Articles on dermatitis

Sensitive Skin: Facts and Myths

Dr. Jeetendra Khatuja, Dermatologist
WHAT IS SENSITIVE SKIN?Sensitive skin is less tolerant to frequent and prolonged use of cosmetics and toiletries. It is self-diagnosed and typically unaccompanied by any obvious physical signs of irritation. WHAT CAUSES SENSITIVITY?With the change in lifestyle and also with increased opportunity to use many new brands of cosmetics and toiletries, there has been an increase in females complaining of unique sensation in their facial skin.PROBLEMS CAUSED BY SENSITIVE SKIN?Subjective perceptions (stinging, burning, pruritus, and tightness) of sensitive skin are noticed immediately following cosmetic product application or delayed by minutes, hours, or days,especially on face skin.WHO IS AT RISK FOR DEVELOPING SENSITIVE SKIN? The condition is found in more than 50% of women and 40% of men, creating a sizable demand for products designed to minimize skin sensitivity.Commonly affects females, young adults aged between 18 and 50 years, hormonal differences in women producing increased inflammatory sensitivity, cultural habits in developed countries, and environmental factors like winter, stress, and atopic dermatitis are thought to promote sensitive skin HOW TO DIAGNOSE SENSITIVE SKIN?It is self-diagnosed and typically unaccompanied by any obvious physical signs of irritation.Good numbers of invasive and non-invasive tests are designed to evaluate and predict the sensitive skin.WHAT IS THE SOLUTION FOR SENSITIVE SKIN? Management includes guidelines for selecting suitable cosmetics and toiletries in sensitive skin individuals.Certain "do's" while selecting the cosmetic for sensitive skin are the following:Powder cosmetics preferredUse cosmetics which are easily removable by waterAlways use fresh cosmeticsUse black-colored eyeliner and mascara\Select pencil form of eyeliner and eyebrow cosmeticsSelect light earth tone eye shadowsSelect physical sunscreen agentPurchase cosmetics products with less than 10 ingredientsNo nail polishesUse powder/cream formulations of facial foundations.Myth 1: HYPOALLERGENIC MEANS NON-IRRITATINGTruth: It doesn't necessarily mean gentle or free of allergens. There are no set standards for this term. You need to know what you're allergic to and look for it on the label.Myth 2: SENSITIVE SKIN TYPES CANT EXFOLIATETruth: Yes, rosacea and allergic types should skip it—those dead skin cells act as a protective barrier to block irritants. But acne-prone skin needs exfoliation to keep pores clear.Myth 3: RETINOIDS ARE OFF-LIMITSTruth: Anyone can use a retinol. Just lessen its harsh effects by layering it over a moisturizer so absorbs less into your skin.

Eczema in Children: Daily Care Tips.

Dr. (Lt Cdr) Siddharth Garekar, Dermatologist
Hi everyone, This blogpost is for people who have atopic dermatitis (eczema) and parents of a child/ baby with atopic dermatitis. Atopic Dermatitis is a distressing disease for the parents and like any other Paediatric Dermatologist in Gurgaon, we frequently spend a lot of time consulting them about daily do’s and don’ts.  Here, we highlighted a few things you should be doing for your little one, in order to minimize flares of the disease.The guiding principle:The most crucial aspect of Eczemz/ Atopic Dermatitis is the preservation of skin moisture. It is only through the maintenance of this moisture that we can break the itch scratch cycle.General care:Use cotton clothes, avoid synthetic materials and especially wool.In winters, the first layer has to be cotton and then a woollen, to avoid direct contact with wool.Keep child’s fingernails filed short.Use regular laundry detergent, but rinse and clean well. No bleach or fabric softener.Wash new clothes before wearing them to remove irritating dyes and fabric finishers.Avoid drying laundry outside during the pollination season.Air the room out in all seasons.Avoid dust, animal hair etc.No tobacco smokeWriting a diary to note any triggers that cause flare-ups.Bathing:Water temperature should be between 32° and 34° (lukewarm)Showers are better. A short duration, a five minute shower every day.Turn the water off when washing to decrease contact time.For those who like baths and for children: add a liquid emollient to the bath to neutralize water hardness. 5-10 minutes at most, to minimise the contact time with the municipal water.Wash with soap-free products (dermatologist recommended) as the pH is closest to that of the skin and does not aggravate skin dryness.Wash hair with dermatological shampoos that are soft or intended for frequent use.Dry by patting, as rubbing reactivates itching. Leave the body wet after bathing.Moisturization in atopic dermatitis:5-minute, lukewarm baths followed by the application of a moisturizer. (Dermatologist recommended)Keep the moisturizer in the bathroom and apply all over the body while wet, to seal in moisture and allow water to be absorbed through the skin.Moisturize 2-3 times a day.Wash your hands before applying a moisturiser.Apply a liberal amount of the moisturizer, warming it first between your hands, and apply in large circular movements. (Massage)Do not apply an emollient on raw/ red skinDo not rub the skinWhen to contact a Dermatologist:Condition not responding to moisturizersSymptoms continue to worsenThere are signs of infection fever, redness, or pain

