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Understanding oily skin

Oily skin medically done as a Seborrhoea” is described for skin that feels greasy, looks shiny usually, have large open pores which is also prone to acne and though viewed as a cosmetic concern, what is skin can have a negative impact on one’s confidence and mental health.

Oily skin is such a common concern for many that the beauty and skincare industry are constantly preying on this concern launching products with highly unrealistic claims and marketing strategies with labels such as “oil free’ , “oil control” etc while hero-ing ingredients that have never actually been proven to help regulate oil production at all.

This post will hopefully help you understand more about what oily skin means: that anatomy, physiology, the function of sebum (oil) in skin, why one has more oiler skin than other with a mention on products that can actually work help reduce skin oiliness.

More about sebaceous glands and sebum

What causes oily skin?

There are many factors that contribute to oily skin.

Can oily skin be treated ?

Though oily skin cannot be completely cured, there are certain treatment options that could help control the skin as well as some causes a suitable that is over-the-counter products that may be able to help with its appearance.

Seek professional treatment from a dermatologist if you only skin is really affecting your self-confidence and your mental health or if over the counter products fail to achieve the desired results. A professional consultation will also help rule out certain medical conditions, which would otherwise require further investigation and treatment

Look out for these ingredients in over the counter products :

Salicylic acid, Niacinamide, Green tea extract, L-carnitine

Though these ingredients do not have a very solid scientific data, there are some small scale studies that have shown that they can help address oily skin

Products mentioned available here

Prescription medication

Most effective in controlling oily skin. However they need to be used with caution and under dermatological supervision

Topical retinoids: Adapalene, Tazoretene, Tretinoin

Oral medications: Isotretinoin

Products mentioned:

Keracnyl PP cream : Niacinamide based matte finish moisturiser

Acne UV gel sunscreen : Matte finish sunscreen

Eucerin Oil control sunscreen : With L-carnitine

Paula’s choice BHA toner: With salicylic acid

Neutrogena oil free cleanser : With 2% salicylic acid

Vitamin B5 in skin care

Vitamin B5 is also called Panthothenic acid which comes from the greek word “Panthos” meaning everywhere which is quite the appropriate name as pantothenic acid functions as a Coenzyme A a co-factor of various biological processes in our body.

It is also referred to as “anti stress vitamin”

Vitamin B5: Pantothenic acid in Human body

Due to the abundance of vitamin B5 in our diet, deficiency is extremely rare. Additionla nutritional supplements is unnecessary if one is having a well balanced diet.

What are the functions of Vitamin B5 in our body?

Vit B5 is responsible for the production of Coenzyme A, which takes part in various biological activities in the body such as:

  • Metabolising carbohydrates
  • Gluconeogenesis ( glucose production)
  • Degradation of fatty acids
  • Synthesis of steroid hormone,
  • Synthesis of acetylcholine

What about topical Vitamin B5 for our skin?

Skin conditions that can benefit from Vitamin B creams/ointment
  • As hand cream for individuals with hand eczemas as a preventative & therapeutic option
  • As moisturisers for atopic eczema patients
  • Nipple eczema
  • For wound healing such as leg ulcers, burn wounds
  • As prevention and treatment of diaper rash

Vitamin B5 creams though rare can cause contact allergic dermatitis or irritation for some

Vitamin B5 containing products

What about Vitamin B5 for hair?

Vitamin B5 has been tried for premature greying of hair (PGH)

So is there treatment for premature greying of hair?

NO, there is still no treatment that has proved to be effective to reverse the process of premature greying of hair.

  • The study using Vitamin B5 for PGH has a very small sample size (n=39). Patients were given 200 mg calcium pantothenate + plucking out of grey hair
  • Only a few patients competed follow up (n=7)
  • At the end of 3 years, 4 had improvement, 2 worsen and no change in 1
So far the best option for premature greying of hair:

Rock those greys, hair dye, plucking out of grey hairs

Red scars or Post inflammatory erythema

Post acne erythema are also called post acne erythema or macular erythema.

They are persistent pink to red marks that occurs in acne patients during the course of acne treatment and persists for sometime even after the acne subsides.

They are more commonly seen in patients with lighter skin (FST I-III), but PIE can also be seen in Indian skin type FST III & IV as well.

PIE is a relatively new term, which is different from post inflammatory hyperpigmentation (PIH) i.e the brownish black scars that follows an acne eruption.

Difference between PIH and PIE

How and why does PIE occurs?

  • Still not clearly understood. Potential explanation is that during the process of inflammation, some pro-inflammatory cytokines that are released causes dilatation of the small blood vessels present in the superficial most part of the dermis.
  • The epidermis while still being in the process of maturation, is thinner, more transparent and can thus more incident light is reflected from the underlying vasculature
Possible mechanism for development of PIE

How to manage PIE?

