Diaper Rash: Five questions answered by Dermatologist

As a first time parent, one is perennially busy  changing diapers especially during the first year. The bottom involves special care as the skin is delicate and exposed to a lot of irritants and cleansing. We often see lot of parents complaining about the diaper rash in their children.Here are a few commonly asked questions that I encounter in my daily practice. I have shared the answers and some useful tips to avoid diaper rash.

Q-1) How do I clean the diaper area of my baby?

Ans . This is the most important of all the steps to prevent diaper rash. There are a few basic precautions like

1. Always clean the area from front to back, especially in girls to prevent urinary tract infections from the faecal bacteria near anal canal.
   
2. Never try to pull apart the foreskin in boys which is fused for the first two to three years.
3. Make sure to clean the creases and the folds making sure that there is no hint of moisture left. Moisture is a breeding ground for infections.
4. Please use a sheet whenever you change the diaper in public places to prevent transmission of infections.
5. Air drying is better than pat drying. The latter is still preferred over rubbing or not drying at all.
   
6. DONOT use wipes which contain alcohol or fragrance. The wipes should be used only when cleaning with water is not available. Minimise their use as much as possible.
   

Q-2) What causes rash or ‘eczema’ on  my baby’s bottom?

Ans- Multiple factors predispose this area to irritant diaper rash. Prolonged contact with faeces, urine and repeated cleaning disturbs the sensitive skin in this area, hence causing rash. Improper cleaning practices or neglect can cause diaper rash.

Q-3) What should I do to treat the diaper rash?

Ans- First and foremost try to adopt proper cleansing practices as outlined above.

1. Avoid using harsh soaps and hot water. Prefer a gentle cleansing lotion ( pH of around 5.5) to a soap bar.
2. Prefer washing the area with cleanser and water than a wipe whenever possible.
3. Apply a skin moisturiser first followed by a barrier cream. The latter which generally contains zinc oxide in higher percentage forms an occlusive film to prevent contact of the skin with faeces.

This should be done at every diaper change.

Q-4) Should I prefer a cloth diaper or disposable ones?

Ans- Actually a disposable diaper is preferable to cloth diaper. The cloth diaper should be promptly changes once soiled. The disposable diaper can be changed every four hours or so. There is no difference in rash if either is used.

Q-5) Will changing the type of diaper help my child?

Ans- The chances of getting a rash are same for all the types whether stick–on type or pant sized diapers. The only type of diaper that is slightly better than others is the one which are superabsorbent as they can be used for a slightly longer duration.

As a Dermatologist and a first time parent, I was bewildered too while making the right choice for my child. I hope this addresses few of those doubts and concerns. Please feel free to ask any queries related to the diaper rash and I shall be happy to help you.

Stay skin healthy and skin wise!!

Dr Divya Sharma is a practicing dermatologist at Bangalore. The data shared in this blog is her personal opinion based on her knowledge and experience. The author is not responsible for any adverse event that arises out of following blog opinion

How to prevent photoageing: premature ageing of skin on exposure to UV rays

Photoaging is premature aging of the skin caused by repeated exposure to ultraviolet radiation (UV) primarily from the sun, but also from artificial UV sources. Photo means light so photo ageing means ageing of skin caused by light.

Q What is photoageing?

Ans. Changes in the skin caused by years of long, uninterrupted exposure to sunlight or Ultraviolet rays to be precise.

Q How does exactly photoaged skin looks like?

Ans. A photoaged skin looks clinically different from normal ageing skin. Apart from fine and coarse wrinkling, it shows laxity, sagging, prominent blood vessels, mottled pigmentation, leathery feel and increased fragility. The lips lose their color and the entire face is lusterless.

Q What are the causes?

Ans. – 

Ultraviolet light (the major source of which is Sun) is absorbed by the skin especially the second layer of dermis. Dermis is formed by a tightly formed network of collagen and elastin fibers. This arrangement which is responsible for the resilience of the skin gets disturbed by chronic sun exposure. The fibers change their composition and abnormal material starts getting deposited leading to age spots and pigmentation.

Chronic sun exposure also leads to accumulation of toxins and free radicals which can even make skin prone to malignancy. UV A is the major culprit as it is absorbed deeper into the skin along with a little contribution from UV B wavelength.