Skin Care and Protection (Mainly for Hands With Eczema/allergy)

Dr. Sandeep Gupta, Dermatologist
Skin Care and Protection1. Wash your hands in lukewarm water. Rinse and dry your hands thoroughly after washingThe skin damaging potential of a detergent is temperature dependent. Warm, soapy water causes more skin irritation than lukewarm or cold soapy water.2. Use protective gloves when starting wet-work tasks  Unprotected wet work is a significant risk factor for the development of skin irritation. Gloves are essential for protecting the skin against water, dirt, detergents,shampoos, and foodstuffs. 3. Protective gloves should be used when necessary but for as short a time as possibleIrritant reactions due to wearing gloves are frequently reported. Prolonged use of gloves leads to impairment of the skin barrier, especially if the skin has previously been exposed to detergents .4. Protective gloves should be intact and clean and dry inside Even a small amount of an irritant may  act as a strong irritant when the skin is occluded. Furthermore, allergens trapped inside a glove could induce sensitization or elicit allergic contact dermatitis in a person already sensitized.5. When protective gloves are used for more than10 min, cotton gloves should be worn underneathWearing a cotton glove inside the protective glove has been shown to protect the skin from deterioration caused by using gloves.6. Do not wear rings at work Eczema often starts under a finger ring. Irritants may become trapped under the ring, causing irritation and irritant contact dermatitis .7. Disinfectants should be used according to the recommendations for the workplaceUse of disinfectants may cause skin irritation followed by irritant contact dermatitis, and was recently reported as a contributory factor for development of hand dermatitis. However, individual factors for each workplace have to be considered.8. Select a lipid-rich moisturizer free from fragrance and with preservatives having the lowest allergen potential, Apply moisturizers on your hands during the working day or after work.Moisturizers have been shown to promote regeneration of barrier-damaged skin. Moisturizers that are rich in lipids promote regeneration faster than those that contain less lipid. Fragrance and preservatives are common causes of allergic reactions to cosmetic products .9. Moisturizers should be applied all over the hands,including the finger webs, fingertips and back of the hand Application of moisturizers to the hands is often incomplete,since many areas are skipped during application .10. Take care also when doing housework, use protective gloves for dishwashing and warm gloves when going outside in winter Development of irritant contact dermatitis is caused by exposure to cumulative irritants, often in low concentrations. Domestic exposure therefore adds to exposure at work. Domestic wet work has been recognised as an important risk factor for the development of hand eczema. During the winter, the skin is more susceptible to irritant exposure.

