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Transcript: Dr. Rupak Ghimire on Skin and Hair Condition

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Dr. Rupak Ghimire, Dermatologist & Hair Transplant Surgeon, who has founded Aaravan Skin & Hair Transplant Clinic located at Durbarmarg, which is quite popular among celebrities and urban communities, was LIVE from our page on Aug 22, 2020 at 4 PM, to share his knowledge on Skin and Hair Condition.

The following is the transcript. As it is the translated version, this should not be considered as verbatim.

About Aavaran Skin & Hair Transplant Clinic

Aavaran is a skin and hair clinic that was established in 2015. It was established with the aim of  pioneering professional hair transplant. This clinic is currently located in Durbarmarg. Exact location can be accessed from here.

What services are provided at Aavaran?

It is a complete center for enhancing the “aavaran’, i.e. outer look of anyone. It provides services like Hair Transplant, Dermatology Consult, Rhinoplasty, Plastic surgeries, Liposuction etc. More details can be acquired via the website

After lockdown we have also started providing consult through the medium  of our app – Skin Consult by Aavaran available on Play Store. Currently, it’s a free consultation app. We plan to enhance our services and also make it payable for detailed diagnosis and consultation to digitize our services. It is easier for us because 70 – 80 percent of skin conditions and issues can be diagnosed by images itself. In the long run, we even plan to provide digital prescription and follow up service via our app.

What is the reason behind hair loss?

To understand hairfall, first we need to know that the normal range of hair loss in one day for an individual is 50 to 100 hairs a day. That means, if your hair brush has a small amount of hair left on it after combing, that is normal. However, if you are losing more, that means you have a hair loss condition. 

Generally, around 50 to 60 percent of male population and 10 percent of the female population experience hair loss issues. 

Hair falls generally due to androgenetic alopecia. Androgen means active testosterone male hormone. Genetics also plays a role. Genetics not only applies to the father side of the family but also to the maternal side. 

Hair loss ranges from Grade 1 to Grade 7. 

What is Hair Transplant?

Usually hair loss occurs on the front of your head, and the hairs at the sides and back of your head is permanent (i.e. not lost easily.) Hair transplant is the process of taking your permanent hairs and transplanting them to your bald area. It makes the bald zone transform to a permanent zone. 

Is excessive hair fall after surgery normal?

Simply explained, yes. Apart from androgenetic alopecia, which is common in 50 – 60% of males, there is another condition called “Telogen effluvium”, more common in females, which is a form of temporary hair loss that usually happens after stress, a shock, surgery or a traumatic event. 

The hair cycle typically has three phases:

Anagen or growth phase.

Catagen or transitional phase.

Telogen or resting phase. 

Telogen phase is a normal phase, where normal hair shedding of 50 to 100 hairs occurs. Telogen effluvium is where the telogen phase increases and your hair falls more. 

However, the good thing about this is it’s reversible easily. 

How can one prevent excessive hair loss?

As a doctor, I would recommend the following tips:

Lifestyle

  • Sleep 8 hours. 
  • Eat a balanced diet with enough protein
  • Make sure you have enough essential nutrients required for your hair, like biotin, manganese, iron, calcium. In general, ensure you get enough micronutrients. 
  • Drink enough water
  • Try staying stress free as much as possible 

Medicine

So far, the US FDA has approved only two medicines for preventing hair loss.

  1. Some over the counter medication can be Minoxidil Lotion to be applied in the hair. This works for both men and women.
  2. Finasteride is a medicine used to treat male baldness. You may google Trump Finasteride to find some interesting results as well.

There is another medicine called Dutasteride which is not FDA approved but has been used in countries like Japan, korea etc to treat baldness.

However, please be careful about using random hacks of putting onion, garlic or ginger paste in your hair, since these hacks have not been proven anywhere, and I as a doctor cannot attest to any of these hacks. 

Also, these are general tips on reducing hair loss, but a detailed consult is required to determine the root cause as well as the treatment. 

When is hair transplant required?Cost of hair transplant in Nepal?

