Cosmetic problems: increasing role of lasers
Dr Gurinderjit Singh

Before laser resurfacing	After laser resurfacing

Although lasers have been in existence for decades, it has only been in the past few years that general interest has been aroused in their use for cosmetic dermatology. The rise in laser popularity has been due, in large part, to the development of a new class of "pulsed" lasers that can treat skin lesion without unwanted thermal (heat) damage.

Dermatosurgeons have been treating photodamaged skin and such dermatologic lesions as tattoos, birthmarks and scars for many years by excision, dermabrasion and chemical peels. These treatments mechanically removed the top layer of the lesional skin, thus invariably leading to scarring. Even with the advent of laser technology in the 1960s, and continued advancement in the 1970s, the risk of scar formation remained high because of significant heat diffusion from the "continuous wave" lasers. It was only in the 1980s that the concept of "selective photothermoloysis" was introduced, when a target lesion of the skin could be selectively destroyed using a specific wavelength and pulse duration.

Let us discuss the various applications of skin lasers in tackling different types of cosmetic problems.

Hirsutism is the term used for hair growth in women that occurs at locations normally found at puberty in men (e.g. face and chest). It may be viewed as and- rogen-dependent hair growth in females. Causes of hirsutism may be heredity, ovarian tumour, adrenal abnormality, oral contraceptives and the use of various hormonal drugs or systemic steroids.

Most modern women desire hairless legs, axillae and inner thighs, and young male models remove hair growth on their backs and shoulders. People employ several temporary manual strategies like shaving, wax epilation and chemical depilatories to remove hair. In some cases, electrolysis may be permanent, but the process remain tedious with occastional scarring. Laser-assisted hair removal has revolutionised the hair removal industry by providing efficient long-lasting depilation over large body surface areas.

However, several realities of hair growth present unique challenges, making laser hair removal a difficult task. This is mainly because hair growth is a dynamic process and hair grows in cycles consisting of both growing and resting phases. Multiple laser sessions are essential for effective hair removal because laser light destroys the growth centre of the hair only during the growing phase. About 30 per cent of the hair is in the growing phase at any given time whereas 70 per cent of hair is in a resting phase. It takes about three weeks to four months for the hair in the resting phase to go into a growing phase . It is only then that the destruction of hair follicles achieves permanent.

Normally, four to five sessions, with a three-six week gap between each session, are necessary to see visible results. For the later sessions, if only, the gap may increase to six-eight weeks as hair growth slows down.

A variety of cutaneous vascular lesions are amenable to treatment with currently available vascular-specific lasers. Facial telangiectasias as well as birthmarks such as port- wine stains can be successfully treated with pulsed-dye laser. The best results are obtained in patients with lighter skin tones because the melanin in darker skin decreases the amount of available laser light, thus requiring additional sessions to achieve the desired result.

Laser treatment of pigmented lesions has traditionally been limited to only benign conditions such as solar lentigens and pigmented birthmarks like cafe-au-lait spots and naevus of Ota. The pulsed-dye laser and QS laser systems do selective photothermolysis thus destroying the pigment cells only.

Decorative and cosmetic tattoos have become increasingly popular, despite growing concerns about the infectious transmission of human immunodeficiency virus (HIV) and hepatitis. Most decorative tattoos are multicoloured with black, green and red inks used more commonly. Cosmetic tattoos involve an injection of flesh toned, brown, rust or red pigment to mimic eyeliner, lipliner or blush.

Despite their popularity, many patients approach dermatosurgeons for getting their tattoos removed. The advanced Q-switched laser systems cause rapid thermal expansion of ink particles leading to pigment fragmentation.

Treatment of scars with surgical excision, dermabrasion and cryotherapy has been limited by undesirable side-effects such as scar worsening and recurrence. Similarly, striae, which arise during puberty and pregnancy, are notoriously difficult to treat. Thick scars and big keloids are best treated by a combination laser treatment, consisting of high energy pulsed carbondioxide laser de-epithelialisation followed immediately by 585 nm pulse dye laser irradiation, which even alone is highly effective in the treatment of striae.

Patients whose skin has been overexposed to sunlight not only are more susceptible to skin cancers but also develop premature wrinkles. Recently, there has been development of high energy pulsed and scanned carbondioxide laser, which selectively and precisely vaporise the superficial layers of the skin leading to excellent facial rejuvenation and resurfacing. Though actual laser resurfacing procedure lasts only an hour or so, postoperative skin care and follow-up persists for several months in the form of repeated sunscreen use in order to avoid post-laser hyperpigmentation.

Laser surgery is no longer reserved for port-wine stains and naevus of Ota, which do not have any effective alternative treatments but it has also become the treatment of choice for a number of conditions such as facial hair, rhytides (wrinkles) and scars, which have been responsive to various other older forms of therapy as well.

Given the recent laser "hypteria" that has hit the medical and public mainstream, it will be especially important to maintain an objective eye to ascertain the distinct advantages of using this technology in the future.

