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Book Clinic Appointment with Dr. Poonam Ravindra Patil
Treatment Of Acne/Pimples
Treatment of Hair Fall
Treatment of Hair Loss
Treatment of Female Hair Loss
Treatment of Dandruff
Treatment of Greying Hair
Treatment of Black Spots on Skin
Treatment of Hair Growth
Skin Whitening Procedures
Treatment Of Acne Scars
Treatment of Oily Skin
Treatment of Rashes
Glowing Skin Procedures
Management of Dark Skin
Hair Health Treatment Procedures
Treatment of Baldness
Treatment of Vitiligo
Treatment of Ichthyosis Vulgaris
Treatment of Sunburn
Laser Hair Removal
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Patient Review Highlights
I found the answers provided by the Dr. Poonam Ravindra Patil to be very helpful. Thank youu
Dr. Poonam Patil provides answers that are very helpful, helped improved my acne problem , professional, practical and knowledgeable. Thank you ma'am.
Doctor had explained causes of acne in detail. Advised Do's and Don't's. Her knowledge is very good. Thank you
" please be gentle with your body. It loves you more than anyone or anything in this world. It fixes every cut, every wound, every broken bone, fights off so many illnesses, sometimes without you even knowing about it. Even when you punish it, it is still there for you, struggling to keep you alive, keep you breathing. Your body is an ocean full of love. So please be kind to it. It's doing the very best it can"
Psoriasis is an immunologically mediated genetic disease affecting 0.5% - 1.5% of individuals worldwide. Psoriasis in children is more frequently precipitated by infections, physical and psychological trauma.
Clinical features in childhood psoriasis:
• more pruritic
• preponderance in girls
• lesions are relatively thinner, softer and less scaly
• plaque type more common but clinical variants are rare
• frequency of remissions are greater in paediatric onset psoriasis
• psoriasis in infants - starts in napkin area.
• flexural psoriasis- manifests in genital and per umbilical areas.
• pustular psoriasis is rare in childhood.
• psoriatic arthritis is uncommon. Nail involvement is observed in 1/3rd of patients.
• palms and soles involvement is uncommon.
Types of peel:
1. Superficial peels: penetrates only the epidermis, can be used to enhance treatment for a variety of conditions, including acne, melasma, dyschromias, photo damage, and actinic keratosis. Epidermal regeneration can be expected within 3-5days. Helps in achieving skin radiance & luminosity. Good method for rejuvenation.
2. Medium depth peels: penetrating to the papillary dermis, may be used for dyschromias, solar keratoses, superficial scars & pigmentary disorders. Healing process is longer. Epithelialization occurs in 1 week
3. Deep peels: affecting reticular dermis, may be used for severe photo aging, deep wrinkles or scars. Epithelialization occurs in 5-10 days
- chemical peels are used to create an injury of a specific skin depth with the goal of stimulating new skin growth & improving surface texture & appearance.
- the exfoliation effect of chemical peels stimulates new epidermal growth & collagen with more evenly distributed melanin.
- chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation & removal of superficial lesions, followed by regeneration & new epidermal & dermal tissues.
- chemical peeling is a popular, relatively inexpensive, and generally safe method for treatment of some skin disorders and to refresh & rejuvenate skin.
1. Myth: acne only happens to teenagers
Fact: an estimated 80% of all people between the ages of 11 to 30 years have acne outbreaks at some point. Some people in their 40s and 50s still get acne.
2. Myth: popping pimples is effective in eliminating acne
Fact: people who squeeze, pinch or pick at their pimples are more likely to get scars & dark spots on their skin.
3. Myth: washing skin vigorously clears up acne
Fact: gentle washing is more effective way to clear acne as hard scrubbing can irritate your skin and make acne worse.
4. Myth: you just have to let acne run its course there is no treatment
Fact: there is no reason anyone should live with significant acne. Most can be treated over time & boost a patient’s self esteem.
5. Myth: acne scars are forever
Q: how does resistance occur?
A: resistance occurs when the fungus adapts itself to the fungistatic/ fungicidal agent being used through some intrinsic genetic/ biochemical mechanisms.
1. Resistance to topical and systemic antifungals:
Q: when can we say that the patient has developed resistance to a particular agent?
A: in common practice, we can presume that the patient has become resistant to the topical/ systemic drug when after 2-4 weeks of consistent and correct use, there is no clinically apparent or symptomatic improvement.
In practice, it develops as a consequence of
• incorrect/ inconsistent use by the patient
• rampant abuse of antifungals by patient/ medical practitioners
• many over the counter preparations especially in india comprise a cocktail of unnecessary drugs, which modifies the growth of the fungus, causing it to temporarily cease its metabolic activity/ reproduction, but thereafter a resurgence occurs leading to undue and aggressive fungal growth.
• an infection with a drug-resistant species of fungus, in which case patient does not show the slightest sign of clinical improvement and it maybe advisable to consider doing a fungal culture/ sensitivity.
Q: how can resistance be prevented?
A: on the part of treating doctor:
- the dermatologist should always start prescribing from the basic/ lower antifungal molecule. Just as in case of antibiotics we start from azithromycin /amoxicillin, likewise we need to start from the lower molecule and then move up the ladder if we feel the former is not working, rather than directly prescribing the" latest molecule in the market.
