Recent weather changes have resulted in a spike in skin diseases of various types affecting young and old alike. For adolescents in particular it has been found, such ailments could be a source of distress and worry if they cause visible blemishes and scarring on their skin. However, the good news is that most of these skin ailments could be effectively controlled and cured with no lasting blemishes if treated early under a structured treatment program, Dermatologists have opined.
To find out more about what these ailments were, how they could be detected, who were most vulnerable to getting them, and most importantly how they could be prevented and treated effectively under professional advice, the Sunday Observer spoke to Consultant Dermatologist and Past President, Sri Lanka College of Dermatologists, Dr. Indira Kahawita for her views.
Excerpts
Q. Currently Sri Lanka is experiencing sudden changes in its weather pattern starting from excessive heat in the day to cool nights . What is the effect of such climatic weather on the human skin?
A. It can be two-fold. Excessive heat and resultant sweating can lead to skin problems like sweat rash and fungal infections. The effect of direct sunlight on the skin may lead to what we call “sun rashes or photodermatitis”
Q. Who are those most vulnerable to exposure of extreme heat on their skin?
 Dr. Indira Kahawita |
A. Those in the extremes of life like babies and the elderly are more vulnerable to heat. Babies, with their relatively immature skin, find it difficult to regulate heat, which is a primary function of the skin. The elderly too find it difficult to tolerate extremes of heat. In addition there are some who are affected by certain diseases that make them sensitive to heat or sunlight. They too find it difficult to tolerate the sun.
Q. How do you prevent / minimise adverse impacts of heat and sunlight on the skin?
A. Wear cotton garments that are not tight fitting. Light colours absorb less heat and are better for day wear. If the sun is very hot try to cover your skin. This can be done by wearing long sleeved garments, using a sunhat or umbrella or by using sunscreen. Drink a lot of water as water is lost by way of sweat.
Q. Currently we are experiencing flooding and landslides in some areas and drought in other areas . What are the common skin infections you now see arising among the Lankan teen population due to these adverse weather conditions ?
A. Fungal infections in the form of tinea/ ring worm and aluham or pityriasis versicolour are common among the teens. Viral warts are also seen but these are commoner in younger children.
Q. Which of them is most prevalent among teenagers?
A. Fungal infections are common. This may be due to many reasons including change in attire (tight fitting synthetic clothes and occlusive footwear), lifestyle changes and poor adherence to treatment. Studies have also shown that the species of fungi causing ringworm infections are also changing.
Q. Acne has also been recently cited in a medical journal as being by far the most common skin ailment among teens and pre-teenagers.. Since many teenagers and pre teens still don’t know the exact meaning of Acne, tell us what is Acne in simple layman language?
A. Acne in simple terms means “pimples”. It can present as small papules initially but can become red, inflamed or infected later. The cheeks and forehead are usually affected but some may have lesions in the front and back of the chest too.
Q. Is it infectious? Can someone with Acne pass it on to another by contact?
A. Acne is not infectious. It is due to hormonal changes during adolescence. A bacterium is involved in the causation of acne but acne cannot be passed on from one person to another.
Q. Is it treatable? Are there natural remedies?
A. Acne is treatable. Treatment is needed if Acne on the face of a young person is visible from a distance or if the person is worried about Acne. One aim of treating Acne is preventing permanent scarring of the face.
Q. How is it treated? Are home remedies advisable?
A. Treatment of acne varies according to severity. The mildest cases may not need any specific treatment apart from an acne face wash or mild remedies like aloe vera. Application of homemade remedies prepared from plants is not recommended as infections may be introduced through these. Moderate to severe acne is usually treated with combinations of gels/ creams and oral medications like antibiotics/ hormonal treatment. These medications must be continued for at least 6 weeks before a good response can be observed. It is important to avoid touching/ “popping” acne since that may lead to permanent scarring.
Q. Do they have to be hospitalised while undergoing treatment?
A. No. All treatments are done at home but regular follow up is necessary.
Q. What is the usual age for teenagers to experience their first sign of acne?
A. Acne usually occurs for the first time around puberty. So girls tend to get acne earlier. Sometimes acne may occur even before other signs of puberty appear.
Q. Some teenagers have been known to seek instant cures for acne and pimples by accessing the internet and ordering instant fixes to their problems from dubious sales outlets which sell sub quality creams with excessive chemicals to produce quick results. Could you tell us about some of the adverse impacts on their skin that long term or short term application of such products can have?
