To help prevent skin problems from developing under your mask, skin specialists recommend these 10 tips.

Wear the right mask.

Look for the following when choosing a mask that is right for you.

• A close-fitting, but comfortable fit.
• Soft, natural, and breathable fabric, such as cotton.
• The fabric on the inside should be soft if you have sensitive skin.
• Cotton material inside if you have acne or oily skin.

Wearing a mask that offers a snug fit helps to protect you and others from the coronavirus but it should be comfortable at the same time. You want a snug fit across your nose, on the sides, and under your chin. A mask can irritate your skin if it is too tight or slides around the face. You are also more likely to repeatedly adjust a poorly fitting mask and when you touch your mask, you can transfer germs to your mask and face.

Avoid synthetic fabrics, such as nylon, polyester, and rayon as they are more likely to irritate your skin and cause breakouts.

Stop behind-the-ear soreness: You can find masks with different types of ties and ear loops or get them separately and wear a different type each day to see what suits you best.

Follow a gentle skin care routine.

Wearing a mask can be hard on your skin. Gentle skincare can prevent your mask from causing skin problems. When washing your face, use a mild, fragrance-free cleanser.

Dr. Siddhartha Saikia

Skin care plays a vital role in healing your skin. The American Academy of Dermatology has an excellent guide to – Face washing 101.

Moisturize your face daily.

Dry skin is a common skin problem arising due to face masks. Applying a good moisturizer adds a protective layer that can reduce dryness. You should apply a moisturizer immediately after washing your face. Skin specialists recommend using a moisturizer with one of the following ingredients

• Ceramides
• Hyaluronic acid
• Dimethicone

The type of moisturizer will also depend upon your skin type.

• Oily skin/Acne prone skin (or when the weather is humid/hot): Gel moisturizer – this should be preferred if you have acne or tend to break out after applying normal moisturisers.
• Normal or combination skin: Lotion
• Dry to very dry skin: Cream

Avoid skin care products that can irritate your skin.

When you cover your face with a mask, some skin care products that you’ve used in the past may irritate your skin. You should stop applying skin care products and medications that can irritate your skin for example:

• Acne treatments that containing salicylic acid
• Anti-aging products
• Aftershave
• Peels or scrubs

When you wear a mask, even for a short while, it can make your skin more sensitive. To reduce skin problems, avoid trying harsh products, such as a chemical peel, exfoliants, or retinoids especially if you have sensitive skin.

“If you’re already using a tretinoin gel (or retinol) for acne or anti-ageing, apply it at bedtime and don’t increase the amount that you apply.”

If you need to wear a mask while you have irritated skin, apply a moisturiser beforehand which adds a layer of protection, so your skin feels more comfortable.

Dr. Siddhartha Saikia

Makeup when you have a skin problem.

Makeup can worsen a mask-induced skin problem. Beneath a mask, makeup is more likely to clog your pores and lead to breakouts.

If you have to apply makeup it is advisable to use an “oil-free” and “non-comedogenic” product, such as mineral-based makeup.

Lip care – protect your lips

Dry and cracked or chapped lips are common face-mask skin problems. You can prevent dry lips by applying petroleum jelly to your lips:

• After washing your face.
• Before you put on your mask.
• Before bed.

Be sure to apply the petroleum jelly only to your lips to avoid breakouts.

Wash your cloth face masks.

Sebum and oils are naturally produced by the skin which tends to collect on the mask along with particles which you breathe out. As they build up, they can irritate the skin covered by your mask. You can remove germs, oils, and particles by washing a cloth mask in a washing machine or by hand.

Wash the masks in hot water. Use a fragrance-free detergent. Besides keeping your skin healthy, the Centers for Disease Control and Prevention (CDC) recommends that you wash your cloth face masks after each use to limit the spread of germs.

Take a 15-minute mask break every 4 hours.

Health care workers working during the COVID-19 pandemic have found that this helps their skin.

Only remove your mask when it’s safe to do so and after washing your hands.

Safe places to remove your mask include:

• Inside your car when you’re alone.
• At home.
• At the office, if it is a separate space and disinfected before entering.

Treat your skin.

Acne: There is a new term being used – “maskne” which is acne caused due to the useage of face masks ina person who normally does not develop acne. Sometimes, people who have acne issues can develop flares and breakouts in the mask area especially which falls under the same spectrum. It is recommended that you wash your face after wearing a mask, being sure to use a non-comedogenic moisturizer after washing. If your face mask causes new acne or makes your acne worse, you may need to apply certain anti-acne medications like tretinoin, benzoyl-peroxide, BHAs like salicylic acid gels or washes. Consult a skin specialist near you if that is the case.

Raw, irritated skin: Apply a moisturiser to the irritated spots on your face before bed. This product is designed to protect the skin so that it can heal. The type of moisturiser you need to use depends on the type of your skin (see above).

Sore skin behind your ears: You can change the type of mask you wear, find masks with different types of ties and ear loops. Wear a different type of mask each day. If you need to wear the same type of mask each day, try wearing a ball cap or headband that comes with buttons so that you can wrap the ear loops around the buttons.

Continue the treatment plan that your dermatologist created for you. If you have a skin condition, such as acne or rosacea, it’s especially important to follow your treatment plan recommended by the dermatologist. This can help keep the condition under control.

Continue to wear a mask to protect yourself and others

It’s important to continue wearing a mask for your own safety and the safety of others.

“It is recommended to wear a mask in public settings and when you are around people who don’t live in your household. A growing body of evidence has shown that masks play a vital role in reducing the spread of COVID-19. I encourage people to wear face masks in public, practice social distancing, and frequently wash your hands to help protect yourself, your family and your community.”

Dr. Siddhartha Saikia

Consult a certified dermatologist

Life gets busy. Sometimes, it’s hard to care for your skin as planned. You should follow the recommended tips above to prevent skin problems due to mask use but if a skin problem still occurs under your mask, you may need to consult a certified dermatologist near you. With the right skin care, you should notice an improvement in a few days. During the coronavirus pandemic, some skin specialists are seeing patients through telemedicine and in-clinic appointments. Find a dermatologist.

Tinea is an itchy superficial fungal infection that can involve the skin, hair and nails. It is also termed “dermatophytic infection”, “dermatophytosis” and “ringworm”. “Ringworm” is a misnomer since it is not a worm infection but rather, it is a fungal infection. However, it is still called that as it resembles a worm in the shape of a ring — hence the name.

There are approximately 40 different species of fungi that can cause ringworm. These infections can affect both humans and animals. The infection initially appears as red patches on affected areas of the skin and may later spread to other parts of the body, scalp or nails.

Which areas can be affected?

Areas of the body that can be affected by ringworm include:

• Feet (tinea pedis, commonly called “athlete’s foot”)
• Groin, inner thighs (tinea cruris, commonly called “jock itch”)
• Scalp (tinea capitis)
• Beard (tinea barbae)
• Hands (tinea manuum)
• Toenails or fingernails (tinea unguium, also called “onychomycosis”).
• Other parts of the body such as arms or legs (tinea corporis)

Symptoms of Ringworm Infections

The symptoms of ringworm usually depend on the part of the body which is infected, but they generally include:

• Itchy skin.
• Ring-shaped rash.
• Red, scaly, cracked skin.
• Hair loss in case of scalp involvement.