Q How to prevent photoageing?

Ans.   

1. The first and most vital step is patient education and awareness about the importance of sun protection.

2. Avoid going out between 11 am to 3 pm.

3. Sun protective clothing, head gears and even UV protected sun glasses are a must have.

4. Sunscreen usage- A particularly daunting challenge is to choose the right sunscreen. Most of the sunscreens do not offer broad spectrum protection because of the unavailability of good UV- A Sunscreen agents. A Good SPF only ensures protection against UVB while there are no accepted standard criteria for UV-A protection. 

5. Right usage of sunscreen– The sunscreen has to be applied in generous amounts at-least half an hour before going out in the sun and should be reapplied every three hours.

Minimum SPF of 30 with Adequate UVA protection is must.
Patients who have already started developing changes suggestive of photoageing can opt for glycolic peels or alpha hydroxy acids.

Since sun damage is cumulative it is never too late to start! so start your regimen of preventing photoageing now!

Stay skin healthy and skin wise!!!

Dr Divya Sharma is a practicing dermatologist at Bangalore. The data shared in this blog is her personal opinion based on her knowledge and experience. The author is not responsible for any adverse event that arises out of following blog opinion

8 womanly tips to a beautiful YOU!

Woman is one of the most beautiful creation of nature. Her life is a canvas full of shades of love in its vivid forms. A daughter, sister, wife and a mother. Bestowed with the highest honors of motherhood, a woman strongly anchors the household and family together. But in playing multiple roles, sometimes she forgets to feed her very own existence . On this day of celebrating womanhood, I want to encourage all womenfolk to take up charge of their own selves. Here are a few tips to a beautiful and a wonderful ‘You’      

      

     1. It all starts with fitness

The real secret to a glowing face is the glory of complete physical and mental fitness. A stroll in the morning for half an hour followed by deep breathing sessions in the garden of your apartment complex can be the most refreshing start to your day. Remember this makes a huge difference in the long run.

   2. Cleansing – toning – moisturizing

A good non –comedogenic, fragrance and parabens free cleanser followed by an alcohol free toner followed by a good moisturiser after twenty minutes of application of former is the minimum you can do as a daily routine.

3. Sunscreen every day keeps ageing away

Daily application of sunscreen with minimum SPF of 15 (Ethnic skin ) upto 50 ( fairer skin type) twenty minutes before going out everyday is a must –have on your dressing table. Donot forget  to apply it before the lunch trips to your son’s school  or bus stop.

4. Hair conditioning

A good hair conditioner containg hydrolysed proteins after head wash at-least once a week.

5. The night cream

A good anti ageing cream with retinol ,  anti ageing peptides after washing face is a good routine to follow. Remember every woman after achieving 30 years should start the night regime. A good serum containing Vitamin C is an added benefit.

6. Anti – Oxidants

A vitamin supplement containing omega three fatty acids and Calcium -Vitamin D should be on the menu everyday.

7. Genital hygiene

Simple cleaning with hot water and gentle soap at bath is enough for cleaning the intimate area. Addition of antiseptic agents and vaginal douching is a strict no as they destroy the good bacteria which aid in natural cleaning and maintaining vaginal health. Cleaning should be done front to back side. Cotton – Linen undergarments are desirable.

8. Keep a ‘ me – time’

      Me time- when you do what you love to do . It could be listening     to a beautiful song, paint or dance to your favourite tune. You are   more than the roles you play.

A Great thanks to all the women who have been a part of our journey and make this world a better place to live. HAPPY WOMANHOOD TO ALL. 

Stay skin healthy and skin wise

Dr Divya Sharma is a practicing dermatologist at Bangalore. The data shared in this blog is her personal opinion based on her knowledge and experience. The author is not responsible for any adverse event that arises out of following blog opinion

Dry skin or Atopic Dermatitis in children

I see a lot of parents in my practice who are anxious and worried about the recurring dry skin of their children or Atopic Dermatitis. This not only is a cause of concern but can be a distressing condition for the children as well. In this blog post on pediatric dermatology, We shall discuss the causes and care required for alleviating the discomfort associated with this under recognized but important skin condition affecting children. I would be glad to answer your queries and comments.

Q – What is the cause of dry skin of my child?