  • So far, there is not much options for treating PIE.
  • The best approach is to minimise the risk of developing PIE in the first place.
  • As blood vessels will dilate during the process of healing, so some amount of erythema (redness) is expected. However as persistent inflammation is the driving force for long lasting erythema seen as PIE, addressing the factors that causes the inflammation will help minimise the chances of developing persisting PIE.

You do not need to buy products with these individual ingredients separately. Just look for products formulated with these ingredients together either in your moisturiser or sunscreen

Treatment that have been tried for PIE

For most individuals with acne, PIE subsides spontaneously after a few weeks to months just with gentle, supportive care in the form of sunscreens, moisturisers +/- ingredient to help with the inflammation.

However for some, PIE can be persistent even with the above measures. Medical management that have been tried include topical creams and different types of LASERS.

There is still no standard treatment for PIE and large scale studies are still lacking

So far, LASER treatment is still the best option for persistent PIE

Christmas gift guide

Do you have loved ones who enjoys a skincare or even just trying out as a beginner? Or are you looking for skincare products to treat yourself with this Christmas?Are you confused with the endless amount of products available in the market?

Being the dermatologist who writes about all things dermatology, skin, hair and nail care, I thought I’ll share of my top favourites skin care products I’ve enjoyed using throughout this year 2020 and help narrow down the search for a Christmas gift for you this year.

1.Cerave hydrating facial cleanser

This non foaming creamy mild cleanser has been every dermatologist’s favourite and for good reasons.

This cleanser effectively removes dirt from your face without stripping it dry. It’s perfect for dry winter months, it’s fragrance free and is perfect for people with sensitive skin, or individuals using active ingredients such as right to know it’s salicylic acid to help with the acne.

It’s currently available in India on Amazon.

It’s more on the expensive side, but the cleanser doesn’t last for at least 6 to 12 months depending on the size and in my opinion, it’s completely worth the money spent.

Price : ₹3219 /355 ml

2. Neutrogena extra gentle facial cleanser

This cleanser is easily available in India, more affordable and is also a great gentle, hydrating cleanser.

It also does not leave the face try after cleansing. This is currently available either on or at

This would be a great alternative to the above mentioned cerave cleanser.

Price: ₹ 600/ 200ml

3. Vichy 89 mineral serum

This hyaluronic serum is the best HA I’ve tried so far. It’s very light weight, spreads easily on the skin, and it gives an instant dewy hydrated look to my skin.

It’s a little of a splurge but the product does exactly what it says and you only need a drip of it and it lasts for at least 4 months even with twice daily use. I’m definitely going to buy more of it.

It is available at amazon currently

Price: ₹ 3990/100 ml

4. Bioderma photoderm max 50+ in the shade teinte claire

A tinted sunscreen containing iron oxide, provides additional protection against visible light. Its a great addition for someone who is prone to pigmentation.

A tinted sunscreen can also work as a foundation. I don’t need any makeup over this anymore.

It has a fluid like texture, it can feel too heavy for some especially if one has oily skin. A trick is to apply a base sunscreen one is comfortable with and layer a light layer of this tinted sunscreen on top.

Available on amazon, nykaa or local pharmacies

Price: 1575/ 40 mL

5. Ekran soft spf 50 sunscreen

This matte finish sunscreen is a chemical sunscreen by an Indian pharmaceutical pharmacy. It’s my favourite matte finish sunscreen. It’s best during the summers, or hot humid days when one sweats a lot.

It provides both UVA and UVB protection and is suitable for oily acne prone skin as well.

Available at amazon or local pharmacy

Price : 650/ 50 gm

6. Taiyu sunscreen spf 50

Another sunscreen by Indian pharmaceutical company, Festival was developed based on Japanese company formula.

What is the broad spectrum sunscreen, with ingredients such as are arbutin and liquor rice extract that helps with pigmentation. It’s perfect for people with pigmentation issues.

Pregnant women should avoid using the sunscreen due to the presence of arbutin and it’s formula.

It has a fluid like texture yet light and does not feel to have you on the skin. Even acne prone patients would enjoy using the sunscreen especially during the winters when a matte finish sunscreen would feel too dry.

Price: 550/ 60 gm

7. Neutrogena lip balm with spf 15

I always have a lip balm with me especially during the winters, it helps keep my lips hydrated and not chapped.

I particularly love this one since it doesn’t have colour to it.

Available at amaxon, nykaa, L’épicerie store in Shillong ( @lepicerie.shillong)

Price: 175

8. La Roche Posay toleraine sensitive cream

This is by far my favourite moisturiser. I purchased this during my trip to Europe but sadly it’s not easily available in India.

This moisturiser is enriched with glycerine, ceramides and nice niacinamide. Its fragrance free and is also great for people with sensitive skin.

