Dr. Munish Paul

Hi!

I am Dr. Manish Paul. I am a Dermatologist, practicing in New Delhi, Dr. Paul's Skin Laser Centre. We are team of 2 dermatologist, 15 more people out here. Our centre equipped here with the latest skin technology including various lasers, machines, surgeries. We are seeing lot of patients with pigmentation. Pigmentation means skin darkening. And we also call it as hyperpigmentation or we can call it as tanning. What is tanning? Tanning is increased pigment in the skin. So, the pigment which is there in the skin can occur in the upper layer of the skin or it can occur in the 2nd layer of the skin. Depending on the skin, the treatment has to be decided. Every patient has to be customized. There is no one treatment which is full proof or which will address the problem of all over patient of pigmentation. So when we see the patient of pigmentation, the first thing is we need to diagnose it.

There might be somebody who has lot of sun exposure. You know who lives outside or his job required to be outside. People want that tan to be removed. So, there are various methods for removing tan. We start all our patients on medical treatments and lifestyle changes i.e. is the most important thing. So, the lifestyle changes, they have to avoid sun. Then to use sunscreen, use scarf, use an umbrella. If you can't avoid sun, we can't get rid of tan. 2nd, patient has to put some skin lightening agents. The skin lightening agents will continue with various creams. The medicines which are given, they are anti-oxidants, which protects us from sunlight and they will prevent sun damage and reduce the tanning.

This works fine when the patient's pigmentation is in the upper layer but it can hamper when the pigmentation is in the dipper layer. In such a situation, basic medicines will not work. But we have another treatment in which various medicines are used in sequence. This treatment comes from California. And Dr. Zein Obagi is the founder of the zein obagi treatment all over the world. So, these medicines are used sequentially. The produce our initial peel effect. Once the peel has occurred, the top skin will be peeled off or exfoliated and then it gives you the younger fresh looking skin. Obagi system can create a very good skin look, glow, it reduces the pore and improves the texture.

They also properly known as the laser tonic or the laser facial. Also, a patient will need 6 sessions which I give once in 3 weeks. It is imperative for all over patients to understand that lifestyle change, medical treatment, laser treatment can take away your tan, can make your skin more even, better, younger looking but it has to be maintained. You can't just do it once and forget it. 2nd thing in few people pigmentation is not just merely a tan, it can be an allergy, you will be surprised that sunscreen can cause it. So, in such patients, we conduct a test. And once you know that you are allergic, you can avoid that. So, the treatment has to be very comprehensive. We have to plan a medical treatment for you. Maybe a chemical peel for you, a laser treatment and the obagi. Putting all these treatments together, we can deliver very good results in all patients.

Thank you so much.

Hi friends!

My name is Dr. Munish Paul. I am a dermatologist practicing in Delhi for the past 18 years now. We have been dealing with a variety of skin diseases starting from allergies, acne, pigmentation, psoriasis and vitligo. We are a team of more than 15 people running the centre for almost 18 to 20 years now. It is a state of art Skin Centre with the latest equipments in terms of hair removal lasers, pigmentation lasers, phototherapy machines, excimer laser. Our main focus of treatment out here is the treatment of vitiligo. Vitligo is also known as a Leucoderma or in common terms we call it as the white patches. So this is a disease in which the patient gets white spots anywhere on the body.

It can start at any age group starting from as early as 1 year to the age of 8 years. Both men and women are equally involved in it and it's a big social concern because these patients of vitligo because of the cosmetic recommend face lot of biasing in the society. They get difficulties in getting a job, they have difficulty getting married, difficulty into getting into some profession. So the treatment is important. The treatment of vitiligo grossly divided into medical, surgical and camouflage. Just to explain to your medical treatment is done when the disease is spreading actively so it is in the form of certain medicines and with the use of phototherapy chambers and excimer lasers. Phototherapy is a device, is a chamber also known as UV-B chamber but in which the patient has to stand after undressing and his skin is given exposure to ultraviolet B rays. The duration of the therapy can vary from 30 seconds to 4 minutes depending on the disease.

Sessions are normally given twice or thrice a week with which the pigmentation start appearing and we see that the area with the patient with vitiligo patches or the white patches are on the black hair respond way faster to the treatment. Now there are some patients which have the very localised disease. In such patients we use the excimer laser that means we do not have to expose the whole body to the phototherapy. Only the localised disease patches can be exposed to the laser light or the UV light. So there is no tanning of the uninvolved skin. With the use of medicines, phototherapy and excimer the patches having black hair will respond. Areas as the fingertips or the lips or areas where the hair have gone white will not respond to any type of medical treatment. So these area are normally treated with surgical method known as Melanocyte transplantation.

Now Melanocyte transplantation is a procedure which is surgical which is done only in patients stable from minimum 1 year. 1 year the patches have not spread anywhere on the body. So in this process it can be done using local anaesthesia or full anaesthesia depending on how much area is involved. Large areas are done under general anaesthesia. So what we do is we take a small bit of skin from the patients own thigh. We trypsinize the sample that means we enzymatically separate all the layers of the skin. Then by filtration method we separate the melanocytes. That's the first step of the process and then the white patch the top layer the epidermis is removed and the cells are implanted. Then it is covered with a dressing which is known as Collagen followed by a gauze and pad.

Dressings and normally left for a week. Once you remove the dressing it looks pink but within three weeks the pigmentation starts. The biggest advantage of the procedure is it gives excellent colour and texture matching and again second advantages with a very small area we can treat a very large area. What we say is the donor recipient ratio that is the area you take from the thigh to the are to be treated is in the ratio 1:10. That means if we take 5 cm of the skin from thigh we can treat 50 cm of the vitligo area. All body parts including face, eyelids, lips, fingertips, trunk, knee, elbows most of the body parts can be treated successfully with this treatment.

Now there are certain patients which will have very very extensive disease where involvement of vitiligo is more than say 50% or 70%. Now in such patient, we cannot really get the pigment back so the choice of treatment is Deep Pigmentation. So what is Deep Pigmentation? Deep Pigmentation is that we remove the remaining brown. So the patient is already white so whatever little bit brown is left that is removed. This is usually done with a laser and certain medicines depending on the site patient might need four to five sessions with which the colour can be made uniform and most patients feel very happy about this treatment. We also have a system of camouflage for the treatment of vitiligo. These are camouflage system or makeup covers which comes in multiple shades and we can help patient match the colour and these can provider extended cover for more than two to three days and they are water resistant. So in patients of vitligo the treatments are very different. The use of medicines phototherapy, excimer, surgical processes, camouflage systems we can manage a vitiligo patient much better. We are totally committed and dedicated to all our patients to treat Vitligo.

Thank you so much!