A detailed diagnosis and consult is required to determine if hair transplant is required or not. Every patient is different. So always check with your dermatologist. However, it should be kept in mind that hair transplant should be kept as plan B, not the first choice. Initially, medications will be used to see if transplant can be avoided. 

Depending on the level of hair loss, cost in Nepal ranges from 50 k to 300 k. For detailed costing you will have to visit the doctor. 

What are some ideal hair and skin products? Also, what are big no’s of derma care?

I will not name brands, but the ideal products to use in you skin and hair should be sulphate and paraben free. For hair, it is better if your shampoo/conditioner has caffeine in it as well. 

Some big no’s will be:

  • Please don’t use soap in your face and scalp. Soaps usually have sulphate and paraben and can cause huge issues to you. 

Does PCOS/Thyroid cause hairfall in women? If yes, how can that be controlled?

Yes. Hormonal imbalances are usually the cause of hair fall in women. PCOS and thyroid issues are related to hormonal imbalances. 

Hair Fall caused by these hormonal issues are treated after diagnosis of the underlying condition via hormonal evaluation and hormonal treatments are done if needed. 

What is Alopecia? Is it synonymous to hair loss? 

As a simple example, Alopecia is like fever. It is not a diagnosis, rather a symptom of a broad spectrum. Like fever can be due to cold or typhoid, alopecia too can be different, and like there are different medicines to treat different fevers, there are different ways to treat alopecia. 

So, it is not synonymous to hair fall, rather it is a broad diagnosis. 

For detailed diagnosis you will have to visit a dermatologist. 

What is the usage of Minoxidil?

Minoxidil is a lotion based medicine that is applied to the root of the hair, i.e. the scalp. It is a general medicine used to treat hair fall. 

It is usually applied in the evening, around 3 hours prior to sleeping. 

Its usage duration varies across cases and also depends on the gender of the user. For men, minoxidil is usually used for long term. I prefer telling my patients that don’t take it as an added responsibility rather make it a daily routine, like brushing your teeth. 

For women, minoxidil can be stopped after proper dosage is completed under supervision of the dermatologist.

To know the proper application process, search for a video by american dermatology association.  

Are there any home remedies for alopecia areata and hair loss in general?

If you ask me, I am not a big fan of home remedies for any hair loss condition, including alopecia areata which is a temporary autoimmune disease. I wont say that any home remedy does not exist, but I prefer that patients should not take risks unnecessarily. Since home remedies are unsupervised by a dermatologist, it can backfire and cause even more damage to your hair.  

To cure alopecia areata, steroid treatment is required. 

What can be the medication to cure scalp psoriasis?

Scalp psoriasis is a chronic inflammatory condition. This stays for a long  time. Its treatment is usually treated with steroids and salicylic acid lotions. 

What is the solution to gray hair?

To know the solution, we must first know the problem. Hair colour usually comes from cells called melanocytes that are in our skin and hair. With age, melanocytes tend to get damaged so if you get gray hairs after 30, it usually is normal and non reversible. But if you are before 30 years of age, it can be caused due to deficiency of micronutrients like calcium and biotin, which can be corrected. 

What is Laser Hair removal? What is its process and how much does it cost?

Laser hair removal is not exactly removing your hair but rather reducing them at the follicle level. At one session, 15 to 20% hair reduction occurs. The process takes 6 to 8 months in the beginning phase, where laser hair reduction sessions will be done every month. After that too it is advised to do bi annual follow up sessions. 

Each session costs around 8 K. 

However, this cannot be done during pregnancy. 

Will medications work on places where there are no hair, i.e. bald spots?

If there are no hair follicles, the medications will not work because medications work on increasing the caliber of hair (thickening etc) rather than generating new hair.

How can we get rid of Acne problems?

Acne problems firstly require detailed diagnosis to determine the root cause of the acne. If it is occurring in the time of puberty (12 to 25) years of age and it is not excessive in amount, that is normal. After 25, 92% of people stop facing acne problems.