A. All teenagers (anyone for that matter) with acne should avoid using such products, especially those that promise instant results. Acne treatment should be tailor-made to suit each individual. Most of these instant cures contain steroids or bleaches to give an immediate sense of cure. Such products may lead to exacerbation of Acne, white/ dark patches on the face or stretch marks. Cosmetic induced Acne needs longer term treatment than puberty related acne.
Q. Apart from the temporary disfigurement they suffer, psychologists have noted that the young victims are often mentally and emotionally affected, some of them refusing to go to school or interact with friends and isolate themselves from the rest of society. In short, they lose their self-worth and some even have self-harm thoughts. What is your observation on this?
A. This is an area less studied in Sri Lanka. In the developed world the psychological impact of acne and other skin problems of adolescence has been studied well. That said, as parents and teachers adults need to be aware of this psychological impact on young men and women.
Q. So before you treat a teenager with a skin ailment do you have a counsellor to discuss their matter and allay his/her fears of disfigurement?
A. In our context a Counsellor is not readily available. According to my experience most young people are able to cope if we explain to them about the condition and the nature of treatment. They will be referred to a Psychiatrist/ Psychologist only if they cannot cope even after these initial measures.
Q. Are pre-existing conditions and use of medications for other conditions they suffer from interfere with the treatment given?
A. For most of the youngsters there are no pre-existing conditions. The commonest medication interfering with acne in Sri Lanka is the steroid group. In most instances steroids are not used for medical conditions. They come in the form of face creams that girls use for a “whiter skin” or the vitamins and supplements boys use to achieve an “attractive body”. Both parents and young people should be aware of this menace as steroid acne can be resistant to treatment and long lasting.
Q. Any drawbacks you face in the delivery of optimal skin care to young people?
A. Some of the quality branded Acne medications are expensive and some are not available in the government hospitals. .
Q. Now that schools have reopened, what are the skin problems we are likely to see in children exposed to adverse weather conditions?
A. White patches in the cheeks are seen commonly in pre-teens. Children with pre-existing dry skin can get this when they are exposed to the sun.
Q. Aluhang is also a condition that is common among young people. What is aluhang?
A. Aluhang is a fungal infection commonly appearing as white patches in the face, upper trunk and upper limbs. In children and adolescents they occur as tiny white dots and patches.
Q. Scabies, boils, skin abscesses, warts are very common skin diseases. How do they occur and why?
A. Scabies, a highly contagious parasitic infestation, occurs mainly as extremely itchy papules in the finger web spaces and flexures. Boils, due to a bacterial infection, may occur when there is excessive sweating. Face is the commonest site for boils. This is commoner in young children. Abscesses are the larger version of boils.
Q. How are they caused?
A. Warts are due to a virus. It’s seen commonly in the hands and feet of young children. Sometimes they may occur on the face as flat warts. Warts are spread by touch and are notorious to occur in areas of skin damage. So it’s advisable not to try removing those using fingernails or sharp objects.
Q. Are they infectious?
A. Yes, all these may be transmitted from one child to another by touch. However as all these conditions are treatable, my advice is to seek help early to avoid long lasting consequences.
Q. What are the recent interventions that the Sri Lanka College of Dermatologists has put in place to help those with skin disorders?
A. The Sri Lanka College of Dermatologists’ website has a section for the public. This contains information leaflets and public education videos about many skin problems in all 3 languages. We also have a YouTube channel talking about common skin conditions and simple cosmetic procedures. Recently the SLCD carried out a campaign titled “the colour of your skin is the colour you own” to educate them on preserving their natural skin colour and discouraging the use of skin whitening agents.
Q. As we are now moving into an hi- tech world, how has this new technology helped in early detection and treatment of skin disorders ?
A. New technology is being used for early detection and non-invasive diagnostics. Also the use of telemedicine and audio/ video consultations have been useful during the current crises where physical consultations were difficult.
Q. What is your message to all teens out there?
A. Most of your skin problems are due to the hormonal changes of adolescence and can be managed effectively to give you confidence to face the world. Please visit the nearest skin clinic or see a dermatologist without trying home remedies and advice from the internet.
Q. Have you got a hotline or contact line where they can reach you?
A. Sri Lanka College of Dermatologists: e mail [email protected]. We also have a website and a Facebook page, where the public can reach us.