Keep an eye out for this one on your next travels you might be able to get it at the pharmacies in the international terminals at the Airport. My advice is grab few of them while you can. This 40 ml pack will last for ~4 months for once a day use.

Price: 1200-2000/ 40 ml

9. E Dew cream

This is another moisturiser with ceramides, and niacinamide. It

has a light fragrance so may not be ideal for people with sensitive skin.

It does feel a little thick but I wasn’t too bothered with the overall texture especially during the winters when my skin gets a little too dry.

People with oily skin may not prefer it especially during the summers when it’s hot and humid. But overall a great moisturiser for a very reasonable price.

Available at amazon or local pharmacy

Price: 269/ 50 gm

9. Hydronic cream

This is another Indian pharmaceutical company moisturiser which is made for individuals with very dry sensitive skin.

It contains aloe vera extract, allntoin, shea butter, glycerine.

Its fragrance free and non comedogenic which means even patients with acne prone skin can use it especially to combat the dryness caused by topical acne creams such as salicylic acid, BPO or retinoids.

Available at amazon or the pharmacy

Price: 299/ 50gm

Merry Christmas


Happy Holidays

How to achieve the best results with your skin care regimen?

How many times have you tried an anti-aging or anti-acne creams or a brightening serum but failed to see it work on you?

Your constant breakouts never stopped, the mirror reflects back new wrinkles and your pigmentation is stubborn enough to never fade.

I’ll be the first to admit, I’m definitely guilty of the above!!

I grew up with acne as a teenager which continued into my adulthood. I’ve tired over the counter creams and in the early 2000’s “Erytop” (clindamycin – an antibiotic cream) was widely available. All my friends were using it. It would work for the existing pimple but news ones were popping up constantly. My mum did take me to a dermatologist then, I would get prescribed one cream- benzoyl peroxide and was advised “apply it once at night” and that was it. I was never explained how long I should be using it for, what cleansers I should be using, nor was I explained about the potential side effects or the expectations one should have with such topical medication.

And it seemed quite normal then, go for that one time consult for acne and the dermatologist would assure my worried mum that “your daughter will grow out of it, the acne will subside when her teenage years have passed”.

This might have been true for older generations but now with the changes in lifestyles, acne persisting into adulthood is quite common. Teenagers suffer from a more severe form of acne with the potential for permanent scarring.

The same holds true for pigmentation issues particularly melasma. Women, though bothered by the facial pigmentation, DIY remedies or creams suggested by their friends were enough to make them feel like they are actively taking care of their skin.

Things are different now. Individuals are more aware through social media about how to care for their skin. Educational content are more accessible about the various skin or hair issues. And skin care products are easily available at the touch of a button.

I personally love to see this change.

How to achieve the best from your skin care?

Skin care is actively caring for your skin (be in for acne, pigmentation, ageing or just general measures) to maintain a healthy looking skin.

Some people can follow multiple steps layering different skin care products both day and night for their skin and this may work wonders for them, but a simple basic routine is also not wrong.

If you have a particular concern I strongly advised seeing a dermatologist for any skin problems.

Before seeing a dermatologist, prepare yourself with the questions you would like to ask. Do not be afraid to clear your doubts. I always advised my patients who are already on treatment for some other condition or who are already on some form of skin care regimen to bring all the medications (both oral-tablets, capsules and topical- creams, ointments, serums) during their consultations.This is because few medications may be contraindicated with the medications that I may prescribe, or maybe the skin rash is actually associated with the medication they are taking. And in India, it is very common to see patients applying the wrong cream for the wrong reason or to the wrong site.

Always remember to tell your treating doctor if you are allergic to any medication or if your skin is sensitive to any skin care product.

Once a diagnosis of your condition is made, try to understand the condition, either by asking your doctor or reading up more about it yourself. Its always helpful to know why it happens, is it curable? how to manage it? how to prevent it from recurring? etc.

Skin care routine is not a static process. It changes depending on the response, the season, the tolerability of a person to an ingredient in a product, the availability of the products, the age or pregnancy status or according to the money and time one is willing to invest in it.

Once a diagnosis is made and a skin care routine is advised, understanding the ingredients in the products is just as important. Its good to know how a product works, how you need to be using it, how to minimise side effects and how long it takes for the product to work.

Most times when people blindly follow the doctor’s advise or a beauty influencer without understanding the product, it either leads to development of side effects, lack of results, pre-mature discontinuation of the product or maybe even worsening of the condition.

Always follow up as and when your dermatologist advised or earlier if needed. Follow up consultations are as important as your first visit. This is when your dermatologist can assess how you are responding to the treatment and if the products need to be changed based on your response. Your dermatologist will even be able to help you manage the side effects if any.

