Introduction 

The common male problem in an Aesthetic clinic, Gyanecomastia, is truly Pseudogynaecomastia with only fatty tissue and minimal glandular tissue. The condition is a part of the co existing Obesity disorder and is rarely, a standalone entity. The treatment options shall include an approach to answer the issue of obesity as a whole, not rest contented with surgical removal of the enlarged breasts alone. What is seen and what is treated is just a tip of the iceberg. 

Gynaecomastia, an innocuous condition, that affects 35-70% of male population immediately after birth, during adolescence and old age is rarely brought to notice as the sufferer makes all attempts to hide it as the condition brings with it a sense of shame and pain in public places and mental suffering. Herein starts the search for the treatment. Medical and multifaceted surgical options evolved over centuries with the current opinion being fat removal by anyone form of liposuction and the gland removal by direct excision. Gynaecomastia, is increased breast tissue in males composed of glandular and fatty tissue. 

Physiological gynaecomastia of puberty that normally regresses with age tend to stay back being sustained by the modern lifestyle changes. Processed foods and environmental pollution of air and water, the cosmetics used on the body like deo odorants, perfumes and toiletries, synthetics and chemicals have contributed to explosions of generalised obesity. With this generalised obesity, the tendency to hold back excess fat in the breast developed. This clearly shows the reason for higher incidence of (pseudo) Gynaecomastia of late. Hormonal imbalance due to reasons stated above, aggravate the situation. Gynaecomastia is part of the generalised obesity and it is more fat and little gland. 
However, this condition does not have any harmful effect on the body, but it can cause distress emotionally. Men may lose their self-confidence and they can be psychologically affected by this.

What Causes Gynaecomastia?

It is a type of hormonal imbalance that results in the growth of the male breast tissues. The ratio of oestrogen v/s androgens gets altered and causes the enlargement of the breasts. For this condition to occur, the amount of oestrogen increase in the body, or the amount of testosterone drops. Sometimes it can be the combination of both.

There are certain diseases that may contribute to gynaecomastia and they are as follows:

Kidney diseases

Liver disease

Drop in testosterone levels

Certain medications such as methadone, medications for HIV or treating prostate cancer

Certain tumours caused in male sex organs such as cancer of the Leydig cells or the Sertoli cells resulting in deprivation of androgen levels

Conclusion: 
True Gynaecomastia that requires surgical treatment is not so uncommon. What is commonly believed to be gynaecomastia is truly Pseudo gynaecomastia with a co exiting clinical picture of obesity, high BMI, sedentary life and wrong lifestyle. Surgical treatment by laser liposuction under Tumescent Anaesthesia gives very good results with high patient satisfaction and negligible post operative complications. Gland fragmented with laser can be extricated thro  same entry point without sub areolar incision.

Gynaecomastia (Enlarged Breasts In Men): Causes and Treatments

Hives, or  Urticaria  in medical parlance, is a skin condition characterized by the appearance of itchy swellings on the skin surface. Hives may break out on any part of your body and can be of different sizes. It is not a prolonged condition and generally lasts for a few hours. Urticaria or hives usually occur due to the secretion of certain chemical substances such as  histamine  from underneath the skin surface.

Some of the possible causes of hives are mentioned below:

Overexposure to sunlight
As a side effect of medicines such as aspirin, painkillers or antibiotics.
Insect bites
Any food related allergy may also trigger hives
People allergic to certain chemicals or latex can also develop hives
Sensitivity to temperature or water can cause hives
Infections such as Hepatitis or chronic diseases such as thyroid may result in the occurrence of hives.
Alcohol or caffeine intake can cause chronic urticaria
The most common symptoms of Hives include:

Skin becomes swollen
Frequent itching sensation
Skin inflammation is also common
You may feel a burning sensation
Within a short span of time, it may disappear and then again reappear on different parts of the body
Red and white patches appear all over the skin surface known as  wheals 
Hives generally go untreated as the condition subsides within a few hours. But sometimes, hives can be chronic or acute in nature. If so, it would require treatment as it can give rise to further complications. Some of the treatment methods are given below:

Corticosteroids may be prescribed by the doctor to control the formation of hives and give relief from inflammation.
Antihistamines (drugs which hinder the impacts of histamines; mainly used for curing allergies) are advised to patients with chronic urticaria. It controls the effects caused due to the discharge of histamines.
Knowing and avoiding the trigger conditions may prove to be helpful.
Applying menthol creams can give comfort due to its cooling properties.

