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2 What Is Your Skin Telling You?

21 March 2023

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'Beauty is of the great facts in the world like sunlight, or springtime, or the reflection in dark water of that silver shell we call the moon'

-Oscar Wilde

'My skin is not too bad, doc, but my nails are chipping away to glory,' wailed

Mickey.

'Mickey, nails can become weak due to frequent use of nail polish or nail polish remover containing acetone. Gel nails and artificial nails are indeed in vogue but too much exposure to UV rays can damage the nail. If you are in contact with chemicals constantly due to your profession and you often don't wear gloves, your nails can become brittle. If you have OCD and wash your hands with soap every other hour, your nails can become weak.'

'But, doc, I do none of that. No gel nails, no frequent washing, no chemicals. I fail to understand this. Help me, doc. I do want my natural nails to grow long so I can shape them well and apply a nail polish to match every outfit I wear for my various functions."

'Mickey, do you know our skin often gives us signals about what is going on inside our body? We must learn to listen to our skin. And when I say skin, I mean nails and hair too because hair and nails are a part of skin. So, there is a hidden reason behind your brittle nails. Your nails are telling you that you are deficient in protein and biotin. Nails comprise of keratin, which is nothing but protein.'

Other deficiencies can also manifest as skin, hair or nail disorders. For example, if your knuckles are turning black, it's time to check if your vitamin B12 levels are low. If you develop dark circles despite sleeping well, your haemoglobin may be going down.

Skin is the largest organ of our body. We think of it simply as an outer covering of the body, like an orange peel, which we can abuse as we please. But it is a vital part of the body. It shields our internal organs, provides vitamin D, regulates body temperature and, most importantly, gives us signs of any internal problem.

We all look at ourselves in the mirror every day. Why not take a few moments to carefully examine our skin? To feel it and see if there is anything abnormal or different. Does it feel dry or oily? Does it look dull, oily or radiant?

If your skin feels dry, you have not moisturized it well. 'But I did apply a moisturizer before sleeping,' said a friend who works at a corporate office. You may have done so, but then you sat in your air-conditioned office for twelve hours. That is enough to dehydrate you. Your skin is asking for more. So please moisturize in the morning as well. My friend answered, 'I am in such a hurry in the morning. Where is the time to moisturize?'

Well, you could keep a bottle of moisturizer in your car and apply it on the way to work. If you travel by public transport, just keep one in your office drawer. You may be in the air-conditioning for long hours or in a place where the temperature is very low. This zaps the moisture from your skin and makes it dry. You need an extra amount of moisturizer. If you are using it only once a day, switch to twice a day now. And do not forget your arms, legs, hands, feet, neck and back.

If you suffer from frequent pimple outbreaks and are losing hair as well, it's time to find out if you have polycystic ovarian syndrome (PCOS) or raised androgens (male hormones which females also have in small quantities). This is an extremely common condition in girls who have attained menarche. Small cysts appear in the ovaries due to a hormonal imbalance in the body. This leads to a series of problems like acne, hair fall, hair growth on body parts like the face, weight gain and sometimes irregular periods. If you have any two of these symptoms, you should get an ultrasonography of your ovaries and do some blood tests during your menstrual cycle.

This will help you find out if you have PCOS or any other hormonal imbalance. If you happen to suffer from PCOS, make sure your weight is under control. And make sure you consult a gynaecologist. Sometimes all your efforts to treat acne will fail or you will end up doing twenty-odd sessions of laser hair removal and still suffer from disastrous pimples and hair growing on the body. But treat the PCOS-and lo and behold! Your acne will disappear, and so will your body hair suddenly respond to laser.

At a party one day, my friend said she was noticing some pigmentation on her back and arms. She was using double the amount of moisturizer and yet her skin felt dry. I asked her to get her blood tested for thyroid hormones. Sure enough, she had high levels of thyroid stimulating hormone (TSH). This signified that she was suffering from hypothyroidism. I asked her to consult an endocrinologist (a doctor who specializes in disorders of hormones). Hypothyroidism is an autoimmune disorder and it can cause dryness of skin and even pigmentation on the skin.