Be patient. Consistency is the key with skin care. Avoid doctor and product hopping too early and frequently. Most ingredients in skin care products take at least 4-8 weeks to start showing effect.

Avoid using too many active ingredients at once especially if you are a newbie.

Be gentle, go slow, skin care is a personal journey and not a competition.

Try to have more realistic expectations. One may never be acne free forever, even with the right skin care, you may get the occasional breakouts, and thats OKAY. Pigmentation can slowly fade with time and anti ageing cream can help reduce those fine lines but your skin will never go back to the skin you had in teenage years.

Lastly, change your perspective about skin care. Do not see it as a burden and a waste of your time. Instead keep in mind that you are actively taking care of your skin and enjoy doing it.

Hope these tips help you achieve the maximum with your skin care routine.

Fungal Acne: A misnomer. Medically it’s called Pityrosporum folliculitis

Acne is such a common condition that to an untrained eye, all red bumps (papules/pustules) must be acne.

There are other dermatological disorders that present like acne but are not acne.

Pityrosporum folliculitis or Malassezia folliculitis (Fungal acne in layman terms, but fungal acne is not a medical diagnosis since it’s not acne or form of acne) is one of the most common skin condition mistaken for acne. It is caused by increase colonisation (multiplication) of a yeast called Malassezia species which is normally present as part of the normal flora in our skin. (yes! our skin has a world of micro organisms living in it 😉 )

It is the inflammation caused by such an increase colonisation that causes the symptoms.

So what causes this increase colonisation by this yeast?

  • Malassezia thrives in the oily environment produced by the sebaceous glands. Adolescents (10-19 years) have an increase sebaceous glands activity due to the hormonal fluctuations. Therefore this condition is commonly seen in adolescents.
  • Excessive sweating is also a risk factor, and people living in hot humid areas are more predisposed.
  • Individuals on topical or oral antibiotic, as this can suppress the growth of the normal bacteria in the skin giving way for this yeast to multiply unchecked.
  • Use of steroids or other immunosuppressant agents.
  • Diabetic patients may also experience such eruptions.
  • Genetic predisposition also plays a role. As mentioned earlier everyone has this yeast in their skin, but only some people are able to mount an inflammatory response to it causing the symptoms while others do not.

How can you differentiate it from acne ?

Firstly by the looks of the lesion, fungal acne presents with monomorphic (uniform looking) papules (red raised bumps) or pustules (pus filled bumps). There will not be any comedones (such as white heads or black heads) unless a patient also has concurrent acne.

Secondly by examining the site of involvement, face (forhead), back, upper arms, chest and back are involved in fungal acne. One wouldn’t normally see acne vulgaris involving the upper arms, neck.

Thirdly, fungal acne tends to be itchy while acne is not. Do you ever remember your pimple itching unless you’ve picked on it and a scab has formed?

Fourthly, history of acne not responding to anti acne treatment despite strict compliance or acne which had responded to treatment and suddenly flares up even while on the same treatment.

Fifthy, individuals with fungal acne may also have dandruff or tinea versicolor.

Do you need to see a dermatologist for such a condition?

Its always better to get an expert opinion before you self treat any skin condition.

Though the above points can help distinguish between acne and fungal acne, it may not be as clear cut in most cases, especially when one also has co existing acne. A variant of acne called truncal acne vulgaris can also present with similar eruptions on the back and chest.

Another dermatological condition called acneiform eruption which presents as eruption of skin lesions similar to acne caused by certain medications, mechanical friction, certain compounds used in textile dyes, insecticides, pesticides, detergents or soaps (halogenated aromatic hydrocarbon) presents similar to acne, and is sometimes difficult to differentiate it from fungal acne.

This is where a dermatologist’s opinion is important, so that certain questions can be asked, and if necessary certain tests performed (such as Wood lamp examination or KOH mount which can help in the diagnosis of fungal acne) for the correct diagnosis and management of the condition.

How to treat it?

As it is seen that the organism causing fungal acne (i.e Malassezia sp) can multiply more in hot and humid areas and summers are the season for most flare ups due to the increase ambient temperature and sweating, measures to reduce these factors can help reduce the symptoms

  • Have frequent cold showers in the summers
  • Change clothing such as gym wear, uniforms as soon as possible
  • Opt for loose fitting clothing
  • Avoid tight fitting attire
  • Seek the comfort of an air conditioned room

Products to use :

Use an anti-fungal shampoo (such as 2% ketoconazole or selenium sulfide or zinc pyrithione), look out for these ingredients in your anti dandruff shampoos. (List of few of such shampoos on previous post)

2% Ketoconazole + zinc pyrithione
Zinc pyrithione
Zinc pyrithione

Massage the shampoos to the affected areas and leave it for 5-10 mins and wash off. This can be done twice weekly for at least 2-4 weeks depending on your response.