— The writer is Chief Dermatologist, Mohan Dai Oswal Cancer Treatment and Research Foundation, Ludhiana.

Destiny of your teeth is in your hands
Dr O.P. Munjal

We like it or not, but we all live in a “beauty-conscious” and “health-conscious” society. A pleasing appearance makes or mars our success in our personal and professional lives. Our face and, more importantly, our teeth are no exception. To keep that smile intact, we have to maintain our teeth in a perfect state.

Then the big question arises: Is brushing twice a day adequate? The simple answer is NO. Actually, plaque — the thin invisible film of bacteria which sticks firmly to the whole tooth surface — is the primary cause of tooth loss because of decay and gum disease. Thus, all our effort to keep the mouth clean is actually a battle against plaque. And plaque removal is a two-step process of brushing first followed by cleaning in-between your teeth/bridges/ crowns/implants, i.e. the areas where the tooth brush can’t reach. Brushing alone cleanses only 60 per cent of the tooth surfaces and 40 per cent remains untouched and uncleaned.

This remnant of the plaque is the root cause for gum diseases, cavities, loosening of teeth and their ultimate untimely loss. Thus, cleaning in-between the teeth is mandatory after brushing. Its importance cannot be over-emphasised. Besides, this is the most neglected effort in our mouth-cleansing daily procedure. The obvious quarry would be: How should you clean in-between your teeth? The answer is again very simple.

(a) Ensure a good flow of saliva by drinking more fluids so that the natural defence system washes away the hidden spaces in-between the teeth.

(b) Roughage in the diet — fresh fruits and salads — cleanses these inaccessible areas.

(c) Inter-dental brushes are very small, tapered or cylindrical fine bristle brushes which are used to clean the plaque in those areas.

(d) Inter-dental wood sticks are triangular shaped wooden sticks which may be used to clean your teeth and massage your gums.

(e) Flossing is an important part of inter-dental cleansing comprising of a simple thread which is passed in-between the teeth to clean where we can’t clean. The exact procedure must be learned from your dentist who will demonstrate the use of floss.

(f) Oral-irrigator system like a water-pik is an excellent system which cleanses those areas with a jet of water.

— The writer is a Chandigarh-based dental surgeon.

WASHINGTON: The shampoo for your luscious locks may damage your nervous system as an antimicrobial agent found in many shampoos and hand lotions has been found to be severely harmful for the development of some particular neuron structures that are essential for transmitting signals between cells.

According to a University of Pittsburgh study, prolonged exposure to low levels of methylisothiazolinone (MIT) restricted the growth of axons and dendrites of immature rat nerve cells by blocking a key enzyme that is activated in response to cell-to-cell contact, and hence were found to have potentially damaging consequences to a developing nervous system.

"While more research is needed to determine what effect MIT would have in rodent models, both at the cellular level and to a developing nervous system, our results thus far suggest there is potential that everyday exposure to the chemical could also be harmful to humans. I would be particularly concerned about occupational exposure in pregnant women and the possibility of risk to the foetus," senior author Elias Aizenman, professor of neurobiology at the University of Pittsburgh School of Medicine, said.

As an antimicrobial agent, or biocide, MIT and related compounds kill harmful bacteria that like to grow near moisture or water and hence are often found in personal care products, as well as in water-cooling system. However, the research has now revealed that even a. 10-minute exposure at a high concentration was lethal to the nerve cells.

"This chemical is being used more and more extensively, yet there have been no neurotoxicity studies in humans to indicate what kind and at what level exposure is safe. I realize it’s a big leap to suggest there may be a parallel between environmental exposure and the noticeably higher rates of diagnosed childhood developmental disabilities, but I would caution that based on our data, there very well could be neurodevelopmental consequences from MIT. Clearly, more study is needed, with both scientists and government regulators equally engaged," Dr. Aizenman added.

LONDON: A new report by ‘Age Concern’ has revealed that having friends can add seven years to an old person’s life as it makes them feel active and positive. According to The Mirror, this is twice the number of years that quitting smoking can add to a person’s life, as quitting smoking at an old age adds three years to life. The researchers are encouraging young people to befriend pensioners, as they are often depressed and die alone.

"Older people live in the poorest housing and in fuel poverty — afraid they will be unable to heat their homes. Dark nights and wintery conditions can make it difficult for older people to get out, leading to isolation which in turn can cause loneliness and depression," the report quoted one of the researchers as saying.

LONDON: Whereas hitting the gym at any time of the day is always a great idea as it can take you a long way in being healthy, experts are now warning that you should avoid ‘binge exercising’ as it can have disastrous long-term effects. Researchers at the Institute of Sport and Recreation Management, say that most people are over-enthusiastic when they first start exercising which makes them overdo it. This in turn leads to various physical problems like damaging muscles, bones and joints.

