Must-Dos By A Doctor

Now coming to diseased skin, a good dermatologist who has good vision along with a good clinical acumen Or  knowledge of dermatology, should be able to in 95 per cent of the cases, diagnose the disease or at least arrive at the most two probable diagnosis, which can then be confirmed as to which particular disease the skin has. But unfortunately, this is not followed in most of the cases and  most  modern dermatologists start their therapy with steroids, which is either warranted or not warranted. Drugs like methotrexate to more toxic substances should be used only as a last resort.

For seasonal skin diseases, some of the diseases which are seen to occur normally in winter are atopic eczema, psoriasis, numular eczema, winter itch, senile pruritis and pitryasis rosea, seboric dermatitis with itchiosis which if congenital could last throughout the year, with the degree of severity increasing during winter. Likewise, preceding summer, generally there are diseases like pitryasis rosea, dishidrosis with erythrema multiformae.

During summer one may get contact dermatitis, tinea of the feet and groins, miliria and prickly heat, actinic dermatitis, insect bites, impetigo and tinea versiculor, which are all very common. On the contrary, Darrier’s disease and epidermolysis bulosa are uncommon and could be drug induced. Tinea of the scalp is more common in school children.

Before jumping to what the conclusion of the diagnosis is, more than just a cursory glance must be given to the skin, which by itself will provide the doctor a 3:1 probability or idea of what the disease is likely to be. This has to be followed by a question answer session, with questions probing in nature to determine the cause of the disease. You will be quite surprised that this could lead to a 90 per cent conclusive arrival of what the disease is or what the cause of the disease would be.

It just takes the remaining 10 per cent to diagnose the actual condition, since if a person is on the right track and a particular set of medicines is being given, which are not immunosuppressive the patient improves and begins to feel positive towards the entire treatment. Above all, time must be taken in explaining to the patient about the disease, so that he or she understands the condition and hence builds up self confidence, which finally leads to being cured completely in as short a time frame as possible.

One of the basic tenements or principles of medicine is that the doctor must see to it that the drug prescribed does not do any harm, if not good and also not to over treat. It is also important for the physician to know which of the medicines prescribed for local use on the skin could be greater irritants and sensitisers on the patient’s skin. This is because there is no substance on earth, which is 100 per cent non-allergic or non-toxic. There could be even one person in a million who could be allergic to a particular substance, which may be contrary to the remaining segment of the population.

Skin allergy is one of the most common skin ailments. Basically, one should have had a family history of urticaria, hay fever, allergic rhinitis, eczema or asthma.

A study proved that a disease can be genetically passed on up to the 9th generation. If an average Indian family is considered. of what it was 8 generations back, would encompass about a minimum of 2500 to 4000 individuals. Family history does play a major role in the diagnosis of the skin ailment and also does play a considerable role in the therapy part too.

Nowadays, substances known as Mast cell stabilisers are available, which prevent the release of serotonin / 5 HT, which makes a break in the allergic cycle that prevents the release of histamine itself. But this takes at least 60 days to start action and should he taken for about 10 months to a year depending on the improvement or the lack of improvement in the individual concerned. Interestingly, this acts on all the five conditions of allergy mentioned earlier. But surprisingly a lot of prescriptions with just a week’s dosage or probably a month’s dosage are prescribed by many doctors.

Sometimes the patient is also to blame, as he or she may not have taken the medicine for the prescribed period. The patient may also say that the previous doctor already prescribed the particular medicine to him or her and it never worked. Well, a new class of medicines called Leucrocrene Inhibitors is available, which act again on a different section of the allergic cycle and also have a different mode of action along with a shorter duration of treatment associated with it. But it has been observed in clinical practice. that certain patients who don’t really respond to these leucocrene inhibitors. but instead have responded more positively to the mast cell stabilisers, which are more than 15 to 20 years old.

So this is evident that it is not necessary for us to assume that the newer medicines are better and more efficient, because there still will be one or two individuals out of ten who respond better to the older drugs.

– Dr. Anand Krishna