Category Archives: dermatology

Glutathione for skin lightening

Glutathione (GSH) either as oral supplements or IV drips as skin lightening agents are the go-to treatments for glowing and bright skin especially in Asian countries and India, where the quest for fair skin is a never ending journey.

In this post we will see what glutathione is? Does it work as a skin lightening agent ? Are there any studies to back up its use in beauty spas or clinics? Is it safe? And is it worth it?

Introduction to Glutathione

Proposed mechanism of GSH as a skin lightening agent

Current scenario

What is the current evidence ?

Concerns with GSH as a Skin Lightening agent

Final word on glutathione for skin lightening

The evidence for oral or topical glutathione for skin lightening is
still not convincing yet to warrant a unanimous recommendation for skin
lightening or as a treatment for pigmentation

Is there a way to naturally increase GSH stores in our body?

YES you can.

The most economical & sustainable way to prevent glutathione depletion in our body is by preventing the need for GSH in the body in the first place by reducing oxidative stress.

Lifestyle habits that one can make to reduce oxidative stress :

  • Limit alcohol consumption
  • Quit smoking
  • Diet rich in fruits, vegetables and nuts which delivers amino acids required for GSH production or rich in other antioxidants : Tomatoes, oranges, spinach, asparagus, avocado, berries, walnuts, almonds ( best consumed raw or lightly steamed)
  • Whey protein is a good source of cysteine (an amino acid essential for GSH synthesis)

Skin changes during pregnancy

Pregnancy, one of the most beautiful journey for a women, but it can be associated with many skin changes that can be bothersome and add unnecessary stress during this time.

These changes in the skin, hair or nails are normal and expected, but the good news is, they are temporary and resolve spontaneously post delivery to a great extent even if not completely to a pre pregnant state. Let’s look at what these changes can be and how you can address them.


This one of the most common change that can see seen in upto 90% of pregnant women. It is more pronounced in women with brown to darker skin type. Body folds, or areas of the body which are normally pigmented such as the under arms, inner thighs, become more pigmented. For some women, diffuse hyperpigmentation can occur.

Such pigmentation does not require any treatment but if one is concern and wants to address it then one can use some product such as lotions, toners etc. Be careful not to overuse AHA’s (gycolic acid) the the underarm areas.


Another common pigmentation issue that develops during pregnancy.

Which skincare are safe to use during pregnancy?

Most skincare, be it moisturisers or serums or sunscreens (chemical or physical) can be used safely during pregnancy.

Experts often recommended limiting the amount of exposure to or avoiding certain ingredients as a precautionary measure and not because the ingredient is harmful to the mother or the developing baby.

Hydroquinone (HQ) can be substantially absorbed into the blood stream when applied topically to the skin. Even though there have never been reports of it causing any adverse effects to the baby when used during pregnancy. It is still recommended to limit one’s exposure to HQ or avoid it during pregnancy.

Retinoids are recommended to be avoided during pregnancy based on the evidence that Oral vitamin A analogues when taken orally during pregnancy can cause birth defects in the developing baby. And as topical retinoids are also vitamin A derivatives, it’s recommended to avoid using them during pregnancy if possible just as a precautionary measure. There is no evidence to suggest that one needs to discontinue topical retinoids if one is trying to conceive.

If you are conflicted with making a decision on whether to avoid such ingredients or continue using them in you routine during pregnancy, it’s best to discuss this with your treating dermatologist and gynaecologist who can help guide you make the decision that is best suited for you individually.

Stretch marks

When it comes to preventing pregnancy stretch marks or reducing their appearance, there are not much options out there and most products available in the market that promises otherwise do not work.

The use of products containing cantella asiatica or silicones or hyaluronic acid have some weak evidence that they may help with the appearance of the stretch marks when applied regularly. However these are not miracle creams, you may still develop stretch marks despite using such products regularly.

If you want to try such products, go ahead, just make sure to spend some time massaging the products into your skin as the increase blood circulation to the skin as a result of the massage may be able to help to some extent and set realistic expectations so that you do not get disappointed.

Oils such as rosemary oil, olive oil, cocoa butter, shea butter have never been proven to help.

Acids in Skincare

We’ve all heard of acids such as glycolic acids, and if you’re acne prone- salicylic acid and the rest. These acids are used in skincare products as chemical exfoliants i.e they help to chemically detach cells in the upper most layer of the skin from one another, yielding a more youthful, smoother, brighter skin.