If the above fails, your dermatologists may add topical anti-fungal creams which are to be applied once-twice daily over the lesions.

Topical creams that helps to unclog the blocked sebaceous glands such as salicycic acid is another adjunctive treatment option in addition to the above.

Systemic anti-fungals (oral tablets/capsules) may be required in some cases.

Remember that the condition may recur, especially in summers.

Applying the anti-fungal shampoos during the summer months once weekly even if you don’t have the flares may help reduce chances of recurrence

Understanding hair fall

We have all, at one point in time, dealt with excessive hair fall that alarmed us enough to either self treat with DIY/home remedies or to seek a dermatologist’s opinion.

Let us understand the normal physiological process that our hair goes through which is called “Hair cycle”.

Hair cycle is divided into 3 main phases :

  1. Anagen (90% of the hair are in this active growing phase ) which proceeds to:
  2. Catagen (resting phase), which then progress to :
  3. Telogen (regressing phase)–> the hair then eventually falls out (exogen) as the hair follicle enters a new anagen phase.

As you can see that as new hair grows, the existing hair in that particular hair follicle has to fall out. So hair fall should not necessarily alarming, and this normal hair shedding is seen to be 50-100/day and in some individuals it could be upto 150/day as well.

When to seek a dermatologist’s opinion?

When the hair fall exceeds what was mentioned above, or you start noticing recession of the hair line or thinning of hair in crown (in men), thinning of the hair and a more visible scalp along the part line (in females), or patches of hair loss.

Common causes of hair loss:

1. Telogen effluvium: Presents with a more diffuse hair loss of >150/day. Occurs 2-4 months after any systemic illness such as infections (malaria, typhoid etc), childbirth, surgeries, crash diet, thyroid disorders, psychological stress etc.

The condition is completely reversible and the hair loss starts improving in 4-6 months once the underlying factor is corrected.

Female pattern hair loss

2. Androgenetic alopecia ( also called male pattern baldness or female pattern baldness in men & women respectively due to the characteristic pattern of hair loss). It is genetic disorder, in which susceptible hair follicles either have a higher response to the hormone testosterone, or have a higher amount/activity of the enzyme ( 5 alpha reductase) which converts testosterone into a more active form.

Male pattern hair loss

This result is the normal terminal hair (thick , black scalp hair) is transformed into vellus hair (thin, fine, light coloured hair mostly found in other parts of our body).

The overall effect is gradual thinning of hair. The disorder can be inherited from either maternal or paternal side

Image: DermNetnz

3. Traction alopecia:

Caused by the excessive constant stretching of the hair shaft from hair styling such as tight braids/ ponytails

4. Alopecia areata: Considered an autoimmne disease normally seen in children and presenting with localised patches of hair loss, rarely it can affect adults and be of a more diffuse nature.

Usually self limiting i.e hair regrows back even without treatment.

There are more causes of hair loss, but the ones mentioned above are the commonest ones experienced by individuals.

Treatment for the different types of hair loss may vary with some requiring no specific treatment at all such a telogen effluvium whereas others have specific therapy such as alopecia areata and androgenetic alopecia.

Biotin: the lack of science behind its use as a hair supplement

Continuing my hair care series, I thought this topic is definitely worth writing about. Biotin (vitamin B7) supplements has been widely popularised for the treatment of hair fall and thinning hair. It’s promised to help grow long, thick, luscious hair and for healthy nails as well.

But is there a rational scientific evidence behind this popular trend?

I’m here to discuss the science (or more like the lack of it) behind the use of biotin supplements for hair loss.

What is biotin?

Biotin is a water soluble vitamin, and functions as a co-factor for various enzymes responsible for energy production in our body. Being water soluble means it does not get stored in the body and is excreted in the urine via the kidneys. So chances of toxicity from over consumption of biotin is minimal and so far there has not been any adverse effects from biotin supplementation. This being said, biotin supplementations for general well being or for healthy nails and hair is still not justified!!

The recommended daily allowance of biotin is 30 µg per day.

And we meet this requirement adequately from our diet.

Some of the biotin rich food

If less is good, is more better?

from my dermatology text book

My answer to this question when it comes to nutrients for our body, is NO!! More is definitely not better and more is actually un necessary.

So why is biotin heavily popularised?

Few reported cases of biotinase (an enzyme required for recycling biotin in our body) deficiency was reported in infants and children who inherited the disease due to genetic mutations. It was noted that few of these cases had alopecia (hair loss) with or without brittle nails. Biotin helped improve the hair and nail changes in these cases.

Thus stemmed the popular trend of biotin supplements for hair fall or nail disorders.There is no regulation on vitamin supplementation production, hence pharmaceutical companies take advantage of this and advertise and market biotin supplements as a saviour for hair loss.