My father once developed pus-filled boils on his legs. I remember going to the local dispensary with him where Dr Singh told him that boils occur because of a bacterial infection called staphylococcus. 'You must be scratching your legs and your nails must be infected with bacteria,' he told my dad. I used to admire Singh Uncle. He was a doctor, after all. Something I would also be when I grew up.

'Oil your legs, they won't get dry and you won't keep scratching,' my granny would tell my dad. She was certainly not wrong. And she didn't have a post- graduate degree in skin to diagnose dry-skin woes. But that didn't work and Dad developed boils yet again. This time Singh Uncle asked dad to get his blood sugar tested. Dad was around thirty-five years old and he wouldn't believe that he could be suffering from diabetes at such a young age. But Singh Uncle was very strict. Dad couldn't possibly overrule his instructions. Besides, who would treat his wounds? So his blood tests were done. One blood sample was taken early in the morning after he fasted for twelve hours. Another blood sample was collected two hours after his lunch. Singh Uncle was in shock. Dad's reports showed that both his fasting and post-meal sugar levels were high. Singh Uncle must have cursed himself for not asking for these blood tests four months earlier, when Dad first got those boils. It happens with all doctors sometime or other. But all's well that ends well. At least the diagnosis was made. Dad was immediately put on anti-diabetic medicines and his wounds healed as if a genie had performed some miracle.

Diabetes can manifest in the form of bacterial infections like pus boils or itchy fungal rashes in the body folds. Sometimes wounds as simple as a scratch on the skin will either take ages to heal or be stubborn and just not heal. Sometimes there is excessive itching on the arms and legs without any visible skin rash. Another common condition seen both in diabetes and hypothyroidism is speckled pigmented patches over arms, legs and upper back. This condition, often mistaken as sun tan, is called cutaneous macular amyloidosis. It sometimes itches but most of the time it may be symptomless. 'Cutaneous' means skin, 'macular' means flat spots or patches, 'amyloidosis' means deposition of a protein-containing pigment called amyloid.

My friend Naina's nineteen-year-old son has a thick band of pigmentation on his neck. It looks like a layer of dirt. 'He doesn't bathe well, J, he is very unhygienic,' Naina said when she brought him to me one fine day after months of coaxing. The pigmentation didn't bother him as much as it bothered her. She had even scrubbed his neck a couple of times but the stubborn dirt did not budge. I told Naina that the stubborn dirt was not dirt at all. Darkening and thickening of skin, almost like thick rugosities on the neck, arms and armpits is known as acanthosis nigricans. It is usually a sign of insulin resistance or diabetes. But it may also be seen in obese people.

One must get a blood test done to check both fasting and post-meal insulin levels as well as blood sugar levels to know if there is insulin resistance. Insulin resistance can eventually lead to diabetes. Insulin is a hormone produced by pancreas. It regulates the sugar level in the blood. Whatever sugar or carbohydrates we eat are utilized for energy with the aid of insulin. The excess sugar, however, is converted into fat. If you have insulin resistance, your cells do not respond to the insulin, and sugar gets accumulated in the blood, raising the blood sugar level. So it eventually leads to diabetes.

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The Skincare Answer Book
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What products should I have in my skincare routine? How do I choose the right moisturiser for my skin? How can I prevent my skin from ageing? As a leading celebrity dermatologist, Dr Jaishree Sharad gets inundated with skincare-related questions every day-be it at a public event, a party, in her magazine columns, or on her social media accounts. But knowing how to properly care for your skin can be very confusing, especially when there is so much advice and information out there. Written in a Q&A format, The Skincare Answer Book helps you cut through the jargon by answering some of the most common skincare questions. From questions on skin types and skin routines to more specific topics like serums, acne, hyperpigmentation, sun allergies, hair loss, anti-aging, rosacea, layering of skin, common skin conditions like eczemas and skin infections, this book will arm you with all the information you need to care for your skin. Praise for the book:’A book on skin care for all ages’ Amitabh Bachchan‘Numerous well-known clients on Dr Sharad’s long list attest to her reliability . . . May she achieve even more acclaim in the future’ Jaya Bachchan‘The best dermatologist I have known’ Dimple Kapadia‘One of the best skin doctors in the country’ Sanjay Dutt‘Doc is my one-point contact whenever my skin is under any kind of stress’ Alia Bhatt