Ans – Our skin has a ‘brick and mortar’ arrangement where the skin cells are the bricks and they are fused with each other by “Natural Moisturizing Factors’ (NMF). NMF is made up of free fatty acids and Ceramides. It is believed that deficiency in this NMF leads to ‘Dry Skin condition’ or “Atopic Dermatitis”. Atopic dermatitis simply can be put as ‘an itch that rashes’. It includes a tendency to have allergies at places where body is in contact with the external environment like allergic rhinitis, hay fever and eczemas.

Q – What are the risk factors for atopic dermatitis?

Ans- A positive family history of similar dry skin, asthma, hay fever or eczema can predispose the children to this condition. It is more found in urban areas than rural. It is largely believed that a cleaner environment and healthier diets to pregnant mothers exposes the child in utero to very few infections. As a result of which their immunity is hyperactive and shifts to a tendency for allergies. (HYGIENE HYPOTHESIS”).

Q – What can I do to alleviate my child’s discomfort?

Ans – There are a basic set of precautions and special care that I advise my patients to reduce the frequency and severity of dry skin in children.

a)      SHORT Bathing time – reduce the shower time to less than five minutes.

b)     SOAP USAGE – Minimal application of soap to the entire body and choose a moisturizer containing soap. (For further reading read my blog on this link ).

c)      LUKEWARM water – instead of very hot water. Water and soap further dry and reduce the lipid layer of ski , hence they aggravate the condition.

d)     MOISTURIZE with a recommended moisturizer within three minutes of bath after gently patting the skin dry. Don’t handle skin in a rough manner at all.

e)      CONTACT with woolen garments, fur and dust should be minimized.

f)       COTTON or LINEN garments should touch your child’s skin.

g)      MINIMIZE things which catch dust like carpets and soft toys around your child.

h)     PREFER vacuum cleaning at least once a month.

Q- Which moisturizer should I use for my child‘s skin?

Ans- Moisturizer is the lifeline to prevent this condition as they seal the fissures and improve the disturbed barrier function. They are of different types-

a)      Emollients - They are naturally found in palm and coconut oil. They replenish the natural moisturizing factors. Shea cocoa butter containing products belong to this category.

b)     Occlusives- They serve to seal the gaps between skin cells and make skin ‘slippery’. They are greasy, messy and have allergic potential.  Petroleum jelly is an ideal example. I would rank them lower in my choice of moisturizers. 

Q- What is an ideal moisturizer?

Ans - Patients who are confused by media hype often ask this question. The ideal moisturizer should be:

·         

·          

Q – Which type of moisturizer do you recommend?

Ans – The following is a quick guide for choosing a moisturizer     

1)Moisturizers designed for the face are typically non-greasy, non-comedogenic emollients, with an emphasis on skin feel and aesthetics with maximal skin benefits.

2) Silicone derivatives in particular are targeted for consumers with oily skin. Kaolin and Talc containing compounds are good for oily skin.

3) Moisturisers marketed as anti ageing should include sun protectants, alpha hydroxy acids (e.g., glycolic acid), and retinol and its derivatives.

4)Prefer lotions for day time use while creams are thicker and should be applied at night.

5)Emollients containing moisturisers like shea butter , squalene should be preferred for very dry skin over body and hands. Avoid them on face as they can trigger ‘acne’ or ‘pimples’.

Q- Which oil should I use for my child?

Ans – Coconut oil has been shown to improve the skin barrier which is deficient in atopic children. Olive oil and other oils are harmful than helpful for skin.It has been proven by studies that the barrier function is best restored with the coconut oil. Coconut milk is equally desirable.

Atopic Dermatitis tends to improve with age. It should not cause unnecessary anxiety and concern. There are simple and effective treatments available which can remit or at-least maintain results. Consult your dermatologist today for daily skin care regimen. 

Stay skin healthy and skin wiser!!

Dr Divya Sharma is a practicing dermatologist at Bangalore. The data shared in this blog is her personal opinion based on her knowledge and experience. The author is not responsible for any adverse event that arises out of following blog opinion

Seven things you must know about Baby's skin care

A common worry that bothers all parents is the care of baby's skin. In my new post I try to capture the frequently asked questions on skin and hair care for babies. 