But the worst consequence of this kind of exercising is that it can ruin people’s confidence in themselves if they are not able to exercise for too long and meet the targets they had set for themselves, which makes them give up on exercising altogether, reports Daily Mail. — ANI

Adequate intake of water helps in skin care
Neelam Sharma
Tribune News Service

Chandigarh: As the mercury dips further and the chilly winds lead to shivering days ahead. Skin specialists advise you to take a bit of extra care to protect the moisture and softness of your skin.

“The most common problem in the winters is skin dryness. In extreme cases, the skin develops cracks due to dryness, which exposes the skin layer. This leads to skin infections caused by bacteria and fungus,’’ says skin specialist S.D. Mehta of the Polyclinic and Health Centre, Sector 22.

The main reason for the skin problems in the winters is the reduced intake of water and fluids, which leads to immediate dryness of the skin. “Since the humidity levels go down, the water intake is drastically reduced in this season. People are recommended to have a lot of water and fruit juices, preferably without any preservative, to keep the skin healthy,’’ adds Dr Mehta.

From mild itching to the formation of blisters, bacterial and fungal infections can worsen if the skin is scratched repeatedly. This situation is more common in the elderly and children who are generally lax in taking proper care of the skin.

As an ideal cure, doctors recommend oil massage before taking bath in the winters.

However, for the oily skin, a good oil-based non-drying bathing soap should be used to reduce damage to the skin. The experts add that perfumed oils and soaps should be avoided.

“The winter sun is also good for the skin. If a person does not have a sensitive skin which is allergic to sun-rays, then basking in the sun is a healthy option as the sun has a sterilising effect and also produces the essential Vitamin D in the body,’’ adds a doctor.

Moreover, cotton clothes should make a direct contact with your skin to avoid infections. Woollens should be worn over the cottons. A direct contact of woollen or synthetic clothes with the skin can aggravate the problem.

Amla has radioprotective potential: scientists

Mumbai: Several fruits and extracts, including “amla”, has tremendous ‘’radioprotective potential’’ which needs to be explored, according to papers presented at an international conference here.

Emblica officinalis, the English name of ‘amla’ belonging to the family of euphorbiaceae and is extensively found in India. The fruits of this plant have been used in Ayurveda as a potent ‘’rasayana’’. The radioprotective potential of this plant has not been fully explored so far, a team of researchers from the Radiation and Cancer Biology Laboratory, Department of Zoology, University of Rajasthan, Jaipur, said in the paper. — UNI

Ayurveda & you
Skin requires special attention in winter
Dr R. Vatsyayan

Though winters are known to be a healthy season, the dry, rough and cool winds of these months have a harsh effect on our skin, making it to appear dry, flaky and chapped.

*The winter season requires a dedicated daily regimen which should include some steps to take care of the skin also. The outer layer of the skin called epidermis constantly peels off and rejuvenates. It is the most easy target of the vagaries of the environment. In order to preserve its delicacy and to prevent any problem arising due to cold weather, here are some important tips which, if followed, can help a better skin care in winters:

*The winter air due to low humidity can be very harsh and drying on some types of skin. Avoid exposing skin to freezing temperatures and drying cold winds. While going out , one should adequately wear warm clothing. Care should be taken to cover the hands, feet , ears and the head.

l It is tempting to take a hot and long shower when it is too cold. Remember, very hot water can strip the skin of its natural moisture. Warm water is skin-friendly, but if you ever want to bathe in hot water use it for a shorter period. Do not use any harsh soap. Instead, select a mild one which suits your skin.

*Ayurveda has since long stressed the need to adopt body massage as a part of the daily routine, and there is no better season than winter to gain its numerous benefits. A 10 - 15 minutes’ pre-bath massage with oils like that of mustard, coconut or olive improves the texture and tonicity of the skin, removes dryness and maintains the youthfulness of the body. Those who are emaciated or have got their skin parched due to excessive dryness can use simple desi ghee for a pre-shower massage.

*Take special care to nourish the skin of the face, hands and elbows. Apply moisturizers to the skin immediately after a bath or shower while the skin is still wet. A cream, ointment or lotion, if put soon after the bath, spreads well and helps trap water in the upper layers of the skin and decreases dryness and itching. In dry chilly weather, wearing a light layer of natural balm like the clarified butter on the lips prevents their cracking.

*The skin of the feet tends to get dry and crack more in the winters. Treating it with a relaxing soak of warm water at night not only keeps the feet looking good but also facilitates a sound sleep. Applying the famous "jatyadi tail" on the hard and cracked crevices of the soles makes them soft and helps a faster healing. In extreme cold conditions and to prevent the chill blains it is better to cover the hands and feet in woollen gloves and socks.

*To provide nutritional support from within, Ayurvedic texts advise the use of a rich, wholesome and unctuous diet in winters. It should include a reasonable amount of milk, butter and cheese and fresh fruits and vegetables. Regular use of amla (Indian gooseberry), the richest natural source of Vitamin-C, promotes immunity, clears the toxins and provides good nourishment to the skin.

— The writer is a senior ayurvedic consultant based at Ludhiana.