Symptoms typically appear within 2 weeks after the skin comes in contact with the fungi that cause ringworm.

Depending on the location of ringworm in the body, the site specific symptoms can be as follows:

• Feet (athlete’s foot): Red, swollen, itchy skin between the toes (especially between the little toe and the one next to it) and peeling of the skin in those areas. The sole and heel of the foot may also be affected. In severe cases, the skin on the feet can blister.
• Scalp (tinea capitis): Scaly, itchy, red, circular bald spots that can grow in size and multiple spots might develop if the infection spreads. Ringworm on the scalp is more common in children than it is in adults.
• Groin (jock itch): Scaly, itchy, red circular plaques, usually on the inner sides of the skin folds of the thigh.
• Beard (tinea barbae): Scaly, itchy, red spots on the cheeks, chin, and upper neck. The spots might become crusted over or filled with pus, and the affected hair might fall out.
• Nails (Onychomycosis): If you’re experiencing dermatophytosis in your nails, they may become thicker or discolored (usually yellowish), or they may begin to crack.

How Ringworm Spreads

The fungi that cause ringworm can live on skin as well as the environment. There are three main ways that ringworm can spread:

1. From a person who has ringworm: People can get ringworm after coming in contact with someone who has ringworm.
2. From the environment: The fungi that cause ringworm can live on surfaces, particularly in damp areas like locker rooms and public showers. One should avoid sharing clothes, towels, combs, or other personal items with other people.
3. From an animal that has ringworm: People can get ringworm after coming in contact with an animal that has ringworm e.g. dogs and cats, especially kittens and puppies. Other animals, like cows, goats, pigs, and horses can also spread ringworm to people. Please click here for more information about pets and ringworm.

Risk Factors

• If one shares clothing, bedding or towels with someone who has a fungal infection.
• Those who wear tight or restrictive clothing.
• Those who live in a warm climate.
• Those who have close contact with an infected person or animal.
• Those who participate in sports that feature skin-to-skin contact, such as wrestling.
• Those who have a weak immune system.

Prevention

• Keep your skin clean and dry.
• Wear shoes that allow air to circulate freely around your feet.
• Don’t walk barefoot in areas like locker rooms or public showers.
• Clip your fingernails and toenails short and keep them clean.
• Change your socks and underwear at least once a day.
• Don’t share clothing, towels, sheets, or other personal items with someone who has ringworm.
• If you play close contact sports, shower immediately after your practice session or match, and keep all of your sports gear and uniform clean.
• Don’t share sports gear (helmet, etc.) with other players.
• Avoid people or animals with ringworm if you have a weakened immune system.

My pet has ringworm and I’m worried about ringworm in my house. What should I do?

For people

• Wash your hands with soap and running water after playing with your pet.
• Wear gloves and long sleeves if you must handle animals with ringworm, and always wash your hands after handling the animal.
• Disinfect areas the pet has spent time in, including surfaces and bedding.

Protect your pet’s health

• If you suspect that your pet has ringworm, make sure to visit a specialist so that treatment can be started.
• If one of your pets has ringworm, make sure your other pets also get checked for ringworm infection.

How is ringworm diagnosed?

Your skin specialist can usually diagnose ringworm by looking at the affected skin and asking questions about your symptoms. The skin doctor may also take a small skin scraping to be examined under a microscope or sent to a laboratory for a fungal culture.

If you’re getting a “KOH test”, your doctor will scrape off a small area of infected skin onto a slide and place drops of a liquid called “potassium hydroxide” (KOH) on it. The KOH breaks apart normal skin cells, making the fungal elements easier to see under a microscope.

Stages of Ringworm

You won’t see ringworm right away when the fungus has infected you. It can take up to 2 weeks before you start noticing symptoms. Some of the stages you may see include:

• Initial stage. During this stage, you may notice a pink or red irritated patch of skin. Sometimes, it just appears very dry and scaly — not necessarily like ringworm.
• Second stage. During this stage, you’ll notice the lesion starts to grow in size. The centre of the rash may resemble healthy skin with a surrounding scaly area.

Because ringworm is very contagious, the treatment should be started as soon as the first signs are noticed. If the treatment is delayed, it may spread and grow.

Ringworm v/s Eczema

Ringworm can closely resemble another condition, discoid eczema (also known as nummular eczema or nummular dermatitis). The two conditions are similar because they both cause round or coin-shaped lesions on the skin. The lesions are often itchy and scaly. Discoid eczema usually doesn’t have clearing in the centre, while ringworm does. Ringworm may also have pustules associated with it, while nummular eczema doesn’t. Sometimes the two conditions look so much alike that the only way to tell the difference is to see your skin doctor who specialises in the diagnosis and treatment of both these conditions. The doctor can take samples of the skin cells and send them to a laboratory for testing if required.

Doctors treat nummular eczema in a different way to ringworm. They use topical steroids, which, if used for ringworm infections, can mask as well as worsen the infection. Antifungal ointments won’t help nummular eczema.

Ringworm v/s Psoriasis

Psoriasis is another skin condition that can sometimes resemble ringworm. Plaque psoriasis is a disorder due to immune dysfunction that produces inflammatory plaques on the skin. It appears as pink plaques with heavy white scales. Small isolated plaques can sometimes look similar to ringworm. Both ringworm and psoriasis can cause red patches of skin as well as skin itching and scaling. However, ringworm on your trunk or limbs (tinea corporis) will usually have a circular appearance with clearing in the middle. Plaque psoriasis skin lesions are usually larger, involve more areas of the skin, and occur in distinct locations (lower back, elbows, knees). Psoriasis lesions also don’t have clearing (normal-appearing skin) in the middle of their lesions.

Treatment for Ringworm

Lifestyle adjustments

• Washing clothes and bedsheets daily and drying them in the sun.
• Drying the skin, especially areas around the skin folds thoroughly after bathing.
• Wearing loose-fitting, cotton clothes.
• Treating all infected areas (not treating one area can lead to recurrences in other areas)

Medications

• Ringworm can usually be treated with non-prescription antifungal creams, lotions, or powders applied to the skin for around 4 weeks e.g. clotrimazole, miconazole, terbinafine, luliconazole etc.
• Severe ringworm infections usually need to be treated with prescription antifungal medication taken by mouth for 1 to 3 months. Prescription antifungal medications used to treat ringworm on the scalp include griseofulvin, terbinafine, itraconazole, fluconazole etc.
• Many people apply steroid creams to ringworm infections. However, that can cause a lot of harm and delay the healing process. Learn more about how steroid creams can make ringworm worse.

What happens in melasma?

Melasma causes patches of discolouration which are darker than your usual skin colour. It typically occurs on the face and the most common areas include:

• The bridge of the nose
• The forehead
• The cheeks
• The upper lip

Melasma may also appear on other areas of the body, especially those exposed to a lot of sunlight like the forearms, neck or even shoulders. Although the skin discolouration doesn’t do any internal harm, one may feel self-conscious about the way it looks.

If you notice such symptoms, consult a dermatologist, a doctor who specializes in treating skin disorders.

