Dr Imran Majid, who left his government job to start his own dermatology centres in three Kashmir districts, tells Syed Samreen about prevalent skin disorders in Valley along with the growing problems arising out of self-medication.
Kashmir Life (KL): Acne is common in teenagers as well as in adults, what causes them and how can one avoid scars on the face?
Dr Imran Majid (IM): Acne is a very common disorder seen from the age of 13-years to 25-years in males as well as females. This condition is also mediated by the same hormone, Testosterone, that causes hormonal hair loss in males and females. Treatment of acne depends upon the severity of the condition and it is important to realize that those individuals who have relatively severe acne need to be treated early and aggressively to minimize the chances of scarring. This is because once a deep scar develops; it is going to be with the patient for the rest of the life.
In the case of females, it is also important to realize that severe acne can be the only manifestation of underlying PCOD. So, as a rule, all females with severe acne or females with acne beyond 25-years of age should be screened for PCOD by doing an ultrasound examination of ovaries.
We also need to understand that diet as well as stress has some role to play in acne. So avoiding dairy products like butter and ghee, dry fruits and junk food does help if someone is suffering from troublesome acne.
KL: A lot of people are witnessing hair loss, especially overweight females, what triggers it and what is the cure?
IM: Hair loss is a very common problem in both males as well as females. And there are varied types of hair fall along with a gamut of reasons behind it. In males, the most common type of hair-fall is the male-pattern baldness or what we medically call ‘Androgenic Alopecia’. This condition is said to affect 30 per cent of males the world over and the incidence is probably the same here. However, with a proper treatment regimen, most of these males can preserve their hair or even partially get their hair back.
In the case of females, hair loss can be because of many reasons like nutritional hair loss, post-delivery hair loss and also hormonal hair loss. Unfortunately, nowadays, hormonal hair loss is becoming very common among females. This type of hair loss is associated with lifestyle disorders like Polycystic Ovarian Disease (PCOD) and many of these females are overweight as well. What we need to understand is that PCOD is basically a lifestyle disorder and is most commonly associated with a sedentary lifestyle. PCOD is increasing in prevalence at a very fast rate and according to some estimates about 5-10 per cent of our females in the reproductive age group are currently suffering from this disorder.
But we should also understand that PCOD is treatable –but the treatment is not drugs alone. A combination of lifestyle modification with appropriate drug intake can take care of this disorder in a satisfying manner.
For hormonal hair loss in females we need to treat the underlying disorder and in addition, we can use certain topical serums and oral drugs to help these cases. Another popular treatment option in these females is PRP (Platelet Rich Plasma) treatment. In this treatment, we basically extract the platelet-rich fraction of plasma from the patient’s own blood sample. This fraction contains a good amount of blood-derived growth factors. These growth factors help a lot in protecting the hair from further damage as well as in making the existing hair healthier and stronger.
KL: What other skin ailments are commonly witnessed in Kashmir. Also, what are their likely causes?
IM: Just like people elsewhere in the world, Kashmiri people also suffer from similar skin related problems. But we do have some peculiar skin problems in Kashmir. Acne, Vitiligo, Psoriasis, Melasma (Buzin in Kashmiri), fungal and bacterial infections of the skin, hair disorders –all these are encountered here. In addition, we have some peculiar issues here like the problem of steroid abuse on the face, Kangri (traditional firepot) burns and Kangri cancers. However, the most pressing one is steroid abuse and self-medication. Our females, and even some males, have a habit of getting topical creams from the local pharmacist or medical shop for their skin problems and in the majority of cases, these pharmacists prescribe potent steroids or steroid combinations on the face and other areas of the body. Some popular combinations used here are Betnovate-N, Clop-G, Clobetamil, Skinshine, Noscar and Retop HC. Once these combinations are applied the skin becomes dependent on them. Over time there is progressive skin thinning and the skin becomes sensitive and hyper-reactive to everything including sun and heat. In females, an additional adverse effect is abnormal hair growth on the face. Treating such cases is a real challenge for us because stopping steroid use leads to a steroid withdrawal phenomenon in these cases. It is really difficult to get the skin back to its normal thickness and normal shape in such cases.
KL: How many cases of burn injuries and deaths caused in domestic violence cases are reported in your hospital?
IM: Burns, especially severe burn injuries are managed by people from the plastic-surgical field and they will be in a better position to answer this question.
KL: As summer is approaching, how can we take care of our skin keeping in view the extreme exposure to the sun?
IM: We should understand that we belong to a place with a very high Ultra Violet-index. Because of the high altitude, we are exposed to a high amount of these rays especially UVA rays. Because of high UVA, we have a higher prevalence of skin pigmentation or Melasma (Buzin) in our population. And, we also have a very high incidence of sun-induced allergies and other photosensitive skin disorders in our population. So, we all should develop the habit of using sunscreen daily on our skin in the spring, summer and autumn seasons. And there are some really important things to understand about sunscreens. People usually believe that sunscreen with higher SPF is better than the one with lower SPF. This is not true and not relevant at all as far as our skin is concerned. We should really not be bothered about SPF as we should be about the UVA locking ability of the sunscreen. Now, all good sunscreens come with another index written on them –the star rating. This star rating is more relevant to us as it denotes the blocking spectrum or the UVA protection of the sunscreen. Any sunscreen with a 3-star or 4-star rating is good for us. Other aspects that have to be looked into are the base of the sunscreen. People with oily skin or acne-prone skin should use an aqueous-based or matte-finish sunscreen. We now have every good sunscreen formulation available in India which blocks the whole spectrum of UV, visible and infra-red rays. These sunscreens should be used by people who suffer from Melasma because it is aggravated by visible as well as infra-red rays.
KL: Which methods and products should one use to protect his/her skin?
IM: For a healthy skin, a balanced diet, proper sleep, a proper cleanser—depending upon the skin type— sunscreen and a moisturizer—again depending upon the skin type— are needed. But one should remember that only a healthy body can have healthy skin. And let me again lay stress on ‘no self-medication’. The medical shop-owners don’t possess any knowledge about a person’s skin or a skin disease. Please avoid seeking advice from them.
KL: You have been a practising dermatologist for a long time. Tell us about the journey from a government sector doctor to setting up your own chain of dermatology centres?
IM: I am an Associate Professor in Dermatology with an honorary FRCP from Royal College of Physicians Edinburgh. I have been practising as a dermatologist in Kashmir valley for the last 16 years now. I worked in Government Medical College as a faculty member till 2018 when I applied for voluntary retirement from government service. Since then I am working full-time at CUTIS Institute of Dermatology where in addition to patient care, we also offer post-MD fellowship courses in Dermato-surgery and Aesthetic Dermatology as well. We have had students from the valley as well as from outside India who got their training at our institute over the past few years. We have centres in Anantnag and Baramulla districts where we offer phototherapy facilities at discounted rates or free for poor patients under our ‘Vitiligo support Foundation’. We have treated patients not only from the Valley but also from places like Jordan, Oman and other countries at our institute. Our first foreign patient was from Jordan who came to us twice for his Vitiligo surgery.