Category Archives: General Topics

Psoriasis: A Brief History

Psoriasis is probably one of the longest known illnesses of humans and also one of the most misunderstood one. It was confused with leprosy till the 19th century.

The biblical term ‘lepra’ was actually applied to various cutaneous disorders including psoriasis, vitiligo, eczema, boils and alopecia areata. Some believe that  ‘tzaraat’ mentioned in the Bible represents psoriasis.

Hippocrates (460 – 377 BC) did describe a skin condition akin to psoriasis.

There are mentions in the literature about the term “psoriasis” as being  used by Aristophanes of Byzantium at the end of the third century B.C. But Aristophanes’ description  of the disease does not, however, correspond to our clinical picture of psoriasis.

Some historians, however, believe that  it was the Roman physician Galen who used the term “psoriasis vulgaris” for the first time, though not particularly for the exact entity .

The name psoriasis is derived from the Greek word psora which means to itch. In fact, before Hebra (see below) the term ‘psoriasis’ was used for many skin diseases where itching was a prominent feature.

In the first century, the Roman Sage Cornelius Celsus described a condition similar to psoriasis and classified it as the fourth variant of impetigo.

JosephJacob Plenck (Vienna, 1776) wrote of a condition similar to psoriasis as being amongst the group of desquamative (scaly or scale like) diseases. He did not dig deeper to differentiate it from other dermatological conditions.

Psoriasis was known as Willan’s lepra in the late 18th century after the English dermatologist, Robert Willan (1757 – 1812) recognised the disease as an independent entity. He identified two categories. Leprosa Graecorum was the term he used to describe the condition when the skin had scales. Psora Leprosa described the condition when it became eruptive.

Finally, it was in 1841 Ferdinand Hebra, a Viennese dermatologist improved on Willan’s notes and assigned the name  ‘Psoriasis’ to the disease for the first time in the long history of the disease.  It was Hebra who described the clinical picture of psoriasis as we recognise it today. The hereditary factor of psoriasis was already known by that time.

Psoriasis was further differentiated into specific types and effective remedies discovered during 20th Century.

Read more about Psoriasis

Topical Corticosteroids: Double Edged Swords!

Topical corticosteroids have revolutionised the treatment of inflammatory skin diseases, since they were introduced in 1952. They are very effective treatment options for many skin diseases and have revolutionised the management of eczema, allergies and other inflammatory skin diseases like psoriasis. Their effectiveness is prompt and most acute allergies can be cured within a few days. For chronic illnesses, like Atopic Eczema in children and psoriasis, they have to be used for a longer duration.

But, If not used with proper titre of dose and strength, they can cause damage to the skin, sometimes permanent. There are many unscientific formulations masquerading as anti-fungal creams and whitening or bleaching creams in the market, where one of the ingredient is potent or super potent steroid. Thus topical steroid creams are double edged swords, the use of which should be carefully titred according to their potency, stage of disease, age of the patient and site of application.

A knowledge of different classes of topical steroids according to their potency is important for everyone prescribing or using these effective and useful medications.

Classes of Steroids and Precautions
Classes of Steroids and Precautions

From the above it is clear that  topical corticosteroids  should be carefully chosen according to their potency, stage of disease, age of the patient and site of application. This is of paramount importance and all those who use these wonderful medications, including patients, pharmacists and doctors should be aware of their strengths and indications of use.

Topical corticosteroids come in several forms, including creams, lotions and ointments. Creams and solutions are a class below in potency than ointments. Ointments are greasy and preferred in chronic dermatitis and scaly diseases like psoriasis. Creams can be used in acute and subacute skin inflammation. Gels and lotions are preferred in hairy areas and scalp.

Side Effects of Topical Corticosteroids

Topical steroids have both topical (limited to skin) and systemic side effects.