Hives - Causes, Symptoms & Treatments

Hypothyroidism is a condition in which the thyroid gland is not producing the thyroid hormones adequately. This is a fairly common condition.

What is thyroid gland?

The thyroid gland is a small butterfly-shaped gland located just below Adam s apple. It encircles the windpipe or the trachea. It is about 4 cms in height and weighs about 18 gms. This gland is responsible for the secretion of thyroid hormones. Hormones are chemicals produced by special glands like thyroid, adrenals, ovaries etc. They act as messengers and are carried by the blood to the various target organs.

What are the hormones produced by thyroid gland and what do they do?

The thyroid hormones are of two types   T3 (Tri iodo thyronine) and T4 (Thyroxine). These hormones are mainly responsible for the body s metabolism - a process in which food is converted into energy in the cells. They influence growth and development and regulate various bodily functions which are mentioned below:

Heartbeat
Body temperature
Breathing
Body weight
Metabolism of fat
Menstrual cycles in females
Functioning of Nervous system
Digestion
Burning calories etc.
What is Hypothyroidism?

Inadequate production of hormones by the thyroid gland is termed as hypothyroidism. This is also called Underactive thyroid state. Hypothyroidism can make the body s development to slow down and reduces metabolism rates.

What are the causes of Hypothyroidism?

Hypothyroidism can be caused by a number of factors:

Hashimoto's thyroiditis: This is the commonest cause. This is an autoimmune disorder (normally body s defence system fight against external infections. In autoimmune disorder the defence system attacks the healthy cells of the body by mistake). In Hashimoto s thyroiditis the immune system/defence system produces antibodies that attack the thyroid gland and destroy it.
Iodine deficiency in diet. For the production of thyroid hormones iodine is very important. The body does not produce iodine normally, so it needs to be supplemented from outside. Iodine is mainly present in the food we eat. It is mainly present in shellfish, salt-water fish, eggs, dairy products. If a person does not eat iodine rich foods, he may end up with iodine deficiency leading to hypothyroidism. Currently, this causative factor is on the decline due to government initiative of table salt with iodine.
Surgery: Surgery to remove thyroid gland (for e.g. thyroid cancer treatment, overactive thyroid etc.)
Radiation to the neck (to treat cancer in the neck area): The thyroid gland cells are damaged due to the radiation.
Treatment with radioactive iodine: This treatment is used for managing hyperthyroidism/overactive thyroid, where the thyroid gland produces excessive thyroid hormones. One of the treatment modalities is by radioactive iodine. Sometimes this radiotherapy destroys normal functioning cells which lead to hypothyroidism.
Certain medicines: Certain medicines used to treat heart conditions, cancer, psychiatric conditions etc.   for e.g. amiodarone, lithium, interleukin-2, interferon-alpha.
Pregnancy: Pregnancy (the reason is unclear but it has been noticed that the thyroid may get inflamed after delivery   this is called Postpartum thyroiditis.
Damage to the pituitary gland: Pituitary gland is a gland which is present in the brain. It produces a hormone called TSH (Thyroxine-Stimulating hormone).The TSH tells the thyroid gland how much thyroid hormone it should make. If the levels of thyroid hormone in the blood are low, then the TSH will stimulate the thyroid gland to produce more Thyroid hormone.
Hypothalamus disorders: This is an organ in the brain. This produces a hormone called TRH (Thyrotropin Releasing Hormone) which acts on the Pituitary gland to secrete TSH. So any disorder of Pituitary gland will indirectly effect the production and secretion of Thyroid hormones. These are very rare disorders.
Congenital thyroid defects: Some babies are born with thyroid problems. This is due to the thyroid not being developed normally during pregnancy. Sometimes the thyroid gland does not function normal. This can be identified by screening for thyroid disorders in the first week after delivery. This is usually by a blood test using a small drop of blood from the baby s heel.
What are the different types of hypothyroidism?