Atopic Dermatitis in Children

Vanikala Venugopal
This is a common skin disease in children. The cause of Atopic Dermatitis is not clear but it affects your child’s skin’s ability to hold moisture. The skin becomes dry, itchy and easily irritated. Most children who have Atopic Dermatitis have a family history of Allergies.Atopic Dermatitis (Eczema) is a recurrent or chronic inflammatory skin disease. It usually begins in the first few years of life.Things that may make Atopic Dermatitis worse include:-Allergens such as dust mites or animal dander-Harsh soaps or detergents-weather changes, especially dry or cold-Skin infections-An allergic reaction to certain foods such as eggs, peanuts, milk, wheat etcThe prevalence of Atopic dermatitis has increased over the past 30 years; children with Atopic Dermatitis are at a high risk of developing Asthma and Allergic Rhinitis.AtopicDermatitis starts with dry skin that is often very itchy. Scratching causes thedry skin to become red and irritated (inflamed) also infection often occurs .Tinybumps that look like little blisters may appear and ooze fluid or crust over. Thesesymptoms-dryness, itchiness, scratching and inflammation may come and go.Mild Atopic Dermatitis affects a small area of skin, is not very itchy and usually goes away with moisturizer.Severe Atopic Dermatitis covers a large area of skin that is very itchy and does not go away with moisturizer.Although the pathogenesis of the disorder is not completely understood, it appears to result from the complex interplay between defects in skin barrier function, environmental and infectious agents and immune abnormalities.Impairment in the skin’s ability to work as a barrier to keep moisture in and harmful bacteria out is considered a possible factor in triggering or advancing Atopic Dermatitis. We don’t know if the bacterial over growth is weakening the skin barrier function or a weakening of the barrier is enabling the bacterial overgrowth, but we do know now that they are co-related.Common sites for babies include the scalp and face (especially on the cheeks), in front of the knees and the back of elbows.In children common areas include the neck, wrists, legs, ankles, the creases of elbows or knees and in between the buttocks. There are no specific tests for Atopic Dermatitis. Diagnosis is based on specific criteria that take into account the patient’s history and clinical manifestations.Education: For optimal disease management, parents should be educated about the disease, the need for continued adherence to proper skin care practices.Skin care principles: A key features of Atopic Dermatitis management is appropriate daily skin care. Bathing once or twice daily in warm water for 10-15 min is recommended to help hydrate and cleanse the skin, assist in the debridement of infected skin. Moisturizing  cleansers are recommended while highly fragranced soaps should be avoided as they may irritate the skin. After bathing the child’s skin should be patted dry with a towel and moisturizers should be applied liberally to help prevent moisture loss and drying of the skin.Salt Room Therapy: Salt room helps to moisturize, detoxify and soften the skin. It helps to strengthen skin tissues, stimulate blood circulation and eliminate toxins.  Regular salt sessions helps to reverse chemical imbalance of the skin and body as well as balance the skin’s natural PH levels, helping to prevent dry skin. It helps in cleansing and detoxifying the skin by removing the irritants and impurities. Parents are very happy about the treatment since this is drugless without any adverse effects.Atopic Dermatitis is the most common skin disorder in children and significantly impacts quality of life.The diagnosis is based on patient history and clinical manifestations.Allergy testing using Skin Prick test or IgE. Measurements may be useful for identifying triggers of Atopic Dermatitis.Optimal skin care practicesSalt Room therapy treatment is effective

Dandruff- An Overview & Tips for Management

Dr. Sanjeev Gulati, Dermatologist
It is a popular name given to a non-inflammatory increased scaling of scalp where scaling (desquamation) is visible and active.It is a precursor of seborrhoeic Dermatitis & progression is though redness, greasiness, irritation and increased scalp scaling.Mostly it’s a cosmetic problem with flaking of scales on scalp, also involving face and shoulders.Dandruff is also associated with acne or may be part of psoriasis.Seborrhoeic Dermatitis may also involve the eyebrows, eyelids, ears, nasolabial creases, lips, axillae, umbilicus, sternum, groin & buttocks; and generally has crusted pink or yellow  patches of various shapes & sizes, with remissions and exacerbations.In infants, yellowish a brownish scales are seen an scalp, which are adherent & called “Cradle Cap”A common yeast Pityrosporum ovale, is found to be abundant in dandruff patients. Patients of Dandruff have to be approached from cosmetic angle to the treatment of related disorders.Patient’s History / Examination:-    An inquiry into – Severity, pruritus, frequency of hair washing / shampooing & seasonal variation is pertinent.    Also history of medication (Arsenic, Gold) Dietary deficiencies (Vitamin B Complex), Acne, Alcoholics, Psoriasis, HIV, Epilesy, Diabetes (Obese People), Malabsorption disorders,  are asked for     A simple visualization of scales, (yellowish, greasy / dry), under a magnifying lens is sufficient to gauge extent & severity of dandruff. An examination for associated alopecia (baldness) of scalp, secondary infection, eczematisation and type of scaling is in order. A scraping (KOH) of scales & rarely biopsy is required.Classification of Dandruff:-    It can be graded based on degree of scaling on a scale ranging from 0 to 10.    A practical grading into mild, moderate and severe forms is done on basis of severity of scaling, itching & evidence of inflammation, acne & seborrhea.Mild / Grade -I: -    Visible fine scaling, non itchy, non-inflammatory – of pure Cosmetic Importance.Moderate / Grade: II:- Larger scaling with itching, mild inflammatory changes, with diffuse alopecia a acne or seborrhea.Severe / Grade III: - Severely inflammatory, severe pruritus, thick scales, with. associated seborrhoeic dermatitis / psoriatic originPrinciples of Treating Dandruff :- 1.    Patients Education & explanation :- regarding a)    Emphasis that dandruff can generally be suppressed with regular treatment for years – permanent cure may not be there.b)    Cosmetic nature of disorder.c)    Seasonal Variation i.e. increases in winter & reduction in summer.d)    Importance of frequent washing of hair and scalp (to eliminate loose scales).e)    Avoid unnecessary use of excessive hair oil (greasy scaling), but minimal application at night to soften scales for easy dislodgement by shampoos.f)    Use of conditioner shampoos if dry scalp & shampoo for oily hair in those with greasy scalps.2.    Medical therapy is started with topical agents to control dandruff – lotion or shampoo formulations.3.    Systemic therapy started as a second line of therapy for resistant cases, very severe forms or if related to Psoriasis & seborrhoeic dermatitis4.    Specific therapy for associated conditions eg. Secondary infection, eczematisation & diffuse alopecia – are co- prescribedMANAGEMENT GUIDELINES FOR DANDRUFF:-