However, if it is excessive medical treatment can be sought, which involves acne treatment and maintenance treatment in order to prevent scars. The treatment is not the same for every patient and it is treated based on the scale of acne.

Does Ketoconazole Shampoo cause hair loss?

No, actually it boosts hair growth.

Which is better: PRP or Microneedling for hair thinning?

It depends on the case as every case is unique. In general, however, I prefer PRP to be better in itselfl, but microneedling combining minoxidil is also good.

How is Keratosis pilaris treated?

This is a genetic condition which is not curable but if treatment is required, Retino 0.5 or 0.25% cream can be used. 

How can we remove Til Kothi (freckles)?

Til Kothi can be genetic. If you want to prevent it, use sun screen. If you want to remove, AAVARAN has Andiac Laser that does the removal.

Can we lighten our skin complexion?

While I believe that natural complexion regardless of the colour is beautiful for everyone, if you have excessive tanning then there is Lightening Brightening Treatment available at AAVARAN.

How can we remove Milia?

Milia can be removed at home by extraction/needling process. It can also be done by parlour. To prevent it from recurring, stop rubbing your eyes.

Is there face pigmentation medication?

The medication/treatment to this must be done only after detailed diagnosis and consult. Please share your photo to AAVARAN app for the consultation. Only after a doctors review, it can be treated. To prevent face pigmentation, make sure you use sun screen regularly. 

How to control itchy and oily scalp?

The general treatment of both itchy and oily scalp is using Ketoconazole Shampoo along with salicylic acid on your scalp while bathing. 

How can we remove flat warts from our skin?

There are medications and if they dont work, laser therapy can be done to remove flat warts. 

How can we increase facial hair?

You can use minoxidil on your face if required. If that doesnt suffice, AAVARAN clinic also offers beard transplant services.

Does hairfall occur on transplanted hair also?

Yes, normal cyclic hairloss occurs on transplanted hair also. But it doesnt cause baldness. 

How can we reduce dark circles?

Dark circles can be caused due to many reasons: stress, sleep deprivation, sunken eyes or skin pigmentation. Depending on the root cause, treatment can be done as laser or chemical peeling. 

What are the pros and cons of Retinoids:

Pros: It is extremely beneficial in reducing acne and controlling other skin conditions.

Cons: It makes your skin extremely dry in the first few weeks of using it. You cannot use it during pregnancy. 

Is it safe to get tattoos if you have keloids?

Tattoos increase your risk of developing keloids so you have to be careful. 

Where can we get detailed consult for skin care during lockdown?

You can use our app Skin Care by Aavaran to get free consult during lockdown. 

How risky is hair transplant?

It is definitely not risky, I myself can attest to that. 

How can we reduce frizziness in hair?

Using oil such as Argan or Coconut oil and also using conditioners. 

Is there a permanent solution to hair loss?

No, it can be controlled and prevented but permanent hair loss can not be solved in case of men. In case of women if it is due to hormonal issues, it can be solved. 

General Skincare tips:

Use sun screen every time you go out

Use cleansers every evening

Use moisturizer every night befor sleeping 

Use good quality skin care products

Ensure good lifestyle

Why does hairfall occur more in males?

It is due to the testosterone hormone being the primary reason of hairfall, and men have more testosterone.

Is there any consequences of long term use of supplements like biotin, zinc or vitamins?

If consumed under required daily amount, there are no long term consequences. 

Prevention and cure to eczema?

Eczema is a really broad term since there are so many types of it. The cure varies accordingly. But if you want to prevent, make sure you use moisturizers regularly. 

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Health&Sports

Myopia Management & OrthoKeratology

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If you are wearing glasses, you surely do remember your first visit to your eye doctor. Many of you might have been prescribed spectacles or contact lenses as a remedy to the refractive correction (Glass Prescription). As a small kid, I remember my eye care professional prescribing me a -0.75 refractive correction (lens power) when I was around 11 years old.  By the time I was 20 years old, my refractive correction was -2.75.  I always used to wonder and ask myself why my refractive correction was increasing even though I was wearing spectacles as prescribed by my eye care professional.  Could this -2.00 Diopter of increase in power have been controlled?  Is there any way we can help children of 4 to 5 years, already having -1.00 Diopter of correction, stop them from becoming high Myopic (>-6.00 D) when they grow? Should we really worry about myopia control in children? What are the risk factors that comes after having a high myopia?

