Sure Cure Multi Clinic

Acne is often misunderstood to be a condition that only affects teenagers. However, acne can develop even when a person is in his or her thirties. This sort of acne is known as adult acne. As wth any other health condition, there are a number of myths associated with adult acne. Here are 7 facts you should know about adult acne.

1. You’re not the only one. Adult acne is a fairly common skin condition. It affects both men and women though the latter are more susceptible to it. Even people in their 50s can develop acne.
2. Adult acne and teenage acne is not the same. Acne that develops in the teenage years tends to affect the forehead area. It consists of mainly white heads and black heads that develop as a result of clogged pores.
3. On the other hand, adult acne affects the lower half of the face appears in the form of bigger, red nodules. These often recur in the same place.
4. Adult acne in women is mostly due to hormonal changes. A woman’s body is constantly facing hormonal changes during menstruation, pregnancy, menopause or as a result of changing birth control methods. These hormonal changes are often accompanied by acne breakouts. A chronic acne breakout can also indicate serious hormonal imbalances or conditions such as polycystic ovarian syndrome.
5. Stress is a primary contributor to adult acne. Stress and acne have a cyclic relationship with each contributing to the development of the other. Chronic stress can lead to hormonal imbalances which further lead to the development of acne. Frustration caused by the appearance of acne can worsen the stress and if not controlled this can further aggravate acne.
6. Using the right skin care products can prevent adult acne. Washing your face multiple times may not prove to be the best way to prevent acne as this rids the skin of necessary oils. When it comes to skincare, it is essential to choose the right product. Ideally, choose cleansers that contain benzoyl peroxide or salicylic acid and non-comedogenic skincare products. Products that contain tea tree oil can also help reduce acne inflammations.
7. Do not pick the pimples. Acne may be a temporary condition but can leave lasting effects if the pimples are picked or manually burst. Doing this can lead to the formation of permanent scars. Acne scars range from mild to severe and can later be treated with a range of procedures including dermabrasion, chemical peels and laser.
8. What you eat can affect your acne. High glycemic index foods and dairy can lead to hormonal imbalances and have been linked to adult acne breakouts. This includes refined carbohydrates, processed sugars and all forms of milk. If you wish to discuss about any specific problem, you can ask a free question.

Aesthetic medicine is an umbrella term, which encompasses all sorts of specialties that mainly focus on the improvement of cosmetic appearance through different treatments. Improving skin laxity, removing scars, reducing wrinkles, mole spots, treatment of unwanted hair, treatment of skin discolouration etc. are a few such aesthetic treatments. One such aesthetic treatment is called platelet rich plasma (PRP), which is used to improve skin laxity and avoid wrinkle formation. PRP injection is a treatment for the skin.

Procedure of PRP
Blood is extracted from the patient, which is then immediately put into the centrifuge. After completion of centrifugation, the plasma and the red blood cells are separated and this plasma is used to extract the rich platelets. Finally, these platelets are injected into the fat skin layer, which would then cause improved collagen secretion and help in improving the health of the skin. The entire process takes about 45 minutes of time.

Numerous body and facial areas can be treated with the help of this treatment. Few such body parts may include the following:

1. Orbital rim around eyes
2. Crepey skin on the neck
3. Cheeks and midface
4. Back of hands etc.

Benefits of PRP

1. Helps in skin rejuvenation and tissue regeneration
2. Is entirely hygienic and non-allergic
3. Eliminates the transmission of sexually transmitted diseases from other individuals, as the process includes using the blood of the client himself / herself

A lot of individuals ask about the time it takes for the rejuvenation phase. Well, the whole process takes about six weeks. However, the time span is also dependent upon the skin condition of the individuals. The skin that needs lesser work would obviously require lesser time to heal completely. Also, these treatments last about 18 months and yet again the lasting process may be dependent on how well the skin is being taken care of.

Setback
The platelet-rich plasma injections are widely used and have been proven to give amazing results. However, the safety of the procedure has not really been clinically studied yet. Cases of PRP injections going wrong have rarely occurred. However, further clinical studies are required to prove that this treatment is not only effective, but is also super safe. If you wish to discuss about any specific problem, you can ask a free question.