Understanding Dandruff

Dr. Jolly Shah Kapadia, Dermatologist
Dandruff is seen as white or yellow flakes seen on your shoulders or in your hair. Dandruff flakes are actually dead skin cells that fall off your scalp. When you have dandruff, your scalp may look scaly or red and feel itchy or raw. Scratching or rubbing your head loosens the flakes. Does having dandruff mean dirty hair? Dandruff doesn't mean you have dirty hair. If you already have dandruff, not washing your hair enough can make your dandruff look worse because dead skin cells build up. What Causes Dandruff?Dandruff is believed to be caused by a fungus called Mallessezia furfur. This fungus usually lives on your skin, but too much fungus may lead to dandruff. Being exposed to a lot of dry air can cause skin to dry out and flake, which can look like dandruff.Dandruff tends to be worse during dry months. Cold, dry winter weather in particular can make dandruff worse. Sensitivity to hair care products (contact dermatitis). Sometimes sensitivities to certain ingredients in hair care products or hair dyes, especially paraphenylenediamine, can cause a red, itchy, scaly scalp. Shampooing too often or using too many styling products also may irritate your scalp, causing dandruff.Stress or fatigue can trigger or aggravate it, too.Dietary deficiency of zinc and a diet excess in saturated fats, refined sugars adds to the dandruff problemAre there other conditions that lead to a flaky scalp?Skin problems like acne, eczema, and psoriasis can cause a buildup of dead skin cells on the scalp. People with serious medical problems such as epilepsy, Parkinson's disease, and HIV are prone to developing dandruff. And, for unclear reasons, people recovering from a stroke, heart attack, or head injury are also more likely to have dandruff.Can Dandruff occur on any other body parts?Dandruff can also occur on forehead, eyebrows, eyelashes, or ears. Flaky skin on your chest -- or anywhere you have body hair -- could be a sign of dandruff, which is a mild form of seborrheic dermatitis. Do babies also get dandruff?When babies have seborrheic dermatitis, it's called cradle cap. The brown or yellow scales may be itchy. You may find it on the skin of a baby's scalp, eyelids, nose, and groin area. Cradle cap normally clears up on its own by the time the baby is 8 to 12 months old. Try putting vegetable oil on the baby's scalp for 10 minutes, then washing with a mild baby shampoo. Is dandruff harmful? Although having dandruff can be embarrassing, it's harmless. Can Dandruff cause hair fall?Dandruff doesn't directly cause hair loss, but scratching your scalp a lot could cause temporary hair loss.Is Dandruff contagious?Dandruff is not contagious: You can't catch it or pass it along to someone else. Does wearing a helmet or cap cause dandruff?Wearing a hat will not cause dandruff but it will aggravate the dandruff condition by not allowing sweat to evaporate.Can blow drying reduce dandruff?Blow drying may make your hair look beautiful for sometime, but it only damages your hair in the long run. It never contributes in the reduction of dandruff.Will Dandruff treatment decolorize my colour- treated hair?Most of the anti-dandruff shampoos available today are colour-friendly. They do not decolorize your perfectly coloured hair. You need not worry while treating dandruff about your coloured hair.How do I use anti-dandruff shampoo? Gently rub the shampoo into your scalp using the pads of your fingers. Leave the shampoo on your head for five minutes -- or as directed -- before you rinse. If you prefer the smell of your normal shampoo and conditioner, you can use those afterward. As your dandruff gets better, you may not need to use dandruff shampoo as often.Do I need to visit a Dermatologist for dandruff?Sometimes what seems like dandruff can be an entirely different condition. Head lice are itchy and lay eggs that look like dandruff, but they're harder to shake off or brush out. Or your scalp could be itching from ringworm, a fungus that causes dandruff-like flakes. With ringworm, you might also have round patches of hair loss and blistered, scaly areas on your scalp.If you've been using a dandruff shampoo for several weeks but still have dandruff, visit a Dermatologist. You should also see a doctor if your scalp is swollen or red, if your hair is falling out, or if you have a red, scaly rash on other parts of your body.

