PLEASE NOTE THAT THIS BLOG HAS NOW SHIFTED TO A NEW WEB ADDRESS

http://www.onlineskinspecialist.com/SkinCareblog/

Dark skin and ring worm: groin

Question

Hello Doc,

Good Morning!!

I was actually looking for some blog like this from long.

Let me tell you about my problem… I am 28 years old and I used to have deadly itching around my pubic region from very long. I think it started when i was in class 9th.

I used to scratch a lot and slowly i observed that i had developed ringworm (aka daad in Hindi) in all that region. I used to scratch like anything and sometimes even blood used to come out.

And lately it started spreading like anything, from my panty line to inner thigh. It lived with my since more than 7 years and i became used to it. During summers its worse due to sweating and somehow i started living with it.

But since now I am getting married in a month and i wanted to get rid of this so i started using Foredom skin cream from cipla and it magically gave me relief from my itching. I am now applying this from quite a while and now there doesnt seem any ringworm or its now very less. But the skin color now seems to be dark. I am a fare guy but that region is quite dark.

Would really appreciate your help here.

Many Thanks,

Dapinder Singh

Answer

Dear Dapinder,

Thanks for contacting me. If you did have a ring work for so many years and you were constantly scratching, the area would have become dark simply from scratching I am afraid. It takes a long time for that to get back to normal. Suggest trying a urea based cream twice a day and that would take away the dark skin slowly. Obviously it would also be important to make sure that the infection is gone!

Regards

Dr.Sasi Attili

Does Proactiv acne treatment work?

Question

Can You please tell me if that Proactiv acne treatment system really works? I have heard a lot about this Proactiv, I see the as seen on tv infomercials like everyday. Please advise. Thank you so much!

Sincerely,

Dan

Answer

Dear Dan,

Proactive simply contains Benzoyl peroxide 2.5% which is a reasonably good agent for some types of acne. However Benzoyl peroxide is available as a drug formulation (on prescription) at a much cheaper price. Often it works best in combination with a topical antibiotic or retinoid and a number of such combination preparations are available.

Hope thats helpful.

Regards

Dr.Sasi Attili

White patches on trunk (Pasted from a real web consultation)

Question:

Initially self-diagnosed as Tinea Versicolor. After using prescribed anti-fungal treatment several times there is no noticable change. Has been a persistent problem for many years – no recollection of when it started. Looking only I wonder if it’s melasma but my face is clear. Pics attached.

Answer

Many Thanks for using my online consultation service, which I hope you will find worthwhile. From what I understand you have had these white flat patches coalescing together, on the trunk for many years. I believe they are not itchy or scaly (dry and flaky)? Please confirm.

Also please confirm that the patches were not preceeded by any other skin problem (like a fungal infection or psoriasis). Also please confirm whether the lesions are getting worse or better with time and apart from your trunk have you got them elsewhere?

Please remember that my diagnosis/ treatment might change depending on your responses to the questions above.

However, on first impressions you seem to have a relatively common but often underdiagnosed condition called progressive macular hypomelanosis. No one exactly knows what causes it but it usually tends to go away on its own after the age of 40! (yes, I am afraid so). It is a completely harmless condition for which no treatment is necessary. It is thought to be a variant of two other conditions Pityriasis alba and idipathic guttate hypomelanosis, but this link is not proven. Research suggests that the disease might be driven by a yeast infection (propionobacter acnes)  Hence, the treatments that have been reported to help include using clindamycin 1% lotion along with benzoyl peroxide 5% gel in combination with UVB phototherapy (usually for about 10-12 weeks). However the disease can come back after you stop treatment and therefore you would have to decide whether to just ignore this harmless condition or go for treatment. Using the lotion and gel is completely harmless and you could certainly try that in the first instance. Phototherapy does carry the risk of skin cancer, but the risk in asian skin after one course (20-30 treatments), is negligible.

I have hyperlinked the technical terms I have used and do see the info links. Many thanks for using my service once again and hope to hear from you soon.