Your skin is one of the most important organs of your body both healthwise and cosmetically. Dry skin is a common skin ailment that causes dry, itchy patches and leads to skin flaking off. This is characterised by the lack of water in the epidermis and can affect men and women equally. There is no single cause for dry skin. The top five causes of dry skin are:

1. Harsh soaps: Soap is a must to keep your skin clean, but the right soap can make a big difference in the quality of your skin. Many soaps tend to rid the skin of moisture and natural oils leaving the skin dry and flaky. This also applies to many shampoos. Ideally, pick a fragrance free soap and shampoo that moisturises your skin and avoid products that are alcohol based. Also, do not use excessive soap while bathing and ensure that the soap is properly removed.
2. Change in weather: Winter is the season for dry skin. Along with the temperature, humidity levels also drop in this season. This dehydrates the skin and leaves it dry. Increasing the temperature will not help in such cases as that will further dehydrate the skin. Instead, invest in a humidifier to increase the humidity levels indoors.
3. Dehydration: Your skin needs water both internally and externally to stay hydrated. To have soft, supple skin, you should drink at least 8-10 glasses of water a day. While this is easy in the summers when the heat makes you feel thirsty, it gets difficult in the monsoons and winters. Caffeinated drinks also soak up moisture and contribute to dehydration.
4. Exposure to hot water and steam: Keeping the above points in mind it might seem that a long steamy shower is a solution to dry skin but in reality, this can worsen the condition. While steam and hot water provide temporary relief, they make it easier for the natural oils in our skin to dry out. Hence, it is best to have a shower with lukewarm water and keep it as short as possible.
5. Internal conditions: Internal factors such as genetics, medical conditions like thyroid and atopic dermatitis can also make your skin dry. Dry skin can also develop as a side effect to medication for high blood pressure, cholesterol, acne etc. Age also affects the quality of your skin. As you get older, your skin gets thinner and is more prone to drying up easily. If you wish to discuss any specific problem, you can consult a doctor.

Hair are an indispensable part of one’s aura and personality. To have thick and voluminous hair adds so much to one’s beauty. It defines one’s image and confidence. Baldness, losing and thinning of hair is of great concern for both men and women. In a stressful and competitive world like ours, people start losing hair at very young age. This is often attributed to our lifestyle, environmental pollution, inadequate sleep, excessive smoking and drinking. Losing hair is depressing as it is a sign of ageing. The cosmetic market today is flooded with products; be it hair fall control shampoos, serums, conditioners or hair masks. Many Ayurvedic remedies are also available for users to try.

However, the truth is nothing offers a tangible permanent solution than a surgery. However, Surgery comes with a host of side effects and is neither advisable nor affordable. Thus, the question is; whether there is any hope for people who want to regain their hair? Well, Aesthetic Medicine is undertaking lots of research on a possible cure for this condition. Recent Research suggests that adult stem cells have the ability to produce different stem cells, thus cells from hair follicles can be utilised to stimulate hair growth. One such research at the University of Pennsylvania, January 2014 described a method to convert adult cells into epithelial stem cells, responsible for hair growth. Many such studies on adult stem cells are underway.

Stem cells are tiny microscopic cells responsible for repair and regeneration of aged and damaged tissues. By now, everyone knows the amazing benefits of stem cells from umbilical cord, thanks to the Stem Cell Banking concept. The good news is that ongoing research on Stem Cells as a non-surgical way to treat baldness now offers a ray of hope for people suffering from hair loss issues.

Stem Cell treatment helps regeneration of damaged hair follicles thus, promoting hair growth. The procedure is simple and painless. It has minimal side effects and requires no hospitalisation. The live hair follicles from the patient’s hair are used to harvest stem cells. The processed stem cells are then carefully and slowly injected into balding areas with the help of very fine needles. Local anaesthesia is used to avoid any pain or discomfort.

Results in the form of visible hair growth, as well as improvement in density and thickness, are visible within a month. Stem Cell treatment is undoubtedly one of the advanced treatments for hair loss available today. Many clinics/ hospitals are now beginning to offer stem cell therapy for hair loss treatment. However, if hair loss is your concern, It is best to consult an expert, ask a free question and get your scalp examined and be assured of the usefulness of this therapy for yourself before deciding to go for the treatment.

One of the biggest signs of not getting enough sleep is to see dark circles under your eyes. For some people, this can be evident after a single all nighter while for others, it can take a few nights of no sleep for it to become visible. However, sometimes, even when you get sufficient sleep, your eyes don’t look as bright as they should and are shadowed by dark circles. Thus, along with a lack of quality sleep, other factors such as age, genetics and lifestyle also play a role in the development of dark circles.

There are four main types of dark circles categorised on the basis of their colour and appearance.