Understanding Allergy

Dr. Loknath Kumar, General Physician
Introduction to AllergyAllergy is a heightened sensitivity to a foreign substance that causes the body’s defense system to overreact when defending itself. Normally the immune system would react if a harmful substance such as bacteria attacks the body. For people with Allergies,their immune system are working too hard and react with relatively harmless substances such as pollen. The severity of an allergic reaction can vary from mild discomfort to life threatening situation.  AllergenAn Allergen is a substance that can cause   an allergic reaction. Individuals who do not react to the allergen are said to be tolerant, whereas those who react are labelled as Allergic or Atopic individuals.                             Clinical features of AllergyThe spectrum of Allergic reactions is summarized below:Skin: Eczema, Atopic Dermatitis, Psoriasis, Urticaria, AngiodermaEyes: ConjunctivitisNose & Sinuses: Rhinitis, SinusitisGastro-Intestinal Track: Food AllergyLungs: Asthma, BronchitisEntire Body: Anaphylaxis                                                                          Diagnosis of AllergyIgE Mediated Allergic reactions can be diagnosed either by Skin prick test or Blood test IgE.Non-IgE Mediated reactions are diagnosed by avoiding exposure to the allergen followed by re-exposure to the allergen.Management of Allergies & possibilities of Boosting ImmunityConventional: Allergen avoidance, Symptomatic treatment, Allergen Immuno TherapyNatural Therapy: Pranayama / Breathing Exercises, Salt Room Therapy, Light exercise like Walking, Combination of these.Avoidance of the Allergen is the best way of management of Allergies. However, this is practically not possible.Natural Therapies opens up a whole new possibility for patients suffering from Chronic Allergic conditions.

Common Baby Skin Boo- Boos!