Regards

Dr.Sasi Attili.  MBBS, MRCP (London), CCT in Dermatology (UK)

Consultant Dermatologist

Acne problem

Question

sir u want 2 ask frm u that i always suffer frm acne problem and this after drying gives black spot on face there is no shining on my face i try many things but no result plz tell me something regarding this matter for this i m v. thankful 2 u sir plz

Answer

Dear Deepshika,

Many Thanks for contacting me online. I would be certainly glad to help with your acne problem. General acne treatment advice is available online http://dermnetnz.org/acne/acne-treatment.html . However for any individual, treatment does depend on the severity of acne and for me to advise which is best for you, I would have to at least see pictures of your face. If you can please upload your details and some good quality photos on http://www.onlineskinspecialist.com/user-registration.php , I can certainly help. If you leave your phone number, I could call you once I have had a look at your case sheet and pictures. My website www.onlineskinspecialist.com should give you all the information regarding fees. I hope to hear from you soon.

Regards

Dr.Sasi Attili. MBBS, MRCP (London), CCT in Dermatology (UK)

Consultant Dermatologist

www.onlineskinspecialist.com

www.onlineskinspecialist.wordpress.com

Psoriasis

Question

I HAVE PSORIASIS SINCE LAST 20 YEARS. IS IT CURABLE OR NOT WHAT I DO, I AM VERY STRESED WITH THEM. FEEL VERY ETCHING. TO MUCH SCLAPS OUT FROM BODY WHILE SLEEPING. MY WIFE LEFT ME DUE TO THIS .

KINDLY HELP & SUGGEST

Exxxxx Gxxxx

Answer

I would certainly be glad to help. I am sorry to hear about the problems you have had with your psoriasis. Psoriasis cannot be cured but can be treated such that no one would know, you even have it.

However most psoriasis treatments require regular monitoring of bloods. I am not sure whether you are mailing from UK or India?? You have included both a UK and Indian mobile.

If you are in India, I could certainly prescribe treatment online as you will be able to get your bloods tests in a lab without problems.

However that is not possible in UK. If you are in UK, you would be better off seeing your GP and getting referred to a NHS Dermatologist.

If you are in India and wish to seek a formal consultation (300 Rs), please do register on http://www.onlineskinspecialist.com/user-registration.php. The online case- sheet contains a set of questions, that  would help me base my diagnosis and treatment advice. So please do enter as many details as possible. The website at the moment is having some problems and we are unable to accept payment of consultation fees online. If you don’t mind, please do a direct back transfer to the following account:

Bank Name: HSBC

ifsc code: hsbc0530002

account number 061-237251-006

Account name : Dr. Venkat Attili

Once you have done that, please reply to this mail and if possible, send me some pictures of your skin problem. I shall give you a call and discuss your problem and treatment options. Please do mail me back if you have any other questions or problems navigating through the links above.  I look forward to hearing from you again.

Regards

Dr.Sasi Attili.  MBBS, MRCP (London), CCT in Dermatology (UK)

Consultant Dermatologist

www.onlineskinspecialist.com

www.onlineskinspecialist.wordpress.com

 

sir which soap is better for aviod acne and iam using now clearasil ultra rapid treatment cream it is better to avoid acne

I am afraid none of the soaps for acne actually work. Treatment of acne depends on the severity of acne. Clearasil contains benzoyl peroxide and is a reasonably good treatment for acne. However if you feel that is not enough then I will have to discuss with you in person, to decide which is best and going to work for you. You might want to look at the following link which lists the treatment options for acne. http://dermnetnz.org/acne/acne-treatment.html.

Regards

Dr.Sasi Attili. MBBS, MRCP (London), CCT in Dermatology (UK)

Consultant Dermatologist

www.onlineskinspecialist.com

www.onlineskinspecialist.wordpress.com

SLE (Sytemic Lupus erythematosus) treatment

Question

dear sir,

my wife is suffering from SLE and also taking hcqs-400 predmet-4mg daily one tablet.she is filling comfortable from pain.but problem is that her face is very darkness day by day and also rashes is coming.may be butterfly rases has coming.please help how can we protect these types of problem.she is 33 years old and also she can not pregnent till(11 years after marriage)

with regards

xxxx

Answer

Dear Mr.xxxxxxx,

Many Thanks for contacting me online. I would certainly be glad to help. Since SLE is quite a complex problem, I need to know the full details of her history. Once I know the details, I could certainly give you a call and discuss in detail. If you can please upload her details and some good quality photos on http://www.onlineskinspecialist.com/user-registration.php , I can certainly help. The online case- sheet contains a set of questions, that would help me base my diagnosis and treatment advice. So please do enter as many details as possible.

