus. They are usually rough and raised above the surface of skin and may contain black dots on the surface.
There are multiple types of wart, however, we see most commonly Common wart, Warts of hands and feet and genital wart. Warts of hands and feet may be painful and are confused and treated as corn (also called Khil in Nepali). The warts caused by certain types of Human Papilloma Viruses in genital area have tendency to cause skin cancer of that reason. Since they are unattractive and have tendency to spread, patients prefer to treatment of wart.
What is treatment of Wart?
Warts can be treated by freezing, or electrocautery or by injections. The warts have tendency to recur even after treatment and the treatment needs to be repeated in such cases.

Fungal infection of skin/nails
What are fungal infections?
Fungal infections of skin, also called ring worm are very common. They are red, itchy ring like patches which are seen in different parts of the body. When they affect hair, they might cause hair loss associated with scaling, and are common in children. Nails when affected are associated with discoloration and crumbling and can be deformed when left untreated.
What are causes of fungal infections?
Generally, there are three sources of fungal infections - Animal, Soil and Water (Public swimming pools), and Humans. They commonly get worse in hot and humid seasons. People get infected when they come in close contact with above sources.
What is treatment of fungal infection?
Because of indiscriminate use of over-the-counter triple combination drugs containing steroids, the management of this condition has become a challenge these days. Because of this, most of the drugs do not work in these conditions in their usual dose and duration. You will need to visit us in order to decide which drug will work for you. Nail fungus might need some sort of surgical procedures for treatment including lasers. Avoiding hot and humid conditions, use of synthetic clothes, maintaining good hygiene, avoiding sharing of clothing and treatment of all affected members of the family are some of the tricks which can be done for prevention of these ailments.

Skin cancers
What are skin cancers?
Skin cancers were relatively less reported in Nepal. These days there is increasing trends of skin cancers. They are easily diagnosed and most commonly preventable conditions. Please report to us as soon as possible if you have one of the following conditions.
a. Basal cell carcinoma
They are common skin cancers and are present on face, neck and hands. Most common signs are a. A pigmented raised skin with ulcer that won't heal b. A flesh-colored, pearl-shaped lump c. A sore that bleeds, heals, and then returns d. A scar that feels waxy e. A group of slow-growing, shiny pink or red growths f. A flat or sunken growth
Treatment includes excisions followed by histopathological analysis for clearance of margins.
b. Squamous cell carcinoma:
They also appear on sun exposed areas like basal cell carcinoma. They have potential for spread so they need to be diagnosed as early as possible. The signs of squamous cell carcinomas includes
a. A non- healing wound which is hard in consistency. b. A Cauliflower like non- healing growth
Treatment is by surgical excisions. In advanced cases, radiation therapy may be needed.
c. Melanoma:
What are Melanomas?
These are most dangerous form of skin cancers. They need to be caught and treated early for better survival. The signs of melanoma are i. A mole on the skin that is growing, changing shape, or changing color ii. A mole that looks scaly, oozes, or bleeds iii. A new dark spot on the skin that looks like a mole, but grows quickly iv. Pain, itching or bleeding in a new spot on the skin v. A brown or black streak underneath a fingernail or toenail vi. A bruise on the foot that does not heal
What is treatment of Melanoma?
Early detection of melanoma is the most effective way of treating this condition. In these cases, the cancerous cells are typically removed with surgical excision from the skin. For cases that are in the later stages, surgery of the lymph nodes, chemotherapy, radiation therapy, biological therapy and targeted therapy are recommended. We may refer you to oncologists to determine the best possible route for your total recovery.

Sexually transmitted infections
Sexually transmitted infections are one of common presentations in our private clinics. In Nepal, these infections are seen as concentrated epidemics. The cause of these infections include unsafe sexual contact with affected person. The common infections which we see are
a. Genital Warts: You may have skin colored/soft lumps on your genital areas. Some of the warts caused by specific strains may turn into skin cancers in long run. They are treated by freezing or chemical cautery /electrocautery or lasers.
b. Urethritis/Urethral discharge/Vaginal discharge: After 2 to 10 days of unsafe sexual contact, there might be difficulty in passing urine along with pus filled discharge from opening of urethra. Females may have discharge coming out of their vagina. They are easily treated with a course of antibiotics to both the sexual partners.
c. Genital Ulcers
There is sore in genital area in these conditions which can be single or multiple, painful or painless. There are lot of causes for this conditions and the common one includes Herpes and Syphilis.
i. Herpes genitalis: There are multiple fluid filled lesions/ ulcers in genital area and are recurrent. They are treated with anti-viral drugs.
ii. Syphilis: A sore develops in genital area after 9 to 90 days of unsafe sexual contact which is painless. Untreated these conditions may pass on to different stages to affect heart and brain. They are usually treated with a course of injectable antibiotics called Benzathine Penicillins.
d. Genital candidiasis: These are common presentations in Skin Department. There are usually small red bumps on genital area and are associated with itching and burning. In females, they are associated with white curdy vaginal discharge. They are sometimes associated with underlying Diabetes. They are treated with antifungals.

Emergency skin conditions
There are certain conditions which needs to be attended immediately.
1. Adverse cutaneous drug reaction: After intake of certain drugs, there might be eruptions of skin rashes associated with fever. When these rashes are red and purple or are associated with blisters or peeling of skin, affects eyes/oral mucosa or genital mucosa, they are labeled as severe type of drug reactions.
2. Angioedema: In this condition there is swelling of lips/eyelids and are associated with difficulty in breathing.
3. Erythroderma: These conditions are associated with exfoliation of skin involving more than 90% of body surface area. There are different causes of erythroderma which can be diagnosed only after careful history, examination and investigations.
4. Immunobullous diseases: These are rare disorders but are life threatening. In these conditions, there fluid filled skin eruptions which involves, scalp, trunk, extremities and mucous membranes (oral mucoa, eyes, genital area. Unless treated, they progress and cause extensive erosions all over the body. There are many types of blistering diseases out of which Pemphigus is common in Nepal.