Topical Side Effects of Topical Steroids Limited to Skin
  • Topical application of steroids causes thinning of the skin by causing atrophy of the skin layers.
  • Dilation of capillaries that are shown through the thinned skin, known as telengiectasia.
  • Stretching and splitting of the skin causing stretch marks or striae dystensiae.
  • Pimple like eruptions on the treated area, especially on the face, chest, back and limbs, called steroid acne.
  • The main problem with topical (and systemic steroids) is the rebound phenomenon or exacerbation of the lesions that occur if the steroids are suddenly stopped or withdrawn. A localized form of psoriasis can become generalized or a generalized form can get precipitated as pustular or erythrodermic forms when steroids are withdrawn.
  • Higher strength steroids should be avoided on the face, especially near eyes, on the body folds and near the genital organs. Steroids used near eyes for prolonged duration have been shown to cause cataract formation in the eyes and glaucoma.
  • Steroids are best avoided in the presence of infection as these can exacerbate infections.
  • Other topical side effects of topical steroids include easy bruising, purpura, skin ulceration, non healing of ulcers, exacerbation of infections, perioral dermatitis, rosacea, hypo pigmentation, hyper pigmentation, and excessive hair growth. Mistaken application of steroids on ring worms cause changes in morphology and spread of the fungal infection, known as tinea incognito.
Systemic Side Effects of Topical Steroids
  • Adrenal Suppression. Because of the absorption of potent steroids into the blood stream, the adrenal glands could become suppressed and their production of normal steroids will suffer as a result. This can have far reaching effects on the body. If prolonged, this can produce a cushingoid (moon like) face in patients and cause other systemic effects.
  • Tachyphylaxis.The body develops resistance to the topical application after some time.
How to Avoid Topical Steroid Side Effects
Unscientific Steroid Combinations
Unscientific Steroid Combinations are better avoided
  1. Topical Steroids are wonder drugs for many skin diseases like eczema and skin allergies but should be used only under supervision of a skin specialist or a modern medicine doctor who is trained to use it.
  2. Never buy steroid containing creams directly from pharmacy
  3. Avoid using fairness, whitening or bleaching creams from saloons, parlours and unlabelled sources. These may contain very strong steroids and cause serious damage to your skin.
  4. Avoid using so called anti-fungal creams containing steroids. When in doubt, consult a skin specialist before using such creams.
  5. Potent and super-potent steroid creams should only be used under the supervision of a skin specialist.
  6. Never use steroid containing creams in the presence of infection or if diagnosis is not sure.
  7. Use appropriate graded strength according to severity, age, site of involvement.
  8. Gradual withdrawal and replacement with safer creams should be resorted to.
  9. Superpotentà Potent à Moderate à Least Potent.  Shift down as the condition improves.
  10. Application free interval: 5-7 days after every two weeks of application helps avoid side effects.
  11. Never use higher strength topical steroids in infants and children.
  12. Avoid moderate to superpotent classes of topical steroids in sensitive areas like face and body folds.
  13. Once acute phase is under control, shift to steroid sparing calcineurin inhibitors like Tacrolimus, Pimecrolimus.
Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 10 am – 2 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

Dr Hanish Babu, MD as a Speaker

 

Dr Hanish Babu, MD is much sought after as a speaker during the Continuing Medical Education programmes in UAE and abroad. Here are some of the certificates of his talks:

Dr Hanish Babu MD CME Talks
Dr Hanish Babu, CME Speaker, Alaska, US
2006 Ras al Khaima talk Dr Hanish Babu, MD Stress Management
2017 Sharjah Infectious Skin Diseases Dr Hanish Babu, MD
2017 Sharjah Infectious Skin Diseases Dr Hanish Babu, MD
2011 Chairperson CME Dr Hanish Babu MD
2011 Chairperson CME Dr Hanish Babu MD
2011 CME Talk Dr Hanish Babu MD
2011 CME Talk Dr Hanish Babu MD
2011 Skin in Diabetes CME Talk in US by Dr Hanish Babu MD
2011 Skin in Diabetes CME Talk in US by Dr Hanish Babu MD
2012 RAK Herpes Zoster and Post Herpetic Neuralgia Talk Dr Hanish Babu MD
2012 RAK Herpes Zoster and Post Herpetic Neuralgia Talk Dr Hanish Babu MD
2012 RAK Talk Dr Hanish Babu, MD Occupational Skin Diseases
2012 RAK Talk Dr Hanish Babu, MD Occupational Skin Diseases
2015 Emergencies in Dermatology Talk by Dr Hanish Babu MD
2015 Emergencies in Dermatology Talk by Dr Hanish Babu MD
2015 Evidence Based Dermatology Dr Hanish Babu MD CME Talk
2015 Evidence Based Dermatology Dr Hanish Babu MD CME Talk
2015 Skin and Thyroid CME Talk by Dr Hanish Babu MD
2015 Skin and Thyroid CME Talk by Dr Hanish Babu MD
2016 Lifestyle Skin Diseases CME Talk by DR Hanish Babu MD
2016 Lifestyle Skin Diseases CME Talk by DR Hanish Babu MD
2016 Skin in Rheumatic Diseases Talk Dr Hanish Babu MD
2016 Skin in Rheumatic Diseases Talk Dr Hanish Babu MD
2017 Sharjah Infectious Skin Diseases Dr Hanish Babu, MD
2017 Sharjah Infectious Skin Diseases Dr Hanish Babu, MD
2006 Diploma in Advanced Stress Management Dr Hanish Babu MD
2011 Sharjah Endocrines and Skin Talk Dr Hanish Babu MD
2011 Sharjah Endocrines and Skin Talk Dr Hanish Babu MD
1990 IADVL National Conference Talk DR Hanish Babu MD
1990 IADVL National Conference Talk DR Hanish Babu MD