What are the various types of acids used in skincare ?

How do they work?

Lower strength acids as found in OTC cosmetics (usually <10%) works at the level of the epidermis specifically at the stratum corneum (upper most layer of skin) and causes exfoliation.

Higher strength acids (>20%) are used as in-office procedures by professionals as chemical peels. Higher strength and lower molecular size acids such as glycolic acid can penetrate deep into the skin (upto the dermis) to boost collagen, GAG’s production thereby increasing the thickness of skin, and reversing signs of photoageing such as wrinkles, deep lines, sun spots etc.

Concept behind exfoliation

As we age our skin cell turn over (cells from the lower layer, divide and mature and are eventually shed off) slows down. As a results more cells from the startum corneum accumulate on the surface which gives aged skin a more dull, and rough appearance. Chemical exfoliation using acids helps speed up the process of shedding the upper layers of the skin. Hence, incorporating acids in our skin care are of benefit a we age and and for addressing certain skin concerns. They are un-necessary for younger age groups as their skin can naturally exfoliate at a good rate.

Rough estimate on the average skin cell turnover with various age groups

Acids beyond exfoliation

Uses of acids in skin care products can be more than just for exfoliation. Different acids have a slightly unique properties that help address specific concerns.

How to choose a chemical exfoliant?

Firstly, not everyone needs a chemical exfoliant in their routine. If you do not have any skin concerns, or if you are happy if your existing routine, continue what works for you regardless of whether you have such acids or not in your routine.

Amongst AHAs : 

  1. Glycolic acid is most commonly used and widely available in skincare products. However being of smaller molecular size, it can penetrate the deeper layers of the skin and cause irritation for some. 
  2. Lactic acid: another common AHA, but has additional properties of being able to retain water thus hydrating the skin. It’s also less irritating as compared to GA 
  3. Mandelic acid : a larger molecular weight AHA that is great for people not tolerating other acids or for people with sensitive skin as it is least irritating. 

PHA and PBHAs, the newer generation acids. Not only do they provide gentle chemical exfoliation, some PBHAs such as lactonionic acid help hydrate and soothe the skin. 

Note: The tolerability of such acids are also dependent on the overall formulations. Some products have a combination of these acids for maximum benefit and least irritation. Most often you only require a single product, and try not to use too many chemical exfoliants in your skin care routine without a professional consultation. 

Products mentioned available at shop my shelf or my amazon store front (for Indian products)

What can go wrong with such products?

Irritation is the most common side effect of using such products. It can present as redness, burning or itching. It can also be seen as bumps resembling acne. Start by using such products just once-twice a week instead of every night and do not forget your sunscreen.

Some people may be allergic to certain acids, always perform a patch test prior to using such products especially if you have sensitive skin.

Over exfoliation can disrupt your skin barrier, making it sensitive, dry and irritated. In this case, stop using such chemical exfoliants and jut stick to the basics: cleanser, moisturiser and sunscreen.

If you already have a routine for your acne or pigmentation, please consult your dermatologist prior to incorporating such products in your routine.

Dark circles: More than meets the eye

Dark circles though very common, can be difficult to address. Many factors are involved in causing dark circles, such as ethnicity, bone structure, anatomy of the skin etc, and most times a cream or serum cannot address all the factors involved, thus resulting in failure of treatment.

Let’s try to understand more about dark circles here.

What causes dark circles ?

There can be intrinsic factors (internal, genetically predetermined factors, inevitable) or extrinsic factors (external, environmental impact, modifiable).

These factors are non modifiable and most topical products such creams/serums cannot completely address these factors
Extrinsic factors can be modified to reduce the risk of developing or worsening of dark circles

Types of dark circles

Understanding the type of dark circles helps guide the treatment options.

Some OTC products that may help

Find products mentioned here
Find products mentioned here

Why are my eye creams not working?

So you have been using eye creams religiously for a long time and you still have not seen results. Why isn’t t it working for you?

  • Lack of sun protection: The under eye area is a commonly missed site during sunscreen application.
  • Not making the necessary lifestyle changes: Ongoing stress, lack of sleep, not cutting down on smoking and alcohol.
  • Underlying cause not addressed: Continuous scratching from eczema irritation.
  • Lack of patience: Depigmenting creams take time to work
  • Incorrect choice of product or treatment: Some form of dark circles benefit more from prescription medications or from a combination of products + in office procedures such as fillers, chemical peels etc
  • Unrealistic expectation: No creams/serum can 100% reduce dark circles. Shadowing effect due to bone structure cannot be corrected by creams. Constitutional pigmentation respond only minimally to OTC products.