A glance in the mirror may still show some darkened patches on your skin that seem to be sticking around despite using over the counter products. These brown blotches, typically on the forehead, chin, cheeks, upper lip, or nose, may signal a condition called melasma. It’s not only associated with pregnancy but can affect women in all stages of life. And it may last for many years.

Dr. Siddhartha Saikia

Who gets melasma?

Melasma is more common in women than in men. It typically begins between the ages of 20 and 40 years. It is also more common in people who tan easily or have naturally brown skin. It is less common in people with very fair skin or black skin.

Causes and risk factors of melasma

It isn’t totally clear what causes melasma. And while melasma isn’t painful and doesn’t present any health risks, it can cause significant social and emotional distress. The condition can be difficult to treat, and there’s a lot of misinformation out there about what causes it.

Melasma appears when the melanocytes (pigment-producing cells in the skin) become hyperactive and produce too much pigment in certain areas of the skin. The mechanism is somewhat similar to what causes brown age spots and freckles, but melasma patches tend to be larger.

Melasma has a lot of different causes. Two in particular stand out:

Hormones (including hormonal medications): Fluctuations in certain hormones can cause melasma, which is why it commonly occurs during pregnancy. It may also occur when you either start or stop hormonal contraception, including birth control pills, or when you take hormone replacement therapy.

Sun exposure: The sun is the big culprit in triggering melasma. Underlying factors such as hormonal changes may not manifest until a person goes on vacation to a western location like Goa, or during the summertime when she spends more time in the sun. The sun is the major exacerbating factor, whatever the underlying cause. Melasma can be caused or worsened by not only the sun’s rays but also heat and visible light.

Other factors implicated in the development of melasma include:

• Genetics: 60% of people report affected family members
• Thyroid disorder can be associated with melasma
• Medications: Certain medicines may cause melasma.
• Scented products: Perfumed soaps, toiletries, and cosmetics may cause a phototoxic reaction to trigger melasma.

How is melasma diagnosed?

For a skin specialist, a visual examination of the affected area is often enough to diagnose the condition. To rule out specific causes, your healthcare professional might also perform some tests.

One testing technique is a Wood’s lamp examination. This is a special kind of light that’s held up to your skin which allows your healthcare professional to check and determine how many layers of skin the melasma affects. To check for any serious skin conditions, they might also perform a biopsy but it is usually not performed these days because other non-invasive modalities such as dermatoscopy are available.

Is melasma treatable?

For some women, melasma disappears on its own. This typically occurs when it’s caused by pregnancy or birth control pills.

There are creams your healthcare professional can prescribe that can lighten the skin. If these don’t work, chemical peels, dermabrasion, and microdermabrasion are possible options. These treatments strip away the top layers of skin and may help lighten dark patches.

These procedures don’t guarantee that melasma won’t come back, and in some cases, the pigmentation can’t be completely lightened. You might have to return for follow-up visits and stick to certain skin treatment practices to reduce the risk of the relapse. These include minimizing your sun exposure and wearing sunscreen daily.

Treating melasma

The first step in treatment is confirming with a dermatologist that your darkened skin patches are indeed melasma, and determining what’s causing it. Treating melasma is unlikely to be effective if the underlying cause isn’t addressed.

At Saikia Skin Care (Gandhinagar), we take a thorough medical history to find out what’s causing the melasma. Then adjustments are made. If a hormonal contraceptive is causing the problem, a woman might consider switching to a non-hormonal option, such as a copper intrauterine device.

Beware dangerous skin-lightening scams

Sometimes women who are desperate to improve the appearance of melasma will seek out treatments online. Hyperpigmentation problems have become a huge moneymaking industry. But many of these products are at best ineffective and at worst, unsafe. These include oral or injected glutathione products, which can cause potentially dangerous thyroid and kidney problems. It’s important to verify the safety and efficacy of any treatment with a certified dermatologist or your skin doctor. Also, keep in mind that the FDA has not approved any injectable products for skin lightening or whitening.

Avoiding Sun Exposure

The next step in treating melasma is to prevent the sun from aggravating the condition. This may require extreme diligence and regular sunscreen application. To know more about sunscreens, check out All About Sunscreen.

The sun is stronger than any medicine I can give you. The most important way to clear up melasma is by using a strict sunscreen regimen. But keep in mind that not all sunscreens are created equal. To prevent melasma, you need a sunscreen that blocks not only the sun’s rays but also its light and heat.

Dr. Siddhartha Saikia

There are two main types of sunscreens:

• Sunscreens that use chemicals, such as oxybenzone
• Sunscreens that use physical blockers, such as zinc and titanium dioxide.

You want to choose the non-chemical, blocking sunscreen, because that will stop all the light and different wavelengths from coming through. Chemical sunscreens don’t offer the same protection for melasma, and in some instances, they may even trigger allergic reactions that can make the condition worse.

It is a good idea to wear a hat that can provide sun protection if you’re going to be outside for an extended period of time.

At-home treatments

There’s more you can do on your own to help your skin heal and prevent future damage. In addition to reducing sun exposure, try these steps:

Establish a good cleansing regimen. Environmental pollution can contribute to melasma. Airborne pollutants can bind to the skin and corrode the protective surface, making it weaker and more susceptible to sun damage. Clean your skin every night before bed with a cleanser that can thoroughly remove particulate matter and help protect the skin.

Combat skin stress with antioxidants. Vitamins C and E can help heal damage from sunlight. So, dab on a few drops of a serum that contains these vitamins to improve skin health and ward off the harmful effects of sun exposure.

Moisturize your skin regularly. Use a good moisturizer after the serum to restore the lipid (fat) barrier of the skin, which helps to protect it from damage.

Be patient. Even with treatment, it may take months for the pigmentation to clear up. There’s no overnight fix.

Be diligent. Melasma will be quick to return if you’re not careful about sun protection. So, long-term maintenance requires an ongoing commitment to protecting your skin.

Topical Therapy

• Hydroquinone: This medicine is a common first treatment for melasma. It is applied to the skin and works by lightening the skin. Higher concentrations of hydroquinone can cause white spots to develop on the skin and may even cause a darkening of the skin in some cases so consult a certified dermatologist before you start it.
• Tretinoin and corticosteroids: To enhance skin lightening, your dermatologist may prescribe a second medicine. This medicine may be tretinoin or a corticosteroid. Sometimes a medicine contains three medicines (hydroquinone, tretinoin, and a corticosteroid) in one cream. This is called a triple cream.
• Other topical (applied to the skin) medicines: You may be prescribed other alternatives to help lighten the pigmentation. Many other agents are under investigation.
  • Azelaic acid
  • Kojic acid
  • Ascorbic acid
  • Tranexamic acid
  • Glutathione
  • Soybean extract.

If you notice any of the following after getting treatment for melasma, be sure to call your dermatologist:

• Skin irritation
• Darkening of the skin
• Other problems

Medical procedures

If topical medications do not work, a dermatologist may recommend procedures such as:

• Microdermabrasion
• Chemical peel
• Laser treatment
• Light therapy
• Dermabrasion

Superficial epidermal pigment can be peeled off using alpha-hydroxy acids (AHA), such as glycolic acid, or beta-hydroxy acids (BHA), such as salicylic acid.