1. Purple under eye circles: Genetics are largely to blame for purplish under eye circles. This is typically caused by pigmentation and hypersensitivity of your skin to external factors such as UV radiation. Ageing also plays a role in this type of under eye circles. As the skin ages, it becomes thinner, bringing the capillaries to the surface. As these capillaries weaken, blood may leak out to the surrounding tissue leaving behind a purplish shadow. This can be noticed especially in the case of fair-skinned people.
2. Blue under eye circles: Bluish under eye circles are preventable and largely affected by your lifestyle. They are signs of stress, not getting enough sleep, allergies and nasal congestion. These conditions restrict the amount of oxygen in the blood and thus makes capillaries turn from a healthy red to a bluish hue.
3. Brown under eye circles: This is caused due to genetics and over exposure to sunlight which results in hyperpigmentation. These are more commonly seen in medium or dark skin tones and are the most difficult type of under eye circles to treat.
4. Dark shadowy under eye circles: Ageing and drastic weight loss can also contribute towards the development of dark under eye circles. In reality, such dark circles are not caused by a change in skin colour but by the loss of fatty tissue under the eyes. This creates a rift or groove between the eyes and cheek muscles where the eyes cast a shadow.

As with any other health condition, prevention is better than cure when it comes to under eye circles. The best way to treat under eye circles is by getting enough sleep, having a well-balanced diet and following a regular exercise regimen. You could also use an under eye cream to nourish the skin and keep dark circles from appearing. If you wish to discuss about any specific problem, you can ask a free question.

70% of our body is made up of water. This clear fluid is essential not only for a good digestive system, but also for clear, glowing skin. Keeping your skin hydrated by drinking enough water can help prevent a number of skin conditions ranging from acne to dry skin.

1. Ideally, a person should drink 8-10 glasses of water a day to stay hydrated. Since the skin is the last organ to receive water from the digestive system, drinking less water will lead to your skin being dehydrated. These 10 glasses of water should be spaced out evenly through the day. This is because the body can absorb a limited amount of water at a time.
2. The skin is the largest organ in the human body and is made up of cells and tissues. Like any other cell in the human body, skin cells primarily consist of water. If not hydrated enough these cells will not be able to function optimally. This makes the skin lose its elasticity and turn dry and flaky. Dry skin is more prone to fine lines, wrinkles and other such signs of ageing.
3. Hydrated skin is firm and elastic and thus is less likely to have open pores. The lesser the number of open pores, the fewer the irritants that will enter the skin and hence the lower your chance of having pimples and blemishes.
4. Water also balances the oil levels in the skin. Too little oil can make the skin dry while too much oil can cover the skin in a layer and lead to clogged pores. Water helps reduce the concentration of oil in the skin and hence helps prevent breakouts.
5. The food you eat and your digestive health also plays an important role in your skin’s health. Water helps the digestive system move smoothly and flushes out toxins from the body. This keeps irritants that could cause skin ailments at bay.
6. Water also affects the quality and lustre of your hair. Hair soaks up water and moisture from its roots. If not kept hydrated, hair becomes brittle and dry. Lack of water can also affect the rate of hair growth. Drinking enough water is also beneficial in fighting against dandruff and Dermatitis Seborrhea.

Along with keeping your skin hydrated by drinking water, it is also important to hydrate the skin externally. For this, moisturising your skin is crucial. Pick a moisturiser that matches your skin type and see your skin glow. If you wish to discuss about any specific problem, you can consult a doctor.

Chemical peeling is a medical procedure which includes application of a chemical agent to the skin, causing controlled destruction of the epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. In simple words chemical peeling or chemical rejuvenation is procedure where a chemical agent or combination of agents of defined strength are applied the skin causing a controlled destruction of layers of the skin. This is followed by regeneration and remodeling leading to improvement of texture and surface abnormalities. It is a safe, effective and affordable option for improving skin ageing and imperfections.

Skin is considered the largest organ of the body and has many different functions. The skin is divided in two main regions, the epidermis and the dermis. The dermis is attached to an underlying hypodermis also called subcutaneous connective tissue.

Epidermis: It is the most superficial layer of the skin. The first barrier of protection from the invasion of foreign substances. The epidermis is divided into four layers – stratum corneum, stratum granulosum, stratum spinosum and stratum basalis(basal layer).

Dermis: It is composed of fibroblasts which are responsible for secreting collagen, elastin and ground substance that gives support and elasticity to skin. It supplies the epidermis with nutrients and has its role in thermoregulation. The dermis is subdivided into two zones, upper papillary and lower reticular layer.

Classification of peels according to histological depth

1. Very superficial peel – Exfoliation of the stratum cormeum, without any epidermal necrosis.
2. Superficial peel – Destruction of the full epidermis, up to the basal layer
3. Medium peel – Destruction of the epidermis, papillary dermis and upto the upper one third of the reticular dermis.
4. Deep peel – Necrosis of the entire epidermis and papillary dermis with inflammation extending to the mid reticular dermis.