- explain the correct usage of the drug to the patient in detail.
> Topical drug should to be applied 1cm beyond the visible margins of lesions
> Dusting powder is particularly advixsed in intertriginous areas
> Treatment regimens should last at least 1month for extensive lesions.
> Topicals should be applied at least 2 weeks beyond clinical resolution
> Follow-up is quite important
- impress upon the patient the need for correct usage/dangers of incorrect usage.
On part of the patient:
- strict adherence to the treatment regimen is advised
- non-usage of any other concurrent medications that he/she might have" used earlier" and" got relief"
- it is advisable to go to a dermatologist.
Q: once it occurs, how to deal with resistance?
A: the ideal solution in the management of resistance is to acquire a confirmation microbiologically. But in case that is not possible, following methods can be used:
- avoid monotherapy, that is, combine a topical and systemic antifungal concurrently
- both should preferably belong to different classes of drugs, so that if resistance occurs to one class of drugs, the other still works.
Prescribe soaps/ dusting powder for extensive lesions/ recurrent cases
- priscribing combination drugs should be avoided.
Varied/ not so classical presentation of lesions:
- many a times, the varied/unpredictable presentations of superficial dermatomycosis pose a diagnostic challenge to the dermatologist
- unusual/atypical infections are particularly common in following settings:
• patients has been treated by multiple doctors previously, including non dermatologist
• use/abuse of over the counter drugs especially steriod containing medications
- differential diagnosis to be kept in the mind while considering a patient of tinea:
• granuloma annulare
• inverse psoriasis
• erythema annulare centrifugum
• contact dermatitis
• frictional dermatitis
• atopic dermatitis
- diagnosis and management become a difficult task and one has to treat with great caution.
Recurrence/relapses despite completion of antifungal regimen/ complete compliance by patient:
What we should not do?
- prescribe yet another antifungal regimen
- add an oral antibiotic and continue both regimens for a longer time period (1 month instead of previously recommended 2 weeks)
- add a potent topical steroid to" counter the inflammation"
What we should do?
- check the compliance of the patient by taking a detailed history of usage of medications
- check for any underlying co-morbidities that might be predisposing the patient for recurrence, eg, rule out diabetes, obesity, type of occupation (involving working in hot humid conditions, like cooking, working in factories), any underlying immunosuppressed states
- check for personal habits (frequency of bathing and use of fresh clean clothes, practice of personal hygiene, patient's surroundings)
- check for family history of similar complaints and advice for concurrent treatment of other members if they have similar complaints
- check for any concurrent medications which might be causing reduced efficacy of the antifungal regimen due to potential drug interactions
- explain inter-personal transmission by fomites, advice patient to use separate towels, soaps, clothes
- educate and counsel patient to stop using over the counter medications for the" ring worm"
- advise patients to be particularly careful during the hot/humid summer/monsoon seasons as fungal infections are on the rise during the said time periods.
Carbon laser peeling is so called hollywood peel. It is gradually growing in india because of its zero downtime and instant results. Carbon laser peel is a laser procedure that uses a carbon layer as a photo - enhancer to improve the skin's radiance and promotes a smooth and glowing complexion. This treatment is used to target active acne as carbon powder penetrates into pores, thus allowing the laser to focus it's energy more effectively. It also helps refine enlarged pores to reduce oil secretion, remove open comedones and achieve whitening effects.
mechanism of action:
Laser energy lightly absorbs carbon particles, heating dermis which results in stimulating the building up of collagen leading to tightening and younger looking skin and lightly ablating the top layer of epidermis. Laser energy breaks up pigment that is carried away by blood vessels and lightening effect is achieved. It has bactericidal effect on propionibacterium acnes and decreases the size of sebaceous glands so a favourable response is seen in acne prone patients.
• enlarged or dilated pores
• presence of fine lines
• oily and acne prone skin
• dull complexion or dyschromia
• acute or chronic inflammatory dermatoses
• history of keloidal tendency
1. Cleansing: it is done with a mild cleanser so as to remove any oil, dirt and makeup and apply eye protective sheild.
2. Carbon paste application:
Then a uniform layer of medicated carbon paste is applied over the area to be treated. Then dab it with a cotton pad so as to remove excess of carbon.
3. Laser pass:
We use q - switched nd-yag 1320nm at maximum fluence tolerable to patient as it should not hurt throughout the procedure. The pass is given without overlapping. The carbon particles are absorbed by laser and leave skin refreshed and toned.
4. Cleaning: the remaining carbon particles, if anywhere, should be cleaned with micelle solution and a layer of vitamin c and hyaluronic acid serum is applied followed by sunscreen.
• avoid sun and sauna bath for 7 days
• use moisturiser and sunscreen on a regular basis.
• maintain hydration
• erythema and transient swelling which may be present for few hours and can be managed well with ice packs
• post inflammatory hyperpigmentation may also occur
• laser burn is quite rare
Even after single session, smooth and even skin is noticed. For ideal results, 5-6 sessions at interval of 2-3 weeks are advised for other indications.