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We have to be asking all these questions now and try getting the answers.  One of the reasons of Myopia progression is due to the elongation of the eyeball with its increase in axial length.  Myopia control wizards (Optometrists) have been trying their best to control this phenomenon of increasing the axial length of the eye ball to control the Myopia progression. Controlling Myopia does not just improve the patient’s quality of life but it also prevents vision threatening conditions like retinal detachments and retinal maculopathy.  Now, the question arises how do we control this normal phenomenon of the elongation of the eyeball? Luckily for us, many researchers has already found a way to control this phenomenon by various methods.

  1. Simply get out of your room and play outside:  Sounds simple yet very effective. If you want your children, brothers or sisters to be less vulnerable to refractive error, then send them outside to play. Though the exact reason for this is not known yet, many researchers have found out that spending just about 10 to 12 hours a week outside the room and indulging in outdoor activities helps to reduce myopia progression in Children.Hence, taking kids out of their digital gadgets and spending time outdoors can be beneficial in reducing Myopia progression.
  2. Low Dose Atropine: A low dose atropine of 0.01% is considered to be really helpful in controlling the progression of Myopia. The ATOM & LAMP trials study has shown that low dose atropine of 0.01% & 0.05% is more effective than 1% atropine with much less side effects and rebound effect. 2, 3
  3. Multifocal Contact Lens: The use of center distance design Multifocal Contact Lenses helps to reduce the elongation of the eye ball by creating a myopic defocus in the periphery of the retina. With normal spectacle and contact lenses, hyperopic defocus is created in the peripheral retina which makes the peripheral retina to elongate in order to focus the light rays into the retina. The center distance multifocal lenses has high add in the periphery which corrects this hyperopic defocus and pushes the light rays in front of the retina creating a myopic defocus which helps to control the elongation of the axial length of the eye ball.
  4. OrthoK Lenses: The OrthoK lenses corrects the Myopia by flattening the center of the cornea without the need of surgery. As in LASIK surgery, the OrthoK lenses helps to flatten the central corneal area which corrects the Myopia. The peripheral cornea creates a myopic defocus that helps to control the Myopia progression as well. The OrthoK lenses are the gold standard treatment for myopia control and is also one of the options for myopia correction.

Why should we worry about Myopia Progression?

Myopia progression today has become a topic of discussion for many of the eye health care practitioners. It is estimated that by the year 2050 about half of the world’s population will become myopic. So, if something is not done to control this progression, we will be seeing rise in more and more myopic patients in the days to come. But why should we actually worry about Myopia Progression?

With this digital age, children today spend most of their time in their electronic devices which is turning them into an early Myopes. We are now getting myopic cases more than ever. It is common to find more than -1 Diopter of Myopia in children of 5 to 6 years. If this is not corrected and controlled, these children are bound to become high Myopic at the age of 18. With high Myopia comes the high risk of many eye health conditions like Cataract, Glaucoma, Retinal Detachment & Maculopathy.

The only goal of Myopia Control & Orthokeratology is to stop these children from progressing from -1 Diopter to -6 or -7 Diopters.  If we can start Myopia Control now, the Myopia progression can be controlled by more than 50% and these children can be saved from the risk factors of high Myopia.

Conclusion:

We are treating Myopia as a refractive error but now it’s time to take myopia as a disease and start treating it and help those children from progressing their myopia to become high Myopic. If you are a parent, brother or sister of a young myopic child, then please do start talking about myopia control with your eye health care professionals. Pediatric Ophthalmologists along with Optometrists who practices Myopia Control can stop the progression of Myopia. Refractionists and Ophthalmic Assistants can help you find if your children has any refractive errors and will refer you to the Myopia Control practitioner.