Microneedling, intense pulsed light (IPL), and lasers including Q-switched Nd:YAG, ablative and non-ablative fractionated and picosecond lasers carry a high risk for relapse and the disease becoming more resistant to treatment, so require expert use.

New skin problems can occur when the person who gives the treatment does not tailor it to the patient’s skin type. For example, peels can work for some people. “And for some people, it makes it worse. It’s very hard to predict. Ask your dermatologist about possible side effects (health problems that can result from the treatment).

Oral treatment

Tranexamic acid blocks conversion of plasminogen to plasmin, with downstream effects inhibiting the synthesis of prostaglandin and other factors involved in melasma. More new oral treatments are being researched.

What is the outcome for melasma?

Melasma can be frustrating to treat. It is slow to respond to treatment, especially if it has been present for a long time. Even in those who get a good result from treatment, pigmentation may reappear on exposure to summer sun. The chronicity and risk for relapse with the need for lifelong sun protection should be emphasised to set realistic goals and outcomes.

Under a dermatologist’s care, many people with pigmentation have a good outcome. Melasma can be stubborn, though and it may take a few months of treatment to see improvement. It is important to follow your dermatologist’s advice. This ensures that you get the most benefit from treatment. It also can help avoid skin irritation and other side effects.

After your melasma clears, you may need to keep treating your skin. This is known as maintenance therapy. Maintenance therapy can prevent melasma from returning.

Formulation of Vitamin C

Vit. C is available in the market as a variety of tablets, creams, serum, powders etc. The bioavailability of Vit. C in the skin is not sufficient when it is taken orally. Therefore, the use of topical Vit. C creams/gels/serum/powder is favoured in the practice of dermatology. The serum contains active Vit. C in an almost colourless form. It is unstable and, on exposure to light, gets oxidized and imparts a yellow colour. It is important to note that the efficacy of the Vit. C serum is proportional to the concentration, but only up to 20%.

When should I apply it?

You can use it in the morning or night time. It depends on your skin care routine.

Apply After Cleansing

Dab vitamin C serum after you wash your face and before you apply sunscreen. It could sting or make your skin red at first, but that should go away if you keep using it. Test any new products on a small area before applying it to your whole face.

Can I use it in the morning before work?

Yes. But make sure to use sunscreen after applying Vit. C serum.

Choose L-ascorbic Acid

This form of topical vitamin C is the most active and the most researched. Skin care products sometimes contain other types that aren’t as effective, like magnesium ascorbyl phosphate or ascorbyl palmitate. Check the label before purchasing the product.

Pick a Potent Product

Look for serums with a concentration of vitamin C between 10% and 20%. Lower than that might not bring adequate benefits, and higher could irritate your skin without bringing any additional value.

How long before you see the results

After just a few weeks of starting, you can see visible results.

Make sure to store your vitamin C products correctly.

In topical skin-care products, vitamin C is sensitive to light and air. When exposed to these factors, it becomes oxidized and is converted to a less stable and less effective compound. So these products should be stored in opaque containers that are either air-restrictive or air-tight like a dropper bottle that requires being opened all the way.

Notice if the product has changed colour.

Your Vitamin C serum should be colourless or light straw colour. If it is oxidized, it becomes yellow or brown and is likely going to be less effective. You can still use it if you want, but it won’t be as effective for your skin.

Don’t use vitamin C with certain other ingredients.

Vitamin C is generally pretty safe and well-tolerated, but if you have sensitive skin, it might sting a little bit; especially if you use it in the same part of your routine as exfoliating scrubs or acids.

You should avoid using Vit. C with benzoyl peroxide, which can oxidize the Vit. C and, therefore, make it less potent. You can still use your benzoyl peroxide products, just not in the same part of your routine as the Vit. C. Try using Vit. C in the morning and benzoyl peroxide in the evenings, or use them on different days.

You can use vitamin C with retinol, but be cautious.

In the past, it was thought that you should avoid using vitamin C products with retinoids at all costs. And that is still sort of true. They work best in different skin environments, so using them at the same time may make both less effective. Using them in the same part of your routine can cause irritation, but it’s okay to use them on the same day at different times. Experts generally advise using vitamin C products in the morning and retinoids at night.

Adverse Reactions of Topical Vitamin C

Topical Vit. C is largely safe to use on a daily basis for long durations. It can safely be used in conjunction with other common topical anti-ageing agents such as sunscreens, tretinoin, other antioxidants and alfa hydroxy acids such as glycolic acid.

Minor adverse reactions include:

• Yellowish discolouration of the skin
• Hypo-pigmented hair
• Staining of clothes
• Stinging
• Redness
• Dryness

These can easily be treated using a moisturiser. Care must be taken while applying Vit. C around the eyes.

Should I use vitamin C powder?

Powdered vitamin C is a relatively new product on the market, but it has been gaining popularity recently. It can be mixed with serums or moisturizers to help protect your face and reduce signs of ageing. Taking the correct amount of vitamin C powder is important and it’s easier to apply a serum which is formulated to a specific percentage.

How to know which product to apply?

There are many different formulations and brands of vitamin C available today. You can consult your dermatologist to find out which product will be the most beneficial and suitable for your skin type.

Eat Your Fruits and Vegetables

It’s not all about lotions and serums. The vitamin C in food helps promote healthy skin, too. Citrus fruits, tomatoes, peppers, kiwis and strawberries are all packed with the stuff.

The bioavailability of Vit. C in the skin is not sufficient when it is taken orally. Therefore, the use of topical vitamin c creams/gels/serum/powder is favoured in the practice of dermatology.

Vit. C does not absorb UV light but exerts a UV-protective effect by neutralizing free radicals, while this effect is not seen with sunscreens. Although Vit. C alone can provide photoprotection, it works best in conjunction with Vitamin E (Vit. E), which potentiates the action of Vit. C four-fold.

Here we take a look at the top 10 benefits of Vitamin C.

Antioxidant Property

Vitamin C is the most abundant antioxidant in your skin. UV rays, pollution, and smoking can all damage your skin by creating free radicals. Free radicals are unstable molecules that pull electrons from your cells and cause damage. Your skin cells store vitamin C to prevent damage from such environmental factors.

Anti-inflammatory Action

Vit. C has a potent anti-inflammatory activity and can be used in conditions like acne vulgaris and rosacea. It can also promote wound healing and prevent post-inflammatory hyperpigmentation.

Collagen Production

Collagen is one of the major components of your skin. Your body needs vitamin C to synthesize this protein. A group of 60 healthy women applied a vitamin C-based solution to their face for 60 days. The researchers found that the vitamin C solution was highly effective at inducing collagen synthesis.

Skin Lightening

Vitamin C inhibits an enzyme called tyrosinase which is required for the production of melanin (the pigment that gives your skin its colour). By reducing tyrosinase, Vit. C can help to make your skin tone lighter.

Evens Skin Tone

Vit. C can help in not only reducing the skin tone but also in making the skin tone uniform by making it even. However, Vit. C is an unstable compound and is often combined with other depigmenting agents such as soy and liquorice for better depigmenting effect.