Dark spots post acne

Medically termed as “Post Inflammatory Hyperpigmentation” or PIH, these are dark brown to blue to black pigmentation that are left behind as a sequelae of the acne.

PIH can cause more concerns for individuals with acne than the acne itself but the good news is that, PIH are lesser evils of all pigmentation issues that occurs in our skin, they are preventable and completely treatable for many.

So why do PIH occurs ?

Skin type (i.e darker skin type), along with UV radiation and ongoing inflammation from the acne all work together to cause PIH

How can one minimise the risk of development of dark spots or PIH?

Though PIH/dark spots from acne can fade with time, we do see many individuals whose PIH last longer than expected.

Why is my PIH not fading?

Do over the counter products work for PIH post acne?

To some extent, YES, they do!

OTC products that addresses pigmentation along with treatment for acne and sun protection can definitely help fade acne scars as long as they are superficial epidermal PIH. Deep/Dermal PIH or mixed type of PIH would respond better to prescription medications +/- in office procedures such as chemical peels, LASERS etc

Products mentioned

How to store skincare products?

I got a few questions on how to store skincare products when one is living in a hot tropical country with summers of >35°C and when instructions on product labels read “store below 25°C or store sunscreen below 30°C?

This is actually a great question and concern for consumers, I was so impressed at this level of consciousness and curiosity when it comes to skincare and cosmetics.

Since I am not a skincare or cosmetic developer, I am not fully aware of the best answer for this question and so I took the liberty to ask for help from a pharmacist and a post graduate in advanced cosmetology: Catarina Cabeçadas to answer this question. She is also the writer of “The skin balance blog

An update on body acne (truncal acne)

I’ve written post on this a while ago, and not much data was available then regarding truncal acne.

So here’s an update on another common issue : Truncal acne.

Truncal acne refers to the acne involving the back and or chest. Around 50% of patients with facial acne also suffer from truncal acne while ~ 3% suffer from just truncal acne without any acne on their face.

How is it different from facial acne?

Truncal acne has been neglected in comparison to facial acne. Not much studies are available on this entity and treatment options are limited as well. Creams or gel that are available for face may not be enough or prove to be too costly for application over large surface areas such as the back or the chest.

Triggers for truncal acne

Triggers are external factors that could cause development of acne in genetically predisposed individuals.

Whey protein supplements have been reported to cause acne eruption in body builders

How is body acne treated?

In general, treatment of truncal acne follows the same principles as for facial acne.

The only difference is that one needs to be mindful for the choice of products for truncal acne. A small 15g cream or gel may prove to be too costly as it may not be enough to treat large surface areas such as the back and chest.

Lotion or foam formulation may be a better and more convenient choice for the back/chest.

Few are available as over the counter (OTC), while medications such as antibiotics, retinoids or steroids require prescription and supervision by a dermatologist

OTC products for truncal acne

Products available at my amazon page
Products available at my amazon page

Conditions that can be confused for truncal acne

When to see a dermatologist?

When OTC products fail to work

When in doubt of the diagnosis and how to use these products

If you have a personal history of developing hypertrophic or keloidal scars (thick, large scars), early treatment will help prevent such scar formation

Severe extensive involvement may require a course on antibiotics or isotretinoin

Managing post truncal acne scars either atrophic, hypertrophic or pigmented scars may require in office procedures such as chemical peels or LASERS, etc

Cracked feet, Corns and Calluses

Be it cracked feet, corns or calluses, everyone of us has suffered from either of these conditions at least once in our lifetime.

Corns and calluses

Corns and calluses are common issues arising on the feet. They are keratotic skin lesions that occur as a results of repeated pressure and friction leading to thickening of the skin as a protective mechanism to prevent ulcerations.

How corns and calluses form?

Corns and calluses

Cracked feet/ Heel fissure

How to take care of your feet?

All factors that contribute to cracked feet, corns and calluses such as friction, pressure and hyperkeratosis (thickened skin) needs to be addressed accordingly.

Reference : AAD

Products available in India

Available at either amazon (for indian products) or shopmyshelf (for international recommendations) your local pharmacy

When to see a dermatologist?