If you leave your phone number, I could call you once I have had a look at her case sheet and pictures. My website www.onlineskinspecialist.com should give you all the information regarding fees (300 Rs). If you wish to go ahead, please email me back and I shall give you details as to how to pay me through my Indian Bank Account. There is a problem at the moment with accepting Indian bank cards online.

Please do mail me back if you have any other questions or problems navigating through the links above. I look forward to hearing from you again.

Regards

Dr.Sasi Attili. MBBS, MRCP (London), CCT in Dermatology (UK)

Consultant Dermatologist

www.onlineskinspecialist.com

www.onlineskinspecialist.wordpress.com

Black spots on body, scrotal hairs and LASER, veins on the penis, small bumps under the penis, penile papules, phimosis

QUESTION

Current age- 18.

I have attached a few pictures..(1).I want to know what are those black spots and what is the cause for their increase in number.(2)Its quite embarassing to confess that I had shaved my scrotum when I was like around 12 or 13..and now a lot of hairs are growing down there. Is there any topical cream or any other safe method to get rid of it permanently(3)what are those small hairs growing on the under side of the penis and 3greenish veins elevated on the penis and small bumps on the under side of the penis? (4)are those blisters-penile papules and what can be done to treat and eradicate smegma?(5)am I a phimosis patient and is there any non surgical method to treat it?.please check them and let me know how much am I to pay for the consultation./And I request you not to put up any of those pictures anywhere./. Thank you

ANSWER

1. The black spots look like simple moles. Unless they are rapidly changing, I would not worry.

2. Hairs on the scrotum and penis are extremely common and is not a disease. There is no way to get rid of them painlessly. You can have Light Sheer diode LASER therapy but it is quite painful in that area.

3. And 4. – I agree they are harmless perly penile papules. I am quite impressed by your self diagnosis. Again one cannot treat these unless one burns these off under local anaesthetic. http://dermnetnz.org/site-age-specific/penile-papules.html

4. I am not sure you definitely have phimosis. Are you saying that you cannot pull back your foreskin completely? If you cannot- then yes you have phimosis. But I would suggest you use ‘Clobetasol propionate’ ointment once daily and try manually gently pulling the skin down a little bit everyday with a little bit of lubrication. Do not do it too much if you pull too much and it bleeds or if it cuts, you will have more problems!! Most physiological phimosis resolve in adult life and do not need treatment. But if it doesn’t then you are better off getting Circumcision. There is no ‘treatment for smegma as it is not a ‘disease’.

Best of luck.

Regards

Dr.Sasi Attili

Consultant Dermatologist (GMC Registration No.: 6036602)

Skin Care Talk: Why random medical advice over the internet is not a good idea!!

I had a very very interesting experience yesterday. As I’ve mentioned in my links above, I am mainly doing this as a hobby and do not intend to become rich from this tele-dermatology service!!

One of my patients in the UK who was pleased with my service suggested that I should register in a forum called ‘Skin Care Talk’, and get myself known. I was not aware of this forum and did not like the idea of randomly advertising to an internet community. Anyway I thought I’d give it a look and registered on the site. It is actually a very useful forum for people to share their skin problems online and seek advice. However the forum rules clearly state that they are not responsible for advice given and the advice posted should not be treated as ‘medical’ advice. This is perfectly reasonable considering that the users of the forum are non-medical personnel.

I was a bit sceptical to start with but did post on a few threads offering an opinion on case histories and pictures posted. What followed however within the next couple of hours completely caught me unawares. I was met with a personal scathing attack on my reputation and was banned from the forum, for offering ‘medical’ advice. I was sent a message that I was banned because the forum rules state that ‘medical’ advice is not allowed. I was/am completely flabbergasted. If they do not allow medical advice, why in the first place are they running the forum. What’s the point of random non-medical advice, which would probably end up confusing everyone?

I think the forum is ruled by a bunch of moderators who are used to their reputation of being half-wits and could not bear with the idea of someone ‘medical’ stealing their ‘fame’!! Anyway, I think I have learned my lesson and it is probably best I stick to my blog. As with every doctor, his/her own patients are the best publicity.