I will start by explaining the skin structure in very simple language and then explore how to take care of baby's skin and hair.

Q 1 – How is the skin of my child different? Does it require some extra effort and then so, Why?

Ans -The skin of an infant is different from adults in many ways which is crucial for understanding the skin care regimen for the parents -

                   

Skin  Structure of Newborn	Implication for skin care
a)           Higher skin surface area to weight ratio (skin surface area of infant is 700 cm2/kg as compared to adult skin which is 250 cm2/kg) .	a) Increased absorption in the blood of topical preparations (applied products)on the skin.
b)           Connection between the upper layers  of skin (epidermis and dermis) is not very strong	b) Blisters can form easily.
c)           The skin barrier is not fully developed	c)More susceptibility to infections and allergic reactions AND Increased water loss from the skin
d)           Smaller  and inactive sweat glands	d)Decreased sweating , more possibility of heat rash or prickly heat
e)           Acidic pH of the skin	e) Any increase of pH can increase bacterial colonization of the skin.

Q2-Doc, which soap should I use for my Baby?

Ans- Most of the soaps contain surfactants ( Read More here) which can have harmful effects on the skin of the newborn-

1. They deplete the lipid part of the skin barrier hence making it weaker
2. Increase the pH of the skin hence increasing the risk of skin infection
3. Denature( destroy) skin proteins further weakening the skin barrier.

Q3- What are the alternative for soap ?

Ans-  Cocoyl isethionate,sodium lauryl sulphate, and betaines are examples of synthetic non soap detergents (syndets ) which retain the normal pH of the skin but can be drying. Such syndets with addd moisturisers like mineral oil , paraffin and glycerince are most suitable. Soap free cleansers should be preferred but in smaller quantities. Soaps which produce more foam are HARMFUL for your baby's skin.

Q4 – When should I start applying soap to my baby?

Ans- Minimal use in first few months.

Immediately after birth, skin pH may be >6.0 which  falls to 4.95 after birth. This protective “acid” mantle protects against pathogens. Any  soap application will raise the skin pH from acid to neutral hence  increasing the total number of bacteria and increased moisture  loss. Regeneration of skin pH takes at least an hour after washing with alkaline soaps.  If at all needed, healthyterm newborns and infants can be washed MINIMALLY  using cleansers of neutral or slightly acidic pH, which have a gentle surfactant, be chemically and physically stable, and should contain an emollient. BOTTOMLINE is MINIMAL use of soaps in the first month of age.

Q5 – How should I wash  my baby's hair?

Ans -  Shampoos should have minimal time of contact with the scalp to avoid irritant dermatitis. The shampoo should be free from fragrance, anti-inflammatory agents and natural products. Most baby shampoos in the market contain anionic surfactant which ensures adequate cleaning. The pH of the shampoo should be close to the a that of tears and should be non-irritating to the baby’s eyes.

Q6- What about the napkin area of my baby?

Ans- The diaper area is probably the most frequently washed area of the baby.

Cleaning the nappy area "Front to back"

1. Regular nappy/diaper change is a must as baby’s stool and urine can macerate the skin of your baby if in prolonged contact.
2. “Baby wipes”- they also should be alcohol and preservative free. Consult your Dermatologist for recommendations.
3.  Always clean the area from front to back with soft cotton cloth or towel.
4. Apply a  Bland moisturiser and a barrier cream containig Zinc Oxide for skin protection if prolonged Diaper wear is required.( Use Dermatologist /Pediatrician recommended Diaper rash creams) 

Q7- What precautions I should take while washing my Baby’s clothes?

Ans-  You should use gentle detergents for washing your baby’s clothes.

1. Avoid  adding antiseptic solutions or cleansers ( e.g Dettol etc.). They are VERY HARSH for your baby’s skin.
2. The detergent should be fragrance free
3. Rinse the detergent thoroughly. (MACHINE WASH IS BETTER THAN HAND WASH)
4. Donot add Fabric Conditioners/Bleaches
5. Prefer cotton and linen waer for your baby
6. Wash any new dress before making your child wear that.

I have tried to touch the most commonly asked questions about Baby Cleansing. Please feel free for comments/queries and spread this message across for Better skin care for our children which they truly deserve and desire. This will be followed by How to tackle dry skin in children. Happy Reading!!! Stay skin healthy and skin wiser!!