Replenishes Vitamin E

Vitamin E is another important antioxidant that protects your skin from oxidative damage. After your skin is exposed to sunlight, levels of vitamin E decline. has found that vitamin C helps replenish vitamin E after sun exposure.

Reversing Sun Damage

Sunlight is good for the body but it can also harm the skin. Applying Vit. C to your face helps to reduce sun spots, free radical damage and signs of aging.

Prevents Sagging Skin

Your skin naturally produces less collagen as you get older. A loss in collagen is one factor that causes your skin to sag as you age. Applying Vit. C to your face helps improve your skin’s production of collagen, especially if you spend a lot of time in the sun or are low on dietary vitamin C.

Prevents Wrinkles

As you get older, your skin tends to become less elastic and thinner, which can contribute to wrinkles. Although the formation of wrinkles is largely genetically predetermined, repeated exposure to UV rays can break down collagen and elastin and prematurely age your skin.

Gives Your Face a Radiant Glow

Vitamin C is one of the few skincare products for quick & long-lasting, brightened, glowing skin. The power of vitamin C in the face serums gives your skin a radiant glow.

Check out: Things to know before starting Vitamin C

Acne, also known as Acne Vulgaris, is a long-term skin condition that occurs when hair follicles are clogged with dead skin cells and oil from the skin. Although it is a physiological condition, when it occurs repeatedly or severely, it can lead to cosmetic concerns as well as reduce the quality of life and confidence of the affected person.

Let’s look at the top 10 causes of acne and the top 10 ways to prevent it in no particular order.

Top 10 Causes of Acne

1. Diet:
   ⦁ Eating too much carbohydrates with a high glycaemic index can lead to acne. Foods like white bread, white rice, pasta, sugar, maple syrups, anything made with white flour like pastries and cake, soft drinks have a high GI.
   ⦁ Dairy products: A recent study found a positive association with acne for the intake of total milk and skim milk. It may be because of the presence of hormones and bioactive molecules in milk.
   
   
2. Stress:
   People tend to have acne breakouts during periods of stress due to increased hormone production to fight the stress stimulus.
   
   
3. Makeup:
   Sometimes makeup can cause as well as worsen acne and clog your pores. It depends on what type of makeup you use and whether you wash it off at the end of the day. Reduce the damage by using fragrance-free and non-comedogenic, sheer or light coverage makeup.
   
   
4. Brushes:
   Bacteria can accumulate on makeup application brushes that aren’t cleaned regularly so make sure to clean your foundation and concealer brushes once a week and other brushes 1-2 times per month.
   Most people do not clean their brushes as frequently as they should or at all. There are a few ways you can clean them, which include:
   ⦁ Run your makeup applicator under lukewarm water and rinse your brush thoroughly. In a bowl of water, add clarifying shampoo. Dip the applicator in the water. Rinse the brush until the water is clear. Air dry your brush.
   ⦁ Use a traditional makeup brush cleaner and follow the product instructions.
   
   
5. Other Medicines:
   Sometimes, Acne can be caused by certain medicines so be sure to consult your dermatologist to clarify.
   
   
6. Bacteria:
   P. acnes is one of the bacteria which plays an important role, both directly and indirectly, in the development of inflammatory acne.
   
   
7. Hormones:
   Hormonal shifts (mainly increase in androgens) are directly related to acne. The breakouts that occur can often be below the nose, along the jaw, and even the neck at times.
   
   
8. Sebum and Oil:
   The normal function of sebaceous glands is to produce and secrete sebum, a group of complex oils. Increased sebum excretion and changes in the lipids are the main events in acne pathogenesis.
   
   
9. Home Remedies:
   Although some home remedies may be beneficial to treat acne, most of the time, there can be worsening of the lesions or other complications of trying home remedies.
   
   
10. Pregnancy:
    Acne is known to occur during pregnancy, usually during the first and second trimesters. This is due to an increase in hormones (androgens) which can make the sebaceous glands grow and produce more sebum.

Top 10 Tips To Prevent Acne.

1. Cleansing: 
   Cleansing your skin with the right type of cleanser is an important part of the daily anti-acne routine. The skin needs some natural oils to remain healthy. Cleansing too often can result in over-dryness and irritation. Generally, cleansing twice a day is sufficient to remove dirt, excess oil, and makeup without stripping the skin of the natural oils. In addition, if you’ve been exercising, are sweaty or dirty, it is recommended to cleanse your skin. And make sure to wash your face before bed to cleanse away the grime and oil from the day and leave your skin ready for the acne medications.
   
   
2. Sun Protection:
   Prolonged sun exposure can increase the shedding of dead cells on your skin’s surface which causes plugging of pores. This can lead to acne. Heavy sunblocks may cause breakouts as they are occlusive, meaning they form a film on the skin. One should use a non-comedogenic sunscreen to avoid breakouts. To read more about sunscreens, click here.
   
   
3. Drink lots of water.
   Drinking at least 8 glasses of water a day is beneficial for skin health.
   
   
4. Diet Tips:
   Swap brown rice for white rice or use a mixture of brown and white rice.
   Eat wholegrain or multigrain bread instead of white bread.
   Eat oats instead of regular cornflakes.
   Eat apples, pears with skin on – skin is rich in fiber and antioxidants (but be sure to wash thoroughly before consuming)
   Include more Vitamin A, C, and E in your diet.
   Vitamin A: Supports the immune function and provides proper growth and differentiation of cells. It is also good for the eyes.
   Vitamin C: Good for immune function and skin health. Helps prevent the damaging effects of harmful free radicals thereby preventing damage and aging of the skin.
   Vitamin E: It has antioxidant properties and also prevents the damaging effects of harmful free radicals.
   
   
5. Tips to manage stress:
   Prioritizing workloads, exercise & yoga, music, talking things out with family and friends.
   
   
6. Sleep:
   Ensure you are getting sufficient sleep of at least 7-8 hours because the body repairs itself and recovers while you sleep.
   
   
7. Cell Phones:
   ⦁ Use an earpiece instead of putting your phone directly to your face.
   ⦁ If prefer not to use an earpiece, make sure to clean your phone regularly. You can use a microfiber/lint-free cloth or cotton swab spritzed with alcohol.
   
   
8. Avoid Touching Your Face:
   Even after you wash hands, avoid touching your face. If you are a student, and you study with your hand resting on your face, then that can also cause little breakouts.
   
   
9. Do not squeeze acne/Prevent Scarring:
   Do not rub or pop the acne or there can be scarring or pigmentation.
   
   
10. Consult a skin specialist:
    Sometimes, breakouts can occur despite taking the best care of your skin. It is important to consult a dermatologist near you so that the doctor can diagnose the condition and find any underlying causes of the acne as well as suggest the latest treatment which will help to clear the skin as well as prevent further breakouts from developing.

To know about the causes of urticaria and it’s trigger factors, check out All About Urticaria.

How do you treat urticaria?

The treatment of urticaria should be tailored to the individual patient. General measures include removal of any identifiable cause, explanation, information and reassurance. Avoidance of certain food products, certain drugs like aspirin and other NSAIDs are recommended because these drugs aggravate chronic urticaria in about 30% of patients. Treatment of underlying diseases, e.g. Thyroid disease, Helicobacter pylori (a stomach infection) is also important as a part of urticaria treatment.