One classification is based on whether the defect is with the thyroid gland or not:

Primary hypothyroidism: The problem is in the thyroid gland itself and thus there is reduced production /secretion of thyroid hormones.
Secondary hypothyroidism: Here the problem is with the Pituitary gland or the Hypothalamus. This results in abnormal production of TSH or TRH, which indirectly leads to less production and secretion of thyroid hormones.
Another classification is based on the symptoms and levels of the thyroid hormones and TSH:

Overt hypothyroidism: Here the patient is having the symptoms. Further the T3/T4 are low and TSH is high
Subclinical hypothyroidism: Here patient may or may not have symptoms. The T3/T4 levels are normal but TSH is high. In this situation the patient is at an increased risk of developing overt hypothyroidism in the future especially if he has Thyroid peroxidase antibodies on testing.
Who are at risk of developing Hypothyroidism?

Women have a higher risk of suffering from hypothyroidism than men.
Older people are at increased risk.
People suffering from other autoimmune diseases like Coeliac disease, Type-1 Diabetes Mellitus, Vitiligo, Pernicious anemia, Multiple sclerosis, Rheumatoid arthritis, Addison s disease etc.
People with psychiatric conditions such as bipolar disorder
People with Chromosomal abnormalities like Down syndrome, Turners syndrome also have a high risk of suffering from hypothyroidism.
What are the symptoms of hypothyroidism?

Symptoms vary from person to person. They may also mimic other conditions and hence be difficult to diagnose. Symptoms may also develop very slowly over a span of moths-years. Some of the characteristic symptoms of this disease are:

Depression
Constipation
Hair loss
Dry hair
Dryness of the skin
Tiredness
Body pains
Fluid retention in the body
Irregular menstrual cycle
Increased sensitivity to cold
Reduced heart rate
Increase in size of the thyroid gland   called Goitre. This is due to constant stimulation of the thyroid gland by TSH.
Weight gain
Carpal tunnel syndrome
Hoarse voice
Infertility
Loss of libido/sex drive
Confusion or memory problems especially in the elderly
What are the symptoms to look for in a baby if you suspect hypothyroidism?

Infants suffering from congenital hypothyroidism may show no symptoms or exhibit signs of excessive drowsiness, cold hands, cold feet, constipation, hoarse cry, poor growth or absent growth, poor appetite, bloating of abdomen, puffiness of face, swollen tongue, persistent jaundice.

How to diagnose hypothyroidism?

Blood tests:

TSH: This hormone is made in the pituitary gland and it stimulates the thyroid gland to produce thyroxine. If the thyroxine levels are low in the blood, the pituitary gland produces and secretes more TSH into the blood to act on the thyroid gland to produce more thyroxine. A raised TSH level indicates hypothyroidism. Other tests are not usually necessary unless a rare cause of hypothyroidism.
T4: A low level of thyroxine indicates hypothyroidism.
T3: these levels are generally not needed to diagnose hypothyroidism
Anti-Thyroid peroxidase antibodies (anti-TPO antibodies) or Anti- thyroglobulin antibodies are present in 90-95% of patient with autoimmune thyroiditis.
Other blood tests include Creatinine Kinase, Serum Lipids, Complete blood picture etc.
Ultrasound of the neck is done if the patient presents with a thyroid swelling.
What is the treatment of hypothyroidism?

Overt hypothyroidism is treated by synthetic Thyroxin hormone which should be taken every day on an empty stomach at least 30   45 minutes before breakfast. The treatment is continued for the rest of the patient s life. Regular thyroid function tests are done once every 8 weeks-12 weeks to adjust the dose of the thyroxine in the initial period of diagnosis. Once the thyroxine dose is stabilised, the tests can be done even once a year. This treatment is quite effective.

Sub-clinical hypothyroidism is only treated if the patient is a woman and is contemplating pregnancy, in patients with symptoms or if the TSH is quite high.

What are the side-effects of thyroxine medication?

There are few side effects if any. Most people tolerate these medications quite well. An important consideration before starting medication is to check if the patient has chest pain/angina. These people are started on the least available dose. If these patients are started on a higher dose they notice a worsening of their angina pains.

Side effects mainly occur if the thyroxine dose is high which leads to hyperthyroidism. The symptoms of this could be palpitations 9increased heart beat), weight loss, profuse sweating, anxiety, irritability etc.