 


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References:

      1. Wu PCChen CTLin KK, et al. Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29371008
      1. Li FFYam JC. Low-Concentration Atropine Eye Drops for Myopia Progression. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31478936
      1. Yam JCJiang Y, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30514630

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Things to know before buying a Soft Contact Lens

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When we get a prescription for refractive correction we start thinking about spectacles. Spectacles has become a very good means of correcting refractive error but sometimes we do want to break free from the glasses and enjoy our coffee without the fog, enjoy rain without the blur & enjoy the dance floor without worrying about the glasses. There are various other options that we can choose if we are fed up with the spectacles. The very first option that I, as an Optometrist suggest to my patients are Contact Lenses. But before buying Contact Lenses we should always know about these wonderful invention and the way to handle it.

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Should I buy Contact Lenses Online?

We find a lot of online stores selling contact Lenses these days but is it a right way to get your contact lenses? If I was an owner of an online store I might have said, “Contact Lenses are just like spectacles you can buy anywhere you want if you have the prescription” but being an Optometrist I know the risk of buying contact lenses without proper fitting and evaluation of your eye health conditions. Buying your contact lenses is fine if the seller can arrange an eye examination from an eye health care practitioner who is authorized to dispense contact lenses but it can lead to serious complications if you buy those contact lenses without consulting with a contact lens practitioner.

How long can I wear a Contact Lens?

If you can understand how long you can stay underwater without oxygen then you will get your answer of how long a contact lens can be worn. This is just an analogy but when the Contact lens sits in front of your eye ( the Cornea ), the time that it can be worn depends upon how much oxygen can be passed into the cornea through the contact lens. This is determined by the property of the contact lens material called Oxygen permeability (Dk). When contact lenses are made with the material having certain Dk the amount of oxygen that will go through that contact lens will now be dependent upon the thickness of the contact lens which will be termed as oxygen transmissibility (Dk/t). So every material with which the contact lens is made has a Dk value.

Now the actual question of how long a contact lens can be worn will be dependent upon the dk/t value of the lens.

For Daily Wear modality lenses ( lens that are worn on day for 10 to 14 hours ), the Dk/t value according to Holden & Mertz criteria is 24 x 10-9

For Extended Wear Modality lenses ( lens that are worn overnight while sleeping ) the Dk/t value according to Holden & Mertz criteria is 87 x 10-9  

Another thing to know in order to understand how long you can wear a contact lens is to know the replacement schedule of the contact lens. This means when you should dispose your lenses.

There are currently four contact lens replacement schedule:

  1.  Daily Disposable Contact Lens
  2.  Biweekly Disposable Contact Lens
  3.  Monthly Disposable Contact Lens
  4.  Yearly Disposable Contact Lens

The daily disposable lenses are worn and disposed every day. So you can wear a fresh pair of lenses every day. This type of contact lens usually come in a 30 or 32 piece lens in a box. Some of the Contact lens also comes in a small eco pack of 4 to 8 piece lens in a box. These lenses are the most recommended contact lens to wear because of very less chance of infections and other complications because every day the lenses are disposed and a new one is worn. Because these lenses are daily disposable you will not need any lens care solution to clean these every day. Simply dispose it and use a new pair of lens. Do Not wear the same daily disposable lenses more than 1 day.

The biweekly disposable lenses are worn and disposed in every two weeks. That means you store these lenses in a lens storing case for 2 weeks and get a new pair after 2 weeks. The lenses are worn each day for 8 to 14 hours depending upon the contact lens material and removed and stored in a lens case after cleaning. The lenses should be cleaned with a lens care solution every day before wearing and after removing during the 2 weeks period time of wearing. These lenses will come in a 6 piece lens pack. That means when you buy one box of biweekly disposable lens you will have 6 lenses to wear and each lens can be worn for 2 weeks. Do Not wear the same biweekly disposable lenses for more than 2 weeks.