Avoidance of trigger factors

In addition to medical management, the cause of urticaria should be eliminated if known e.g. drug or food allergy. Avoidance of relevant allergens clears urticaria within 48 hours.

• Treat identified chronic infections such as H pylori.
• Avoid aspirin, opiates and nonsteroidal anti-inflammatory drugs (paracetamol is generally safe).
• Minimise dietary pseudo allergens for a trial period of at least three weeks.
• Avoid known allergens that have been confirmed by your doctor by a positive skin prick test.
• Cool the affected area with a fan, cold flannel, ice pack or soothing moisturising lotion.

Avoid physical triggers for inducible urticaria

The physical triggers for inducible urticaria should be minimised; see examples below. However, sometimes symptoms can persist despite this in which case you may need to combine medical therapy to your urticaria treatment.

• Symptomatic dermographism: Reduce friction, e.g. avoid tight clothing.
• Cold urticaria: Dress up carefully in cold or windy conditions and avoid swimming in cold water.
• Delayed pressure urticaria: Don’t hang heavy bags on your shoulders or wear tight belts.
• Solar urticaria: Cover your skin with full sleeves and apply broad-spectrum sunscreens.

Some patients with inducible urticaria benefit from daily induction of symptoms to induce tolerance. Phototherapy may be helpful for symptomatic dermographism.

Lifestyle and home remedies to treat urticaria

Chronic urticaria can go on for months or years. They can interfere with sleep, work and other activities. The following precautions may help prevent or soothe the recurring skin reactions of chronic hives:

• Wear loose, light clothing.
• Avoid scratching or using harsh soaps.
• Soothe the affected area with a cool bath, lotion or anti-itch cream.
• Keep a diary of when and where hives occur, what you were doing, what you were eating, and so on. This may help you and your doctor identify triggers.
• Avoid known triggers.
• Avoiding certain foods may help. Foods known to trigger histamine production include spinach, fish, yoghurt, fish, tomato, processed, meats, chocolate, and strawberries.
• Apply sunscreen before going outside.
• Cut down on alcohol or abstain.
• Avoiding certain medications.
• Avoiding stress, if possible, perhaps with meditation or relaxation techniques.

Some recommend supplements such as evening primrose oil, vitamin C, D and others. It is important to speak to a doctor before using supplements, as some supplements can cause flare-ups. Keeping a record of flareups can help identify a trigger.

Medical Management

First line treatment

For urticaria treatment, the first step in medical management is to start with antihistamines. The newer generation H1 antihistamines have a less sedating effect and fewer side effects so they are preferred over the older generation H1 antihistamines as the initial choice of therapy. In pregnancy, certain antihistamines are safer so consult your skin specialist to know which is the best and safest option for you.

Certain antihistamines have been proposed as preferred for particular subtypes of chronic urticaria, such as hydroxyzine for cholinergic urticaria and cyproheptadine for cold-induced urticaria. Second generation nonsedating (or less sedating) antihistamines like levocetirizine, bilastine, loratidine, fexofenadine, desloratadine etc. can also be used for urticaria treatment.

It is common to double or triple the dosage of nonsedating antihistamines if patients do not respond to the standard dosage. The EAACI/GA2 LEN recommendation of using nonsedating H1 antihistamines up to four-fold above the recommended doses appears to be effective with mild sedation. If the response is less, then the tricyclic antidepressant doxepin,10-25 mg initially up to 75 mg at night or H2 antihistamines or mast cell stabilizers can be added.

Second line treatments

Your doctor may prescribe short courses of systemic steroids for 3-4 weeks, in resistant cases of chronic urticaria, but long term therapy can not be given because of known adverse effects. If urticaria relapses after a short course of steroid therapy, and symptoms are not adequately controlled by H1 antihistamines, leukotriene-receptor antagonists can be tried. These have been shown to have a beneficial effect in the treatment of chronic urticaria especially in cases which were aggravated by the NSAIDs and food additives.

Resistant/severe cases:

Cyclosporine has been shown to be effective in severe unresponsive cases.

Omalizumab has been tried in patients with chronic autoimmune urticaria resistant to antihistamines and is currently the second line if up dosing antihistamines don’t control the hives as per the European guidelines. Treatment with omalizumab 150-300 mg once or twice a month depending upon weight and IgE levels resulted in a significant reduction in the patients’ hives, reduced the need for additional medication to control symptoms, and improved patients’ quality of life.

Plasmapheresis has been used to treat some patients with auto-antibody positive severe chronic urticaria.

Low-dose methotrexate, hydroxychloroquine, sulfasalazine and dapsone, which have immunomodulatory properties, have been used effectively in the treatment of chronic urticaria. Cyclophosphamide has also shown a beneficial effect in treating severe autoimmune chronic urticaria.

Phototherapy with UV light or photochemotherapy has been used to treat urticaria, but the reported results have been variable.

ASST has been used successfully by many skin specialists in their practice for autoimmune urticaria which is an advanced form of whole blood therapy.

Histaglobulin has been used successfully by many skin specialists to reduce the severity and flares of urticaria.

Alternative medicine

Few authors have suggested that acupuncture is effective in up to 90% of cases of chronic idiopathic urticaria.

Psychological therapy

Complementary psychological treatment of patients suffering from chronic urticaria, particularly hypnosis and relaxation techniques may help in the improvement of the urticarial wheals.

Future prospects in urticaria treatment

Right now, the management of chronic urticaria is to stop the histamine release but there is no permanent cure and it may return after months or years. Medical science is constantly evolving. Today, we can treat so many conditions which did not have any treatment a decade ago.

Read about some common myths and FAQs about urticaria.

Myths about hives

MYTH 1. Hives are contagious.

Hives are not contagious. There can be many causes of urticaria. To know more about the causes and triggers of urticaria, read All About Urticaria.

Upto 30 percent of chronic hives are caused by an autoimmune reaction, which means your body’s immune system activates to fight an infection that isn’t there. Many people with chronic urticaria never find an answer as to why the hives appear.

Dr. Siddhartha Saikia

MYTH 2: All hives are due to allergies.

Hives are not all due to allergies.
Although hives are often caused by allergens, there are other non-allergic causes of hives. Occasionally, hives may be the presenting feature of another systemic disorder like thyroid disease, and should prompt an individual to seek evaluation by a doctor. Sometimes, there is no specific cause of hives which is called idiopathic. Many cases of chronic urticaria may develop spontaneously without any particular trigger.

Acute Urticaria can be a known reaction to allergens, for example, if you eat peanuts and then break out with hives. But chronic urticaria is different. They usually appear without any evidence of an allergy. Despite this, many people suggest avoiding high-allergen foods, such as sour food or peanuts.

Dr. Siddhartha Saikia

MYTH 3. Patients with urticaria should be given an extensive list of foods that must be avoided.