Classification of chemical peeling agents

Very superficial Peel:

• Glycolic Acid 30-50% applied for 1-2 minutes
• TCA* 10% applied as one coat
• Jessner’s solution 1-3 coats

Superficial Peel:

• Glycolic acid 50-70% applied for 2-10 mins (depending on the type and thickness of the skin)
• TCA 10-30%
• Jessner’s solution 4-10 coats
• Very superficial and superficial Peels are the mildest form and often called, “the lunchtime peel.” These peels break down corneocyte adhesion, causing dead skin cells to shed off to reveal the fresh, healthy underlying skin. These peels address minor skin irregularities like discoloration, acne, surface scarring, fine lines, and sun spots.

Medium Peel:

• Glycolic acid 70% applied for 3-30 mins (depending on the type and thickness of the skin)
• TCA 35-50%
• Glycolic Acid 70% plus TCA 35%
• Jessner’s solution plus TCA 35%

Deep Peel:

• Phenol 88%
• Baker Gordon phenol formula
• Medium and deep peels increase the collagen and glycosaminoglycans content, cause collagen remodeling and increase dermal thickness to improve the clinical appearance of the skin with reduced wrinkles, skin tightening and pigmentary dyschromia.

Reason behind chemical peeling:

• Wound healing process is an important reason for rejuvenation. The phases of wound healing after chemical exfoliation are apparent:
• Inflammatory phase (1-5 days) – This phase is evident after peeling as erythma and swelling on the skin
• Proliferative phase (2-21 days) – In superficial peels, the basement membrane is intact, hence normal epidermis is restored in 2 to 3 days. In medium to deep peels, wound is below basement membrane and re-epithelialization takes time.
• Remodeling phase (3 weeks to 2 years) – collagen remodeling is the main reason that chemical peels cause rejuvenation and reduce wrinkles.

Indications for peels:

1. Pigmentary disorders

• Resistant melasma
• Pigmented cosmetic dermatitis
• Freckles
• Lentigines
• Post inflammatory hyperpigmentation

2. Acne

• Comedonal acne
• Post acne scars
• Acne cosmetic
• Acne excoriee

3. Cosmetic

• Photoageing
• Fine wrinkling
• Skin glow and rejuvenation
• Oily to rough skin
• Actinic keratosis

4. Miscellaneous

• Keratosis pilaris
• Macular amyloidosis
• Dilated pores
• Seborrheic keratoses

Contraindications

• Active bacterial, viral and fungal infection and open wounds
• Oral isotretinoin use within the past three months
• Pregnancy and breastfeeding
• History of keloid formation
• History of taking oral contraceptive and photosensitive drugs
• Unrealistic patient expectation
• Uncooperative patient, eg. Patient is careless about sun exposure or application of medicine
• For medium depth and deep peels, history of abnormal scarring, atrophic skin and isotretinoin use in the last six months.

How to choose a patient:

A patient should be chosen depending upon 4P’s:

P – Pathology

P – Point of depth required

P – Patients skin

P – Previous peeling agents

Newer peels:

Many peels like mandelic acid, kojic acid, lactic acid, citric acid and many more have been introduced in the market which are also available in combination. These peels are not only more skin friendly but also more patient friendly. They have buffering agents like licorice extract and willow bark extract to minimize irritation to skin and antioxidants to infuse the skin with restorative nutrients. The change in the skin often occurs at cellular level and are not apparent to the naked hence making it more popular amongst busy patients who are seeking effective treatments quickly with little or no downtime.

Benefits of chemical peels:

The skin becomes noticeably smoother and rejuvenated.

• It reduces pigmentation, improves dull and uneven skin tone, reduces signs of photoagaeing, acne and enlarged pores.
• Removes dead and damaged skin cells and improves skin texture
• Helps in removal of tan
• Skin becomes brighter and more vivid because chemical peels not only cause re-epithelialization of the epidermis but also collagen remodeling.

Pre peel and post peel precautions:

• Patient has to be motivated enough to get multiple sittings of the peel ( 4-8, depending on the indication and type of peel) every 2-3 weekly to get the desired result.
• Patient should not wax, bleach, scrub, shave(the same day) or get any other aesthetic procedure like microdermabrasion, ipl, derma-roller one day before the chemical peel procedure. A gap of at least 7 days before and after the peel should be maintained.
• Patient should use a mild soap/ non soap cleanser after the peel
• Broad spectrum sunscreen and moisturizer should be used liberally, at least 2-3 times a day and sun exposure should be avoided.
• Patient should be strictly prohibited from scratching, picking or scrubbing the skin.

Take home message:

Chemical peeling is a simple office procedure for the treatment of acne, pigmentation, skin rejuvenation and photo ageing. These are not one time procedures but require 6-8 sessions and maintenance peels to achieve maximum improvement and prevent recurrences. The newer peels are safer and effective. If you wish to discuss about any specific problem, you can consult a aesthetic-medicine specialist.