Dr. Pradnya Shastri, Dermatologist
Every time worried parents bring their babies with skin problems to the clinic I remember my grandmother and her stories of how she ‘treated’  the baby in distress(often that baby was me). Baby is crying... gripe water. Baby has dry skin... apply coconut oil. Baby has fever... use wet handkerchiefs on forehead to bring it down till you get to see a doctor. Although Dadi’s Potli does work at times, there are instances where nothing works for which you need to see a dermatologist.Here are a few diseases that you budding & doting parents should know of, so that you can prevent them and more importantly, know when not to dilly dally and go see a dermatologist.CRADLE CAPCommonly affects newborns but can be seen even in infants. Thick, yellowish brown crusts cover parts of thescalp or the entire scalp at times. The baby isn’t uneasy but it’s parents certainly are. What you can try: If there is only a tiny patch, you could try apply coconut oil (no, not any other oil) 15 min before you give the baby a head bath. Do not massage (because massaging is not the solution to everything!). The oil softens the crusts and thus it is easier to wash them off while shampooing the baby’s scalp.When to go a dermatologist: When you don’t see the baby’s scalp and see only crusts! At this stage an anti-dandruff shampoo (no not the ones that you see on TV commercials) are needed, for which you will need to consult a dermatologist and refrain from experimenting at home.DIAPER RASHCaused by prolonged exposure to a soiled diaper. The diaper covered areas like the groins, buttocks and genitals are the most affected. The faeces and the urine contain certain substances that can literally ‘eat through’ (cause severe irritation) your baby’s skin. If neglected, then what develops is DIAPER DERMATITIS where the skin becomes angry red and starts oozing.What you can to do prevent it: Use tap water to clean the area and ‘dab’ the area completely dry. Use a good moisturizing cream immediately and use powder (preferably talc free) to soak the sweat that occurs under the diaper. And change diapers as many times as possible! No matter how ‘super duper absorbing’ they are, they still remain moist. So don’t believe what all the diaper manufacturers say. The best thing that you can do: use ‘Langots’... Loin cloths! Unlike the diapers, it’s easier to know when a langot soiled and thus are changed on time! Yes, it is cumbersome to use them... but then what is more important... your convenience orthe baby’s comfort? You could stick to using diapers when you are going out. When to go to a dermatologist: When there is oozing and crusting and severe redness on the skin under the diaper. I have seen parents constantly wash the area with hot water, scrub it with a towel and use wet wipes! Please... do not do any of those things! Especially wet wipes! They have alcohol in them and using them leaves the skin very dry and more susceptible to the irritating effects of the urine and faeces. So rush to a dermatologist since only the use of topical steroids will alleviate the skin rash.PRICKLY HEATLike adults suffer from prickly heat (miliaria as we call it in the medical lingo), so do babies. It can affect the  face, neck, back andbottom. Tiny red vesicles are seen on an inflamed skin and the baby tends to become irritable (cries more than usual).What you can do to prevent: Please don’t wrap up the baby like you are wrapping up a gift! I have seen parents wrap up the baby so tight that it cannot move its hands or legs, all due to the fear that the baby will catch a cold. Yes, that would be true if we were living in place like say... Alaska! But we live in a tropical hot country like India, where even in the winters (barring a few places) aren’t that cold. So please let the baby’s skin breathe a little. It sweats too and needs ventilation. The sweat actually helps the baby cool off and feel relaxed. Also, avoid using hats and gloves!(I have seen parents using them for babies in Mumbai!). The other unwarranted fear I have seen in patients is of using the ceiling fan when the baby is in the room. I have seen babies sweat buckets and parents refusing to turn the fan on. Use the fan without fear. When to go to a dermatologist: When the baby is already cranky and crying and you see a red rash covering it’s body. Refrain from using ‘home remedies’ or ‘oil massages’.VIRAL RASHA lot of viral infections can occur at this age. Usually the infections are characterised by a  vesicular rash(chicken pox), red papular rash(measles) or red patch on the cheek (due to Parvo vius) etc. Fever is a common association along with vomiting, diarrhoea and an irritable child.Here it is imperative that you visit your paediatrician and dermatologist at the same time. Timely intervention is needed. I hope that I have clarified a few, if not all things, with you 'Newly born parents'!Babies aren’t the best of speakers (how wonderful if they could speak straight out the womb!) which is why you need to understand the demands they make; of being fed, being cleaned etc. So remember, even their skin speaks a language. Understand that and you will have a happy child!