The monthly disposable lenses are worn and disposed in every one month. Similar to biweekly you should clean these lenses every day with lens care solution for the period of one month and dispose it at the end of the month and wear a new one. The lenses are worn each day for 8 to 14 hours depending upon the contact lens material and removed and stored in a lens case after cleaning. These lenses will also come in a 6 piece lens pack and you can wear each lens for 1 month.  Do not wear the same monthly disposable lenses for more than 1 month.

Yearly disposable lenses are not prescribed in western and developed countries now a days because of high chances of infection and complications than other disposable lenses. They usually come in a pair and the same lens is worn for a year. Similar to monthly and biweekly these lenses should be cleaned every day with a lens care solution. These lenses are not usually recommended to wear.

In short, while buying a contact lens you should know which replacement schedule contact lens you need ( daily, biweekly, monthly or yearly) and when to dispose it. Before buying any lenses make sure you have a detailed eye examination and after buying the lenses make sure you are taught how to correctly insert and remove the lenses with proper maintenance and lens handling.

Summary:

Contact Lenses are great alternative for your spectacles. There are daily disposables, biweekly disposables, monthly disposables and yearly disposables contact lens currently in market. Make sure to choose the right one with the help of your Optometrist. Don’t buy any contact lens without consulting with an Optometrist and make sure you are taught the proper way of lens care and maintenance. A good Optometrist will always help you to make you comfortable with your contact lens.

( Only Soft Contact Lens is discussed in this article. There are many other contact lens which are used as specialty contact lenses )


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Dengue : Causes, Symptoms and Prevention

Dengue is not transmitted from one person to another, but an infected person can be the source of virus for another mosquito.

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What is Dengue?

Dengue, also known as breakbone fever, is a mosquito-borne viral disease caused by Dengue Virus (DENV). Till now, four distinct strains of dengue virus have been known, namely DEN-1, DEN-2, DEN-3, DEN-4.

How does it spread?

It is mainly spread by the bite of infected Aedes Aegypti mosquito. These mosquitoes are most active at daytime, so biting period ranges from early morning to dusk before sunset. Dengue is not transmitted from one person to another, but an infected person can be the source of virus for another mosquito.

What are the symptoms of Dengue?

Symptoms of Dengue can be seen at earliest from 3 days and late up to 14 days from the day of biting.

1) In case of Dengue Fever

High fever (40°C/ 104°F), accompanied by at least two of the following symptoms:

Image result for Dengue

  1.  Headaches
  2.  Pain behind eyes
  3.  Nausea,
  4.  Vomiting,
  5.  Swollen glands,
  6.  Joint, bone or muscle pains,
  7.  Skin Rash

 

2) In case of Severe Dengue

Severe Dengue appears in the lethal forms of Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). It occurs in the patients with multiple medical conditions. It may also develop if a person who has developed immunity against one strain of Dengue Virus gets infected with another strain.

As a person develops Severe Dengue, initial fever may decrease, which should not be mistaken for recovery. S/he may show following symptoms:

  1.  Severe abdominal pain
  2.  Blood Plasma Leakage
  3.  Bleeding gums
  4.  Vomiting blood
  5.  Rapid breathing
  6.  Fatigue/ restlessness
  7.  Blood in urine
  8.  Persistent vomiting

If any suspicion of Dengue arises, blood test should be done immediately for the confirmation of Dengue Virus.

Cure and Treatment

There is no specific cure or treatment available for Dengue yet. According to World Health Organization (WHO), patients should seek medical advice, rest and drink plenty of fluids. Paracetamol can be taken to bring down fever and reduce joint pains. However, aspirin or ibuprofen should not be taken since they can increase the risk of bleeding.

Prevention

Community awareness and participation plays a key role in prevention and control of Dengue. Aedes Aegypti mosquitoes, are mainly found in damp and wet places, as water is the perfect place to lay their eggs. So the main step would be to eliminate the mosquitoes egg laying sites like discarded bottles, containers, potholes, drums for collecting water, etc. Apart from that, exposure to mosquito should be avoided as far as possible, using mosquito repellent, mosquito netting, wearing long sleeved shirt and pants etc.




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