There are some tablets which increase with thyroxine tablets. These include carbamazepine, iron supplements, calcium supplements, rifampicin, phenytoin, warfarin etc.

What are the complications of hypothyroidism?

If untreated hypothyroidism can lead to:

heart problems like heart attack due to increased levels of bad cholesterol like LDL, or heart failure due to fluid retention
obesity
infertility
joint pains
depression
A pregnant woman with hypothyroidism is at increased risk of giving birth to a baby with congenital hypothyroidism, also known as cretinism. Further, the woman may have pregnancy related complications like pre-eclampsia, premature delivery, low birth weight baby, anemia, post-partum haemorrhage (bleeding after delivery) etc.
Myxoedema is another complication where the patient has extremely low levels of thyroid hormone. The body temperature drops drastically making the person lose consciousness or go into a coma.
References:

2013 ETA Guideline: Management of Subclinical Hypothyroidism; European Thyroid Association (Nov 2013)
Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee; British Thyroid Association (2015)
The diagnosis and management of primary hypothyroidism; Royal College of Physicians and others (June 2011)
Suh S, Kim DK; Subclinical Hypothyroidism and Cardiovascular Disease. Endocrinology Metabolism (Seoul). 2015 Aug 4.
UK Guidelines for the Use of Thyroid Function Tests; British Thyroid Association (2006)
Gaitonde DY, Rowley KD, Sweeney LB; Hypothyroidism: an update. American Family Physician. 2012 Aug 1 86(3):244-51.
Bindra A, Braunstein GD; Thyroiditis. American Family Physician. 2006 May 15 73(10):1769-76.
Wilson GR, Curry RW Jr; Subclinical thyroid disease. American Family Physician. 2005 Oct 15 72(8):1517-24.
British National Formulary; NICE Evidence Services (UK access only)
Baumgartner C, Blum MR, Rodondi N; Subclinical hypothyroidism: summary of evidence in 2014. Swiss Medical Weekly. 2014 Dec 23 144:w14058. doi: 10.4414/smw.2014.14058. eCollection 2014.

Know Everything About Hypothyroidism

Soft growth occurring on the genitals are known as Genital Warts. Genital warts are infections that are transmitted through physical intimacy (STI). These are caused by certain behaviours of the human papillomavirus (HPV). These growths on the skin cause discomfort, pain and itching. They are particularly harmful for women since certain types of HPV might also cause cancer of the vulva and cervix. HPV is one of the most common sexually transmitted diseases. Due to this, sexually active people are most vulnerable to various health complications, including genital warts. Prevention of this infection requires essential protection and treatment.

Symptoms:

Transmission of genital warts occurs through sexual activity. Development of warts occurs several weeks after the infection. Sometimes, it is not possible to view them with the naked eye. The top of the growths might resemble a cauliflower and might feel slightly bumpy or smooth while touching. The person who is infected may have a single wart or a cluster of warts.

In males, the genital warts may appear in the following regions.

Groin
Scrotum
Penis
Thighs
Inside or around the anus
In females, they might occur in:

Cervix
Outside the vagina or anus
Inside the vagina or anus
In a case where the person has had oral sexual contact with the infected person, the genital warts might appear on the mouth, lips, throat or tongue of the person. In case the genital warts are not visible, the other related symptoms include:

Itching
Vaginal Discharge
Bleeding
Burning
Treatment

Even though the genital warts disappear with time, it is not possible to eliminate the virus once it is in the bloodstream. This would result in several outbreaks during the entire course of life. This is a vital reason why the symptoms should be managed so that transmission of the disease is prevented. Treatment is possible only for relieving symptoms that are painful or for minimizing their appearance. Some topical wart treatments prescribed by the doctor may include:

Podofilox and Podophyllin (Condylox)
Trichloroacetic Acid (TCA)
Imiquimod (Aldara)
Some surgeries that the physician might conduct to remove genital warts that do not disappear with time include:

Interferon injections
Laser treatments
Cryosurgery, or freezing warts
Electrocautery, or burning warts with electric currents
Excision, or cutting off warts
Periodic Pap smears after the initial treatment is recommended for women with genital warts to monitor changes in the cervix.

Genital Warts - Can They be Treated? 