Living Well With Rheumatoid Arthritis

Dr. Dheeraj Kondagari, Rheumatologist
If you were recently diagnosed with arthritis or one of the other rheumatic diseases, you are not alone. An estimated one crore people in India of all ages and genders have arthritis or other rheumatic conditions. Many rheumatic diseases are chronic conditions. They are unlikely to go away. There may not be a cure for your condition, but effective management is available for most. Many people with rheumatic disease lead happy, satisfying lives year after year. You may be feeling anxious, even a little overwhelmed. This is a natural response to an unexpected turn in the road.How do you handle your very real concerns? By knowing the facts. First, the reality. With proper treatment, you can manage this condition and still have a good and productive life. There are numerous medications that have been proven effective and Rheumatology experts who will help. However, you also have to take control of the situation. That means making sure you get adequate exercise, ample rest and good nutrition. It also means learning about this disease and taking steps to address your own needs. The knowledge you acquire and the positive approach you take to your new lifestyle will make the difference between just coping with rheumatic disease and living well, despite your diagnosis. What is rheumatic disease?Arthritis and other rheumatic diseases are a family of illnesses that can cause inflammation (redness, swelling and pain), changes in the joints and pain in the surrounding structures.They also may make it difficult to do daily activities. In fact, there are more than 100 different rheumatic conditions including, but not limited to, osteoporosis, rheumatoid arthritis, gout, fibromyalgia, osteoarthritis, systemic lupus erythematosus, and scleroderma. While the symptoms may vary, as a rule, these conditions target the musculoskeletal system, including the bones, joints, muscles, and tendons that contribute to function. Some people also can have internal organ involvement or even more than one of these conditions at the same time. Therefore, it may take time for your primary care physician, rheumatologist, or other healthcare professional to determine your particular diagnosis and the best treatment approach for you. Your participation in this effort―and your patience―will make a substantial contribution to a successful diagnosis and your comfort levels.What can you do? Make your medical visit count!Plan ahead for your visits with your health care provider and, above all, communicate. Arrive with a list of your specific concerns. Consider bringing someone with you who can listen to the health care provider and take notes as appropriate. Respond to the medical professional's queries honestly and directly. Talk about your emotions, stress or discomfort if they are interfering with your lifestyle. Ask for a clearer explanation if you don't you understand any recommended treatment, including benefits, instructions and duration. Identify the team of medical professionals who will be of the most benefit to you. Initially,your rheumatologist, who has special training in the diagnosis and treatment of rheumatic diseases, will probably work closely with your primary care provider. Once you are diagnosed,a number of other medical care providers are available to help you manage your condition,Orthopedic surgeons, Nurse practitioners/physician assistants, Physical therapists, Occupational therapists, Pharmacists, Health educators, Psychologists. Make it a point to learn more about your medications. Rheumatologists only prescribe or recommend treatments to help patients manage their arthritis. The real key to living well with the disease lies with the patients themselves. Research shows that people with arthritis who take part in their own care fare much better. An important fact not shared openly by many doctors is that they go a mile extra to help patients who are interested in themselves and work more and more on patients who want to get better and resume their normal activities. So don’t resign yourself to fate. Only you, with the help of medicines, good understanding about arthritis and good scientific strategies can fight the disease effectively. It is very important that you take these medicines regularly and only as prescribed. You have to follow these important instructions while taking treatment for effective remedy 1)Start the medications –Early start of treatment is very important in preventing joint damage. Due to ignorance and apprehending side effects of drugs prescribed, patients do not start medications. The rheumatologist aptly takes care of patients and administers drugs as per the requirements only. If the patients do not comply and do not take the medicines prescribed by the rheumatologist, joints may get damaged permanently and one is compelled to go for surgeries to repair them, which is very costly.2) Do not give in to illogical fears about medications –Side effects are like accidents. They occur rarely and individual patient specific. If the patient follows up regularly and gets some basic tests done at regular intervals, as advised, most side effect can be identified at the earliest and corrected. Fortunately all these side effects are rare and can be managed very easily provided they are reported at the earliest possible time. Follow contraception as advised by your rheumatologist if you need to be on methotrexate, cyclophosphamide, leflunamide and mycophenolate mofetil. However after a certain washout period of these drugs, you can try to conceive again.Discuss all your concerns with your doctor.3) Don't stop the medications when you feel better. Medicines for reducing damage and inflammation need to stay in your bloodstream at therapeutic levels. Skipping a dose when you feel better could cause the pain and inflammation to return. It may be more difficult to relieve. Its better to keep it under control than allow it to flare and try to get it under control again. Your doctor will himself reduce and stop medications one by one if your disease is inactive for more than 3­-6 months.4) Keep up your appointments and do not use medicines on your own. You may not feel the need to see your rheumatologist when your arthritis is less active. Still keeping your appointments is important. Also do not continue the medicines on your own. Self treatment may be dangerous. During your regular planned visits your doctor will monitor the course of disease and determine response to treatment, adjust your treatment if necessary and Look for side effects based on clinical examination and lab tests as well.5) Do regular physical activity –Regular exercise is one of the best things for overall health. When the disease flares up, as stretching to keep joints flexible. Inactivity can make pain, fatigue and stiffness worse. As your disease becomes less active, increase your exercise. Talk to your physiotherapist about the best and safest exercises for you. Warm water aerobic exercises maybe another choice to consider as­ it relieves stiffness and pain steps down a little. 6) Quitting smoking and maintaining oral hygiene may reduce the chances of developing severe forms of arthritis according to recent evidence. They also reduce risk of cardiovascular events which is increased in Rheumatoid arthritis.7) Dietary restrictions ­- There is no clear evidence for any dietary restrictions in Rheumatoid Arthritis. However, for reducing cardiovascular risk, the American Heart Association recommends eating fish twice a week. Fish high in omega­3s are powerful anti-inflammatory foods that offer a multitude of health benefits. Don't eat fish? Other foods rich in omega­3 fatty acids include walnuts, canola oil, and soybeans.8) Fight Depression ­Living with Arthritis is not easy. It can be painful and unpredictable developments do occur. It may be hard to do normal things you enjoy. It is understandable to become sad at times, but you do not have to accept depression as a part of your disease. Discuss these feelings with your doctor. Family support is also required. Developing motivated and proper frame of mind to fight the disease is of utmost importance. According to recent evidence Individual Patient‘s interest in self care is the most important factor in the treatment of rheumatological diseases9) Don't log on without a diagnosis: Don't log on to various internet sites describing symptoms and pains to diagnose yourself. Many rheumatic diseases will be associated with elevation in sedimentation rate (so called, ESR test) pain and stiffness of the joints . So better have a documented diagnosis first. Also you should check only valid patient education sites on the web to get trustable information. 10) Whenever you are in severe illnesses due to infections, you need the opinion of a Rheumatologist available, regarding usage of the prescribed drugs.11) Pneumococal and annual Influenza vaccines are advised to prevent infections. Discuss with your doctor if you have other comorbidities like COPD,Diabetes and you are aged above 55 years.12) Get your eyes checked up by an opthalmologist every 6 months to look for steroid induced effects or hydroxychloroquine effects13) Doctors give you a prescription only after weighing potential benefits against risk. You can have increased hair loss, nausea, burning in the chest, oral ulcers, allergic reactions & skin rashes, increased friability and striae of skin, cataracts, weight gain, increase or decrease in certain cell counts, osteoporosis, avascular necrosis of bones, increase in infections, increase in blood sugars, facial hair, acne, slight increase in blood pressure, etc. while using these drugs. However, in majority of the patients these are easily manageable (Ex: increasing the dose of anti diabetic oral drugs or insulin in case of diabetic patients). It is generally advised to concentrate on the benefits of the drugs, keeping an eye on the side effects. Stopping medications out of illogical or unrealistic fears may lead irreparable damage to bones, joint deformities and serious organ damage in various diseases. Good news is that apart from the traditional anti rheumatic drugs which do work quite well,there are newer drugs in research and some, already into the market. It is possible now to prevent joint damage with these medications.