Note: in these cases describes above, biotin was a treatment of choice because they lacked biotin in their body.

Biotin deficiency in general population is very rare as we get adequate amounts from our diet. Supplementation of high doses (500-1000 µg/ day when the required amount is only ~ 30 µg/ day) is highly unjustified.

The few rare instances when a person can develop biotin deficiency are:

So does biotin also improve hair loss in healthy individuals without its deficiency?

There has never been any scientific study on the effectiveness of biotin for the treatment of hair loss in healthy individuals.

A study on 541 women with hair loss, showed that only 38% of these individuals had biotin deficiency of which 11% had histories on being on long term medications that can cause biotin deficiency and 35% of these women also had co-existing skin condition called seborrheic dermatitis, which shows that in individuals with hair loss, majority had normal levels of biotin and supplementation was un-necessary.

Even lab studies found that the differentiation and proliferation (growth) of the follicular keratinocytes (cells in the hair follicle) was unaffected by the level of biotin.

Biotin supplementation is not the treatment for hair loss/ hair thinning nor does its intake help aid other scientifically proven treatments for hair loss

Can biotin supplements do any harm?

Like I’ve mentioned earlier, there are no known toxicities reported so far as a result of biotin supplementation.

However, excessive amount of biotin in the blood can interfere with many of the laboratory investigations such as thyroid function tests, other hormonal profiles as well as levels of troponin in the blood (which is an indicator of a heart attack).

Many lab tests rely on a biotin-streptavidin reaction as part of the test procedure. The low amount of biotin we obtain from our diet does not affect these tests however biotin level > 1 mg/ day (Biotin supplements available in the market contains around 10mg of biotin) can result in false positive or false negative test results.

FDA issued a warning to help educate about the possible interaction between high biotin levels in the blood and troponin level ( a biomarker which helps physicians diagnose a heart attack for patients presenting with chest pain). This could be dangerous as a heart attack requires immediate treatment and an early diagnosis could potentially be missed.

My take on this topic

  • Biotin supplements are not required for the treatment of hair loss.
  • If you are on long term supplements, remember to mention it to your treating physician especially if you are getting evaluated for hormonal issues, thyroid function or for a chest pain.
  • Follow the general hair grooming measures available on a post on my instagram feed.
  • Get the hair loss evaluated by a dermatologist to get to the cause of it as different types of hair loss requires different form of treatment.
  • Instead of wasting your money on buying these vitamin supplements, spend it on products that have actually proven to work such as minoxidil, or well formulated shampoos and conditioners instead.

Prickly heat : Another nuisance of the summers

Summer is here is various parts of India!!! Its hot, its humid, we’re sweating and for the unlucky few, the skin is actually itching and pricking.

Stay ahead of the summer…

Miliaria also called “prickly heat”, “sweat rash”, “heat rash” “ñiang shit” (in my mother tongue) is a common dermatological condition occurring mostly in hot, humid summers. Infants ( <1 year) are more susceptible as their sweat glands have not well developed.

But this does not mean adults are spared, it can occur in adults as well, both males and females

So how and why does it occur?

  • Miliaria is caused due to blockage of the sweat glands ( eccrine glands) which may be due to excessive colonisation of a bacteria in our skin ( don’t worry its mostly the bacteria which normally resides in our skin. Yes! we have bacteria and yeast, a small little world living in out skin :p).
  • Sometimes these sweat glands can be occluded by debris (i.e dirt)
  • Sweating is therefore a risk factor, and activities or febrile illness (infection/medical conditions that causes fever) that could increase sweating are high risk factors for developing miliaria.

Source :

Levels of occlusion of the sweat duct and its resulting clinical presentation
  • Sometimes the duct ruptures causing inflammation around the area, seen clinically as red bumps, itching, pricking sensation.

How does it present?

Occlusion of these sweat glands result in sweat not being able to leave the surface of the skin, & instead gets pushed back into the different layers of the skin forming small sweat filled lesions.

Depending on where the blockage occurs, the presentation can be different clinically.

  1. Miliaria crystallina

Blockage occurs at the superficial part of the skin (epidermis). Presents with these asymptomatic (no itching /pain/burning sensation) clear fluid filled lesions (vesicles) over normal looking skin.They are referred to as “dew drops” .
The fluid collected is actually sweat!!

2. Miliaria rubra

Most common form, presents with multiple red raised lesions (papules). (“Rubra”= Red in Latin). Individuals also experience an uncomfortable pricking/itching sensation in their skin. Pustules (pus filled lesion) may also be present and its referred to “miliaria pustulosa”.

Miliaria rubra

3. Miliaria profunda

Least common form. Mostly seen in individuals who suffer from repeated episodes of miliaria rubra. Seen as large deeper lesions either skin colored or red. May be itchy.

Is this condition dangerous?