Patients do not always have to avoid “trigger foods”. Often, doctors suggest avoiding egg, milk, brinjal, spinach, prawn, and fish as these are the “triggers” for urticaria. Strict avoidance has little or no effect on the frequency of urticarial eruptions in chronic urticaria. However, there are some foods that release more histamine and clinical advice often entails educating patients to avoid eating most of the foods that are high in histamine during acute urticarial eruptions until the “episode” settles down.

In selected patients with supportive histories, presence of IgE to specific foods or sensitivity (non-IgE mediated reactions) to certain dyes or colouring agents in food (pseudo allergies) could have a relevance to their chronic urticaria symptoms.

MYTH 4. Patients with urticaria should undergo testing to exclude specific allergies.

Allergy testing is not usually required for urticaria. Whilst the concurrent presence of house dust mite (D. pteronyssinus, D. farinae, and Blomia sp.) allergy or other aeroallergen sensitivities can be found in some patients, these tests should be reserved for patients who complain of allergic rhinitis symptoms rather than urticaria.

Usually, house dust mite reactivity in chronic idiopathic urticaria is linked with respiratory allergy. Avoidance of these allergens will, therefore, have little effect on urticaria, except in a few cases where there is a strong consistent history of contact urticaria on exposure to dust, but antihistamine and nasal spray treatment will have an effect on the rhinitis and will encourage the patient to continue on antihistamines that will control the urticaria. In some highly atopic individuals, allergens such as grass pollens, moulds, animal dander, house dust mites, and latex might aggravate chronic urticaria but this is usually not the primary cause for the urticaria.

MYTH 5. Patients should not receive high doses of antihistamine medications and definitely not in pregnancy.

Not true. Almost all specialists dealing with chronic urticaria patients recognize that standard or recommended doses of antihistamines are usually ineffective in treating this condition. Consensus guidelines recommend that higher doses, even up to four-fold higher, are safe and have been verified in studies. First-generation antihistamines should preferably be avoided in infants and children as well as adults especially those dealing with heavy machinery or ]skilled tasks such as driving.

The EAACI/GA²LEN/EDF/WAO consensus guidelines mention that loratidine is safe in pregnancy but supratherapeutic doses should be carefully considered.

MYTH 6. Skin specialists will prescribe steroids.

Not true unless it is severe. It is true that sometimes steroids are required to control the disease in acute and severe flare-ups. But long term steroid usage is not helpful in chronic urticaria especially because of the side effects. Usually, skin specialists give a medicine known as “anti-histamine” which is not a steroid and it is safe to take even for extended periods without any major side effects. The newer antihistamines are non-sedative and do not cause drowsiness.

MYTH 7 There isn’t any treatment for chronic urticaria.

While there is no cure for chronic urticaria, there are many treatments, such as taking non-drowsy antihistamines, that can help relieve the itching and reduce the number of flares. Treatments are aimed at controlling symptoms. To know more about the management of urticaria, check out Urticaria Treatment.

MYTH 8. I will need to take medicines for a lifetime.

You may not need lifetime medicines. Chronic Urticaria (lasting for more than 6 weeks) can have an unpredictable course. Some may recover in a few months and for some, it may take many years. Sometimes, it can be frustrating to think that one needs to take medicines to control the hives for their entire lifetime. Unlike chronic medical conditions like diabetes or high blood pressure which requires lifetime medication, urticaria may not require that. Many people do recover spontaneously and modern medicines are very safe and can be taken without any major side effects.

MYTH 9. Chronic urticaria doesn’t affect quality of life.

CU can affect the quality of life and can be stressful for patients. When you live with chronic hives, you live with uncertainty. You don’t know when or how severe your next flare will be. Some people avoid social gatherings because they fear breaking out in hives. If your chronic hives are caused by an autoimmune reaction, you battle fatigue on a regular basis and might feel too tired to even get out of bed.

MYTH 10. There is nothing to worry about. Urticaria does not have any complications.

It is rare but urticaria may have severe complications requiring emergency care. While it’s true that usually the symptoms of urticaria are not severe or life-threatening and one shouldn’t worry too much about urticaria as stress can cause flare-ups; urticaria may sometimes be accompanied with angioedema which is a deeper form of swelling which usually occurs on the face, neck or extremities. If you are having angioedema and it is causing difficulty in breathing, contact your emergency doctor immediately. Another rare complication is anaphylaxis which may occur with urticaria sometimes and it is a medical emergency requiring immediate treatment.

Conclusions

• Chronic urticaria is a relatively common condition in India and most cases have no specific allergic trigger and remain idiopathic (no specific cause).
• Autoimmune causes have been found to be associated with up to 30-40% cases.
• It is important to look for physical triggers such as pressure urticaria in chronic cases.
• Avoidance of foods without appropriate testing for food allergy should not be routinely recommended.
• Long-acting nonsedating antihistamines at even higher than standard doses if necessary are safe and effective.
• Quality of life is affected adversely in many patients with chronic urticaria.
• Psychological stressors can play an important role in this disease and require special attention.

Types of urticaria

The classification is based upon duration.

• Acute urticaria (< 6 weeks duration) – Usually it is gone within hours to days.
• Chronic urticaria (> 6 weeks duration) – Daily or episodic weals are common. Chronic urticaria may be spontaneous or inducible. Both types may co-exist.

Who gets urticaria?

One in five children or adults has an episode of acute urticaria during their lifetime. It is more common in atopics and affects all races and genders. Chronic spontaneous urticaria affects 0.5–2% of the population.

Causes

Hives occur when certain cells release histamine and other chemicals into your bloodstream. Doctors often can’t identify the reason for chronic hives or why acute hives sometimes turn into a long-term problem. The skin reaction may be triggered by:

• Medications: Hives may be caused or flared up by certain medicines. Most commonly pain medicines like aspirin, other nonsteroidal anti-inflammatory drugs, opioids, ACE inhibitors, oral contraceptives, and alcohol.
• Contact With Allergens: Contact urticaria occurs within 30-60 minutes of contact with an allergen like latex (especially in health care workers), plants, animals (eg, caterpillars, dander), medications, and food (eg, fish, garlic, onions, tomato).
• Neurological factors: An Italian study reported an association between CU and fibromyalgia. The authors proposed that CU is a consequence of fibromyalgia-neurogenic skin inflammation.
• Thyroid Disease: In some cases, chronic hives may be related to an underlying illness, such as thyroid disease.
• Insects or parasites
• Infection
• Food allergy: Usually milk, egg, peanut, shellfish.
• Vaccination
• Bee or wasp stings
• Scratching
• Heat or cold
• Stress
• Sunlight
• Exercise
• Alcohol or food
• Pressure on the skin, as from a tight waistband

Hives and stress

One factor that can make hives worse, is emotional stress. A study in 2005 linked stressful life events, low family support, and insomnia with hives. Chronic stress can lead to dysregulation of various inflammatory mediators and exacerbate the underlying disease. In other words, when a person is stressed, any inflammatory reactions are likely to be more severe in a person who is susceptible to a reaction. In this way, hives can be linked to stress.

Infections

Hives has been reported to be associated with a number of infections including Streptococcus, Mycoplasma, Helicobacter pylori, Mycobacterium tuberculosis, Herpes simplex virus, and Hepatitis B virus. Fungal infections such as onychomycosis, tinea pedis and candida have been considered as possible associations. Chronic Hives has been associated with parasitic infestations such as strongyloidiasis, giardiasis and amoebiasis.