If the above measures fails to provide the desired response, visit your dermatologist for in office procedures.

Atopic eczema: On the rise

Atopic dermatitis or eczema is a chronic inflammatory skin condition characterised by recurrent acute flares of erythematous (red) itchy skin rash with all without some oozing.

Atopic eczema (AE) usually starts in infancy (< 1 year) or during childhood. Some children outgrow the disease while for maturity it may persist into adulthood. AE can also present for the first time in adulthood

It is estimated that approximately 2.3 million people worldwide suffers from AE. The number of cases is increasing globally including in Asia. Though AE has a lower prevalence in India compared to other Asian countries, the prevalence has consistently increase over the years.

How does one develop AE?

AE is cause by numerous factors interplaying with each other.

How does Atopic eczema presents?

Itching is a hallmark feature of atopic eczema. Itching can worsen the rash or even trigger the onset of eczematous rash.

For this reason atopic eczema is rightfully termed as an “itch that rashes

Itching in atopic eczema patient can become chronic, lasting for >6 weeks. Scratching to relief the itching can set in motion a viscous itch scratch cycle.

Atopic dermatitis is more than just skin deep?

The damaged skin barrier in patients with atopic dermatitis/eczema allows various allergens (proteins able to mount an immune response in the skin, body) to penetrate the skin, thereby sensitising an individual and causing allergic immune response seen clinically as red itchy rash.

Similar process can occur in the lining of the nose, pharynx predisposing patients to be sensitised to inhaled allergens such as pollen, pollution, dust etc resulting in Allergic rhinitis and or Bronchial Asthma.

A follow up article on the treatment and skin care measures for atopic eczema will be posted in the next blog post.

Atopic eczema in skin of colour

Prevalence of atopic eczema has been reported to be higher in individuals with skin of colour. However the clinical presentation of AE in darker skin tone is different from AE in Caucasians.

Erythema (redness) is usually masked in darker skin tone individuals. Other presentation or associated features are hyperlinear palms, prurigo nodularis, peri orbital melanosis (dark circles), lichenified lesions (thickened hyperpigmented skin) etc.

Denie Morgan line

Pityriasis alba

A skin condition better known as “Khaid” in my mother tongue : Khasi.

Pityriasis alba is a common skin condition mostly seen in children & adolescents between 3-16 years of age

Pityriasis” refers to the fine scales and “Alba” refers to the pale hypo-pigmented patches.

These pale patches are mostly seen on the cheeks, arms, chest, or back.

What causes P.alba?

The aetiology is still unknown. However there are some factors that have been implicated in the development of P.alba:

How does P.alba present?

P. alba evolves through different stages:

  • First stage : Starts as areas of mildly erythematous (red) patches on the cheeks or chin, or arms. It may be itchy at this stage. This stage is commonly more noticeable in fair skin individuals and often missed in darker skin individuals.
  • Second stage : The erythematous patches subsides leaving behind pale hypo-pigmented patches with the fine scaling on the surface. This is more prominent in darker skin tones and it is usually at this stage that parents seeks medical attention for the patches.
  • Third stage: The pale patches spontaneously subsides in a few months to years leaving no scars

Variants of P.alba

Should I be worried that my child has P.alba?

No, P.alba is a benign self resolving condition. The patches subside spontaneously within a few months or years for some without any sequelae.

It is important to remember that it may take years to complete resolution of the patches of P.alba in few patients.

Why do you need to see a dermatologist?

P. alba can mimic many other skin conditions, therefore getting an expert to examine the skin lesions for a proper diagnosis is of utmost imporatance.

You dermatologist can help conduct certain bedside test on the skin to help rule out the above mentioned conditions.

Once the diagnosis of P. alba is ascertain, the dermatologist will advised on your skin care and treatment accordingly depending on the stage of the condition.

How is P. Alba treated?

What one can do to help improve the appearance of the skin lesions:

  • Avoid excessive bathing and excessive washing and scrubbing of face
  • Use moisturisers, it helps improve the appearance of the dry scaly patches
  • Always use a broad spectrum sunscreen which will help prevent further tanning and darkening of the surrounding skin, thus minimising the contrast between the pale patches and the neighbouring tanned skin.

What your dermatologist may prescibe?

  • A Short course of mild topical steroids especially during the first stage of the disease when the rash erythematous and itchy.
  • Topical calineurin inhibitors such as tacrolimus or pimecrolimus during the second stage.