Apart from being a nuisance, miliaria normally resolves once the factors causing the sweating is removed.

In very rare occasions when the involvement is extensive or in infants with poorly developed sweat glands, it can be threatening.

Normally, sweating is a defence mechanism to increasing body temperatures, which cools the body down as the sweat evaporates from our skin. As the sweat glands are blocked this process is not able to take place and individuals may then be at risk of hyperthermia.

Signs to look out for:

Fever, muscle cramps, headache, fainting, increase heart rate, dizziness.

How to prevent and treat it?

As the condition is cause by heat and sweating, the main measures are to reduce exposure to such environmental conditions as much as possible.

General measures

  • Staying indoors in air conditioned , well aerated rooms/offices.
  • Avoid strenuous exercise which is a potential risk factor.
  • Wear loose fitting, cotton clothing
  • Avoid tight fitting clothing ( jeans, jeggings, treggings and all the likes) , un-necessary bandaging as friction can lead of excess distension of the sweat duct causing its rupture.
  • Avoid wrapping your baby in layers of clothing.
  • Take frequent showers with cool water and mild pH balanced soaps (such as dove, or other syndet soaps) to help remove debris from the skin. You do not need to use a soap for every bath you take in a day, using a soap once a day is adequate.
  • Cool compressed with a damp towel helps calms the skin
  • If you don’t have the luxury of travelling in air conditioned cars/buses, try carrying a face towel with you which you can damp with cold water for regular compressions on your face, chest, neck etc.
  • Change clothes such as gym wear, uniforms and hop into a cold shower immediately once the activity is over.
  • Avoid use of occlusive moisturisers/ointments.

Specific treatment options

  • Powders/Sprays formulated with menthol (for cooling and anti-itch action), anti-bacterial (boric acid), anti-septic (zinc oxide) are easily available in the market. Note that, without the general cooling measures mentioned above, this form of treatment would not be effective on its own.
  • Seek a dermatologist opinion if the rash gets too uncomfortable, as a course of mild steroid to help reduce the inflammation my be required. ( I stress on the term “mild steroid” as there are various classes of steroids with various potency and we do not want you to be given the wrong form of such creams/ointments as they do come with their own set of complications)
  • A course of antibiotic cream may be needed if pustules are present and extensive.

Heat rash usually subsides spontaneously even without treatment if the above general cooling measures are followed and treatment is usually un necessary.

Miliaria crystallina, usually subsides within 24 hours of removal of the predisposing factors. And the good news is that miliaria heal without scarring.

featured image: Photo by Hans Reniers on Unsplash

Hair oils: Science behind its use in hair care

Hair oil application has been the basic hair care remedy for beautiful, black, luscious hair especially in Indian females (and for some males who groom their beard religiously :P). We’ve been taught at a very early age about hair grooming, mothers would be seen applying and massaging layers of oil into their daughters scalp while enjoying the afternoon sun.

I remember during my time living in Kerala (southern tropical state in India, where the inhabitants use coconut il for everything, from cooking to hair grooming). Girls there has long thick hair touching their knees, but it was always covered in coconut oil so I could never appreciate the overall health status of their hair. I couldn’t tell if the shine was natural or because of the layer of oil, the split ends were beautifully hidden as well. But this was the norm there, they love having oil on their hair day and night and it seems to work for them.

Personally for me, as someone with fine hair, which can get oily pretty quick even just after a day post hair wash, hair oiling never played an important part in my hair grooming process.

Individuals with thin fine hair do experience oiliness of the hair quicker than those with thicker hair, as the sebum produced in our scalp can be transmitted to the hair shaft easily.

As a dermatologist, I often get question on which oil is best to use, how frequently is it to be used, is pre or post shower hair oiling better and so on and so forth.

Honestly, there is no right answer to these questions, as there are very few scientific studies done to compare between the various hair oils or their methods of application.

Lets see which hair oil actually have science backing up its claim

Coconut oil

Studies have found that coconut oil is able to penetrate the hair shaft and this can be enhanced by application of warm oil. The oil coats the hair, prevents absorption of moisture into the hair and thus prevent the recurrent swelling and shrinking up of hair cortex which is responsible for hair fragility and breakage.

Coconut oil has been found to be the only oil to prevent protein loss from the hair shaft, thus providing more stability to the hair.

Photo credit: Photo by Marvin Meyer on Unsplash

Sunflower oil

Though this oil also provides hydration to the hair similar to coconut oil by forming a film coat on the hair . It however cannot prevent protein loss from the hair shaft due to its bulky nature and presence of double bonds that prevent penetration into the hair fibre.