Infections are more likely to cause acute urticaria in children where it accounts for a higher percentage of cases as compared to adults. Sometimes dental infections can also lead to hives.

Chronic Spontaneous Urticaria

Chronic spontaneous urticaria (CSU) is mainly idiopathic (cause unknown). An autoimmune cause is likely. CSU has also been associated with:

• Chronic underlying infection, such as Helicobacter pylori, bowel parasites.
• Chronic autoimmune diseases.

What are the clinical features of urticaria?

The wheals can be a few millimetres or several centimetres in diameter, coloured white or red, with or without a red flare. Some of the characteristics of hives are:

• Each weal may last from a few minutes to several hours and may change shape.
• The weals can occur in any part of the body and tend to occur in different areas throughout the duration of the condition.
• Itching, which may be severe.
• A tendency for signs and symptoms to flare with triggers such as heat, exercise and stress.
• A tendency for signs and symptoms to persist for more than six weeks and to recur frequently and unpredictably, sometimes for months or years.
• Painful swelling (angioedema) – This occurs in 30% of the cases and commonly affects the face (especially eyelids and around the mouth), hands, feet and genitalia. It may involve tongue, or inside the throat.

Complications

Anaphylaxis is a severe allergic reaction that can affect the whole body. Immediate medical attention is needed if there is:

• Nausea and vomiting
• Swelling of the lining of the mouth, tongue, lips, and throat, causing breathing difficulty.
• Rapid heartbeat
• Faintness or lightheadedness
• Unexpectedly abrupt feeling of intense anxiety
• Cold and clammy skin

When to see a doctor

Consult a skin specialist if you develop acute or chronic urticaria. The dermatologist will usually prescribe a non-sedative newer generation H1 antihistamine to control the hives as well as any further counselling and treatment according to the severity and characteristics of the condition. Patient education is also a very important part of the treatment for hives.

Investigations

In spite of extensive laboratory investigations, 50% of cases of chronic hives remain idiopathic which means that it does not have any specific cause. An elevated WBC count or elevated ESR may suggest the possibility of an underlying systemic disease and eosinophilia should prompt a search for parasitic diseases. Screening test for thyroid function and antithyroid peroxidase and antithyroglobulin antibodies may be carried out in candidate patients. Positive autologous serum skin test (ASST) suggests an underlying autoimmune mechanism. In vitro ‘basophil histamine release assay’ is currently the gold standard for detecting functional autoantibodies.

Diagnosis

Usually, the diagnosis depends on the patient’s history and the clinical features on skin examination. Your skin doctor will do a physical exam and ask you a number of questions to try to understand what might be causing your signs and symptoms. He or she may also ask you to keep a diary to keep track of:

• Your medical history including any pre-existing conditions or recent infections etc.
• Your activities.
• Any medications, herbal remedies or supplements you take.
• What you eat and drink.
• Where hives appear and how long it takes a to fade.
• Whether your hives come with painful swelling.

If your physical exam and medical history suggest your hives are caused by an underlying problem, your doctor may have you undergo testing, such as blood tests or skin tests.

Read about some common myths and FAQs about hives.

To know more about the treatment of Urticaria, check out – Urticaria Treatment.

The Cons!

• It is a long process: A session of laser hair removal on the upper lips takes less than a minute. However, it takes multiple sessions to see real results and you generally have to wait 4-6 weeks in between treatments. Different parts of the body have different growth rates and therefore could take longer or shorter depending on the area being treated.
• You need to attend every session: You have to be consistent with treatments to get the best results.
• The cost factor: Laser hair removal is costly.
• Less effective in dark-skinned individuals: LHR works best on fair skin with dark hair because the contrast between the skin tone and the hair colour allows the laser to easily pick up the target areas. In patients with darker skin tones, the pigment-rich skin competes with the hair follicle for the laser energy absorption. Certain lasers, like the Nd:YAG, are better in such cases so discuss with your skin specialist about which laser is to be used in your case.
• Epidermal Burns: If done by non-certified personnel, laser hair removal could leave burns or scars on the skin. Unfortunately, licensing procedures vary from state to state, and sometimes there are no requirements at all. Make sure that the procedure is being done by a dermatologist or under the supervision of a certified doctor.
• There are a few risks: There is a risk of burning which was discussed above. some of the other risks include blistering, discolouration, redness, and scarring. There’s also the possibility that your hair could grow back and may require yearly treatments to keep new hair growth at bay.
• Risk of pigmentation: There is a chance of increase or decreased pigmentation in the treated areas. To overcome this, you will need to apply a sunscreen with SPF30 regularly before and after the procedure is done, regularly.
• Reduced effectiveness if there is hormonal imbalance: Sometimes, hirsutism (unwanted hairs growing in females) can be a result of PCOD or other hormonal imbalance. In that case, your doctor will investigate you for the same and suggest medicines depending on the condition. Sometimes, additional medicines are required to control these hormonal imbalances in addition to laser therapy or as an alternative to it.
• Not available everywhere: Some of the skin care clinics may not be having the laser services due to high cost and upkeep of the machines.
• COVID19 Era: While treating areas such as the upper lips, the mask has to be removed. Make sure that the clinic where you are taking the LHR services are using the national guidelines of COVID19 prevention in their laser room.

The Pros!

• Best hair removal option: Yes, laser hair removal doesn’t get rid of hair forever (see the cons) but it does drastically reduce hair growth — to the point that you can stop shaving altogether and remains the most effective treatment for unwanted hair.
• Can be done for any area: You can get it done anywhere on the body, and the machine can cover large areas quickly. You can target the face, neck, underarms, back, arms & legs, bikini line, stomach etc.
• Excellent results: While laser hair removal can work on any body part, it is especially effective on the lips, chin, and underarm areas, especially if the hair is dark and the skin is fair.
• It shouldn’t be painful: When it comes to pain level, laser hair removal falls somewhere between shaving (painless) and waxing (painful). The skin specialist will usually use a cooling system to numb the area before and after the laser treatment. It also gets progressively less painful as treatments continue and the hair becomes finer.
• Precision – Lasers can selectively target dark, coarse hairs while leaving the surrounding skin undamaged.
• Speed. Each pulse of the laser takes a fraction of a second and can treat many hairs at the same time. Small areas such as the upper lip can be treated in a few minutes.
• Predictability. Most patients have great results after an average of 4-6 sessions.
• Diode Laser: The diode laser is very effective for light and dark skin and it is the most commonly used laser for hair removal in our country.
• Don’t worry if you’re on your period. Unlike getting a bikini wax, you should not cancel your treatment due to your period. It’s very important to stay consistent with treatments.
• The cost factor: Yes, it was mentioned as a con. But if you see the cost of regularly buying razors and waxing, those costs also add up to pretty much the same amount. So in some situations, it can be considered as a “beauty investment”. At our skin care clinic, we are doing LHR at very affordable rates to make sure that the cost is not an issue.

Although laser hair removal is not without its fair share of cons, it is a very beneficial procedure to be done especially if it is being done by a certified dermatologist. Read more about the frequently asked questions related to LHR.