Dr Divya Sharma is a practicing dermatologist at Bangalore. The data shared in this blog is her personal opinion based on her knowledge and experience. The author is not responsible for any adverse event that arises out of following blog opinion

How do I choose a cleanser for my face? A simple guide to understand cleansers

Cleansing is one of the most common and essential regime followed worldwide. It is not only required for purpose of maintaining hygiene but it also plays a significant role in neurosensory and musculoskeletal development of children. We often wonder which cleanser should I choose for myself. in this blog post. I will try to explain the principles of cleansing which should be kept in mind, next time you think of the ideal choice of cleanser for your skin based on your skin type.

Q- How do cleansers work? 
Ans- The cleansers are surface active substances that lower the surface tension on the skin and remove dirt, sebum, microbes and dead skin cells in an emulsified form. At the microscopic level, cleansers are made up of a chain of hydrocarbons. One end of this hydrocarbon chain attaches to grease and oils on your skin while the other end of the chain bonds with water. When you rinse with water, the soap and any attached impurities wash away. 

Q – What are the various types of cleansers available? 
Ans - They include soaps, superfatted soaps, beauty bars, dermatological bars, liquid cleansers, antibacterial washes and foaming solutions. 

Q – What is wrong with applying just any other soap available? Is soap harmful to apply on the face? 
Ans-Soap is a combination of fats and oils (of animal or vegetable origin) and salt. It is the simplest anionic surfactant, forming soap salts in water that emulsify whatever is on the skin surface while increasing the pH of the skin. Applying just any cleanser may result in swelling of the upper layers of skin and loss of natural moisturizers and water leaving the skin dry and the barrier compromised. 

Q- How do I choose the best cleanser for myself? 
Ans- In my previous blog post I had put up a simple quiz which will allow you to understand your skin type (here). Based on your skin type you can follow this simple check-list and also the ingredients that I mention in the answers below to choose your cleanser

Q- What about "Beauty Bars"?

Ans- They are similar to the normal soaps but fragrance and few moisturisers are added to enhance their cosmetic appeal. But the efficacy to prevent dry skin is unknown and hence not recommended.

Q- How are the soaps prescribed by doctor different from the regular soap bars?

Ans-  These soaps contain weak organic acids to lower the ph of the skin and have moisturisers like glycerin , lanolin, Vitamin E and Natural lipids like Squalene. Colloidal oatmeal containing soaps are much more beneficial.

Q- What about so many Liquid cleansers or face washes?

Ans-  Liquid cleansers are composed of non ionic or amphoteric surfactanta with very high rinsibility factor. Their ph is similar to skin and hence they are less drying. One study demonstrated that, following hand cleansing, a liquid cleanser removed 85% of bacteria while a bar soap was able to remove only 65%.

Q – Is a face wash better than a soap if I have pimples or acne?

Ans – Research has shown that use of an acidic liquid cleanser or face wash  led to a reduction in inflammatory ( pus filled) acne lesions and the number of bacteria Propionibacterium acnes (P. acnes) on the skin aiding in faster resolution of pimples while maintaining  smoothness of texture.

Q- Which type of cleanser  is recommended for people with sensitive skin?

Ans- There are certain general recommendations I would like to make when it comes to choosing the right product for sensitive skin. Choose a cleanser with

Non – Ionic surfactants (like polysorbate).

Silicone surfactants ( e.g. Dimethicone) which can penetrate follicles or crevices and hence bring debris to the surface. ( Always check this component in products claiming to be ” DEEP CLEANSERS”).

It should contain moisturisers and humectants ( they prevent water loss when bathing).

Last but not the least , It should have a high rinsibility factor so that it does not leave any skin residue.

Q – What do you recommend for my face if I have conditions like ‘Rosacea’ or ‘Cosmetic Intolerance’?

Ans – Apart from the above said points , One should go for a cleanser which is fragrance and parabens free. Parabens and formaldehyde donors (e.g., diazolidinyl urea, Quaternium-15, DMDM hydantoin) are the major classes of preservatives which can trigger or worsen eczema in such patients

Let me know how choosing a cleanser works with you. And like always stay skin healthy and skin wiser!!