Articles that claims its beneficial effect on hair are based on the study of the effect of Vitamin E on hair growth. A study of 39 patients (note- small sample size) showed that oral vitamin E supplementation for a period of 8 months had positive outcome on patients suffering from hair loss. Sunflower oil is also rich in Vitamin E, but it doesn’t necessarily mean that topical application of a vitamin E rich oil will also achieve the same result as daily oral supplementation.

Moroccon argan oil

Another oil rich in vitamin E, the argan tree is endemic to Morocco, has emerged as the most expensive essential oil and as a popular hair cosmetic from shampoos, to conditioners to hair oils.

Is it worth the hype?

There are no scientific evidence for its use in hair care so far, the only reason for its popularity is that its rich in Vitamin E (a potent anti-oxidant) and the study mentioned above, of Vitamin E positive effect on hair growth.

Almond oil

Again rich in Vitamin E, though it has lots of health benefits when consumed. The effects of almond oil in hair, except for its emollient action i.e coats an oily film on the hair and prevents breakage, no other scientific data available for stimulating hair growth.

Olive oil

Compound found in olive oil such as oleuropein (promotes anagen hair growth -active growing phase of hair, in mouse skin. No human studies yet.

Oleocanthal an anti-inflammatory phenolic compound found in olive oil, when consumed orally is known to help reduce inflammation. Again no data on its effect when applied topically.

image credit:Photo by Roberta Sorge on Unsplash

Rosemary oil

Unlike other oils which lacks strong scientific evidence backing up their claims in promoting hair growth, rosemary oil actually helps improve microcirculation ( improves blood flow to skin). It has been compared to be equally effective to 2% minoxidil in the treatment of androgenetic alopecia (male pattern hair loss). Increase in hair count were seen only after 6 months of daily application.

Whether minoxidil can be completely replaced by rosemary oil, the answer is still “NO”. Because though it was seen to be as effective as 2% minoxidil, we normally prescribe a 5%-10% strength of minoxidil in dermatology.

Hibiscus oil

An animal study concluded that extracts from the leaves of hibiscus plant does promote terminal hair growth. No new hair follicles were formed.

Image credit:Photo by Georgia de Lotz on Unsplash

Onion Juice extract

Crude onion juice extract was used in a study of patients with alopecia areata (auto-immune condition causing patchy hair loss) which is different from diffuse hair loss from other causes. Daily topical application of onion juice to the area of hair loss showed significant improvement in the form of new terminal hair (dark, thick hair) at the end of 6 weeks.

How it works is thought to be by “antigenic competition” ( my fellow dermatologist will understand this term.:P

To summarise

Hair oils (all types; from coconut, almond, olive, vegetable oil etc) are beneficial in a way that they form an oily film on the hair shaft and prevents excess moisture absorption from the environment and prevents water loss from the hair cortex. This is important because the recurrent swelling (from absorbing water) & shrinking (from losing water) of the hair cortex is responsible for the fragility, split ends and eventually breaking off of the hair from its weakest point (which can be seen as hair fall).

Oiling hair can prevent split ends, strengthen the hair (coconut oil) and reduces the friction that arises when combing the hair. Thus, helps manage frizzy hair, gives the hair shine and tames the fly aways.

With regards to stimulating hair growth, only rosemary oil has scientific data backing up its claim.

Olive oil could have potential based on the studies available. Still no conclusive data yet as a topical application.

Heat i.e warm oil application helps the oil to penetrate into the hair fibre and leaving just a thin film on the hair shaft, giving a less oily appearance.

Regarding how to use hair oils, frequency, duration, sadly I do not have the right foolproof answer for this. My personal advice based on my understanding of the research on this topic is :

Coconut oil is definitely the hero here, its the best, safest & cheapest option, especially if you have dry, frizzy, splits ends, apply it on you hair from root to tip. It has the additional advantage of preventing protein loss from the hair. There is actually no need to apply to the scalp, as your skin produces sebum naturally. But go ahead if you have dry scalp or if you enjoy the head massages.

Since we all do not like walking around with oily hair, and since we have products like conditioners & hair serums to use post showers, to make our hair more soft, shiny and manageable, reserve hair oil application for pre-showers. Applying too much & leaving the hair oil for too long will only attract more dirt to your hair which will make it difficult washing the oil out from the hair. Extra manual effort of massaging the shampoo will only cause more friction which can lead to increase falling of hair in the shower.

You can use hair oils as frequent as you like, all the studies reporting positive effects is based on daily hair oil application. I know its impossible to keep up with this in real life, so be flexible, go with your flow. ( I know, not a very scientific advise, but there is no clear cut science behind it yet!! )

Do not depend on hair oils to fix all your hair issues. It should only be a complimentary step to your already existing hair care (shampooing, conditioning, serums, or hair treatment such as minoxidil).

And lastly, if you have straight, non frizzy hair and you’re not in the habit to apply hair oil, then thats also okay. You do not need to follow the crowd.