How to Prepare a Practical New Year Resolution

Tips on How to Set up Achievable Goals for The New Year

Who told setting up new year resolutions is a drag and useless exercise? 

Take the following step by step guide on how to draft practical New Year resolutions and you will be be pleasantly surprised to see that these simple steps will turn the annual ritual into an absorbing, fruitful exercise.

Here, then, is the step by step guide on practical new year resolutions:

Step 1: The SWOT Analysis- Review Your Last Year.

SWOT Analysis means analysis of your strengths, weaknesses, opportunities and threats. SWOT analysis is a very useful tool to use whenever you take up a task in daily life. Though you may not succeed every time, your failure rate is drastically cut down when you use SWOT analysis and act accordingly. Your confidence and self respect will grow because you know that you have done what you must. When you make the SWOT list, put them under the following headings- personal, family, social, professional and spiritual.

S for your strengths. Which were your best achievements last year? Which personal qualities helped you achieve those? What are your professional and financial strengths? Backups? Have you underutilized any of your strengths last year? Make a list of each.

W for your weaknesses: What were your failures?  What do you think were the reasons for those weak performances? Make a list. Do not cheat yourself.

O for Opportunities that knocked on your door during the last one year. Make the list of opportunities that you turned to your advantage and also those which you have missed. You may get additional points for your strength and weakness lists when you prepare this list.  Also prepare a tentative list of opportunities that you think may come up next year.

T for Threats. What were the challenges that you had to face during the last year? How many did you tackle head on? How many actually pulled you back? Make a list of the threats that you may have to face next year.

Step 2: Review your SWOT analysis list.

Now that you have your SWOT analysis list, go through it with a comb.

For each weakness, jot down the positive changes you would make (in your attitude and actions) during the next few months.

For each threat, note down the resources that you will have to mobilize so you can nullify their negative effects and practically convert them into advantages for the coming year.

Sort out the gems and pearls among your strengths and opportunities that you would like to retain and improve upon.

Convert challenges into opportunities for progress. Prune your list so that essential, even difficult tasks get priority over simple, not so essential tasks.

Chuck out the really difficult new year resolutions that you know you cannot and would not keep. How ever, if you feel that these are essential for your progress, give them a try. There is nothing to lose, only a little self respect maybe, but everything to gain!

Keep your ego aside and discuss the list with your spouse and/or close friends. They might help you realize some important personal characteristic of yours that you might have missed.

Step 3: Goal Setting: Prepare a Plan of Action.

Prepare a plan of action in black and white. Write down your short term (1-3 months), intermediate (3-12 months) and long term (1 year) goals. Group your selected goals into ‘very essential, essential and not so essential’ categories. Also try assorting into ‘easy, not so easy and difficult’ new year resolutions.  Look at the list again and prioritize them. Take a final bold step and strike off the resolutions or goals that you know are not going to materialize.

Step 4: Record Your New Year Resolutions in Black & White.

It is always advisable to have a vision of what you want to achieve during the next one year,

popular new year resolutions – colorful sticky notes on a cork board

5 years, 10 years and so on. At present, though, let us concentrate on the coming new year. Putting down your goals with a date and plan of action in black and white is the essential step forward in achieving your visions.

Remember: A vision is a goal with a date and plan of action.

Take a large size printout and paste it where you can see it first thing in the morning and last thing before going to bed at night, on the wall opposite your bed, on the fridge door, near the bathroom mirror.

Finally, review, and if necessary, revise the list periodically. There is no hard and fast rule that you cannot improve upon your new year resolutions!