One of the most important functions of the skin is protection. During this process, it comes in contact with various substances including chemicals, pollen, dust, and other pollutants. While it does protect the overall body from all these, there is some damage that is inevitably done to the skin through these exposures. Different skin and different bodies react differently to these, and while some may have no reaction, others develop allergies. This is also defined by how strong the person s immunity is.

Hives is one of the most common skin allergy responses. While it is not easy to pinpoint what causes the allergy or the hives, the causative agent can be nailed by observing patterns and excluding out some of the causative agents. There are a set of regular household and surrounding items that could lead to urticaria, and working around these can help pin down the source.

Origin: When the body encounters a foreign body, it produces what are known as histamines. When they are produced, the plasma in the cell leaks out, producing a red and swollen appearance. Hives are red, itchy, raised patches on the skin. They are seen in about 20% of the population. Hives are usually allergic in nature, implying that they occur when there is a foreign substance that induces an allergic reaction. Hives can appear either due to coming in touch with some substance or due to eating some allergy-inducing substance.

Hives can be acute or chronic. Acute is when the hives appear in response to an allergic reaction. These usually disappear in a matter of days to a week at the maximum. In some people, they could be chronic and can last for months together.

Treatment: Given that they are allergic in nature, managing hives includes a combination of immediate treatment as well as preventive measures. While most are topically managed, others might require systemic intervention also.

Once the hives have developed, the following can help in the relief of symptoms and prevent from spreading further. The redness and swelling will take some time to disappear.

Avoid tight-fitting clothes
Use cool compresses on the hives
Avoid warm or hot shower
Stay in a cooler room
Avoid itching the hives
Use topical moisturizer to prevent dryness
Use topical steroid cream to manage the inflammation
Take a systemic antihistamine or an injection of epinephrine if required.
While these help in managing the hives which have occurred, preventing is via the following.

Avoid the source once identified
If the source is not yet known, record when the hives are occurring
Manage stress and see hives appear much less
Increase moisturizer use
Keep an antihistamine handy so you can take it immediately in case of suspected hives. 

Urticaria (Hives) - The Best Way It Can Be Treated!

Eczema is a common chronic skin condition, which is characterized by skin inflammation and irritation. The most prevalent type of eczema is Atopic dermatitis. It is not a communicable disease and is usually caused, owing to immunological alterations within the body. Eczema can be cured if the persistent immunological disturbances get corrected by internal medications like homeopathy treatment, which is known for providing safe and effective treatment. The presence of red, inflamed and itchy skin can trigger psychosocial and emotional stress in the patients suffering from eczema and can become a dominant cause of severe discomfort.

Homeopathy treatment for eczema
In homeopathy, Eczema is considered as an external demonstration of an internal disease; it requires internal and deep cleansing to tackle the problem effectively. The treatment of eczema begins with the assessment of initial symptoms in order to identify the root causes of the disorder effectively.

The fundamental characteristic of homeopathy treatment is that it targets:
1.  Genetic components
2.  Coping mechanism with sentimental triggers

Major advantages of homeopathy include:
1.  It treats the disturbances of immune system and treats the roots of this disease
2.  In most of the cases its effects are long lasting
3.  It is non-toxic and causes zero side effects

The following are effective homeopathic remedies to treat eczema:
1.  Excessive itching: Sulphur is a Natural Homeopathic medicine, which is considered one of the most effective remedies for eczema. It provides instant relief from burning sensation and excessive itching. It is also beneficial in the case of eczema that has worsened due to the indiscriminate usage of external ointments.

2.  Weeping type of eczema: Graphite is an effective homeopathic medication that treats the weeping type of eczema that usually occurs between fingers or toes, behind the ears and scalp. It provides effective relief from eczematous eruptions that discharge sticky fluid and eczema that develops on eyelids.

3.  Dry eczema in knees joints and bents of elbow: Sepia officinalis is an ideal homeopathic remedy for eczema in knees and bends of elbow. It provides relief from severe scratching that occurs due to dry skin.

4.  Gastric or urinary trouble: Lycopodium clavatum is an effective remedy for patients suffering from some sort of urinary or gastric trouble. It is also known to provide effective relief from severe itching and bleeding resulting from eczematous eruptions. It also provides relief in cases of deep fissures and hardening of skin.

How to Best Manage Eczema With Homeopathy

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