Losing Weight With Rheumatoid Arthritis

Ms. Swati Kapoor, Dietitian/Nutritionist
Rheumatoid arthritis is a chronic inflammatory disorder that may affect many tissues and organs but primarily affects the small joints of hands & feet. It affects the lining of joints, causing a painful swelling that can eventually cause poor bone density and joint deformity. It can lead to substantial loss of functioning and mobility if appropriate medical treatment is not given on time.It is an autoimmune disorder which means that the body’s immune system works against own tissues and organs and mistakenly starts attacking them.Rheumatoid arthritis is more common in women between the ages of 40 and 60.Rheumatoid arthritis symptoms may vary in the degree of pain and swelling. The symptoms may also disappear at times and come back. Weight loss is also a general symptom of rheumatoid arthritis in many cases. Increased catabolism (muscle breakdown) with loss of appetite can lead to malnourishment. However weight gain is a problem with many living with rheumatoid arthritis. Carrying around extra weight can put more stress on painful joints. Excess fat stored in fat cells secrete certain hormones that can promote bone damage. So, it’s very important to lose any extra weight and maintain weight in a healthy range. With painful joints it might not be possible to maintain a regular normal exercise routine. Moreover, some medications in rheumatoid arthritis can increase appetite and can add on to pounds.Following guidelines can be helpful in maintaining a healthy weight with rheumatoid arthritis:Eat A Balanced DietChoose low calorie, healthy meal options. Minimize sugar and fat intake in the diet. Opt for seasonal vegetables, fruits, whole grains, lentils, low fat dairy products. Avoid packaged and processed foods. Take advise from a qualified nutritionist who can help you design a well-balanced healthy diet schedule which can also help in losing extra weight.ExerciseIt’s a very common myth that exercises can harm those with rheumatoid arthritis. In fact, doing joint friendly exercises and water based activities can increase muscle strength and bone structure. Strengthening exercises with low impact cardio like walking, swimming are preferable options.Avoid AlcoholAccording to some studies, drinking in moderation on occasions can help in easing joint pain in rheumatoid arthritis. However, drinking alcohol on regular basis can hinder with absorption of vital nutrients. This can also add on to the pounds as alcohol is primarily sugar and can make weight loss difficult.Maintain A Food DiaryTracking your weight loss progress by writing your daily intake can help you stay disciplined and motivated. Plan ahead your weekly meals and record it on daily basis to reduce chances of deviations and to be on the right track.Re-assess Your MedicationFew medications in rheumatoid arthritis can have side-effects like water retention and increase in appetite contributing to weight gain. If you note these changes take guidance from your doctor and ask for alternatives for such medications.Try the above tips to manage your eating and activity in a better way with rheumatoid arthritis.