Tec Sanchez-Tolosa, MD, FPDS

Normal, healthy skin in patients with an intact and competent immune response is highly resistant to the many microorganisms to which it gets exposed. The hardened, keratinized layer of the epidermis – the stratum corneum – provides a formidable barrier to many bacteria. It is through the breakage or disruption of the integument that bacteria are able to invade and produce the characteristic lesions on the skin and their complications. Disturbance of the skin barrier may be brought about by acts as simple as scratching or rubbing, or by insect bites and foreign bodies (e.g., splinters).

The most frequent bacteria found in common skin infections are Staphylococcus aureus and Streptococcus pyogenes. Together, these two account for majority of the bacterial skin lesions seen in outpatient dermatologic practice. This article presents the typical lesions associated with these infections.

Impetigo is caused by staphylococci, streptococci, or a combination of both. It is contagious and is observed to be more common in children who come in close physical contact. In both types of impetigo, the areas around the nose and mouth, as well as other orifices (e.g., perianal area), are most usually affected. There is consensus that offending staphylococci may be harbored in the nares (inside the nose) before they invade the skin. Impetigo may or may not present with blisters. Known in the vernacular as mamaso (from paso, meaning, scald or burn), the lesions in their early stage look like burns from cigarette stubs. Later on however, the more typical presentation appears, when the roof of the blister collapses, causing a thin, honey-colored crust to appear in the center. In brown- or black-skinned patients, healing is accompanied by darkening of the injured area. When left untreated, impetigo secondary to streptococcal infection may lead to kidney involvement.

Staphylococcus aureus also gives rise to other skin lesions. The term folliculitis refers to inflammation of the hair follicle caused by infection, inflammation and irritation, or physical injury. Staphylococcal folliculitis is perhaps the most common form of infectious folliculitis. On any body surface, a pustule or a group of pustules may appear. This occurs following injury, abrasion, steroid use or even occlusive wound dressings. Another manifestation of staphylococcal infection is sycosis barbae, a deep involvement of the hair follicle. The beard area is affected and becomes studded with large, inflamed pustules. Shaving is identified as the primary culprit, and lesions continue and become more diffuse as shaving is continued on a regular basis. The condition may also be caused by dermatophytic fungi.

Very common during the hot, summer months are furuncles or abscesses (called boils, or pigsa in the vernacular). This is a walled-off collection of pus, forming a reddened, inflamed, softly fluctuant and exquisitely painful mass. S. aureus is the often the culprit, but other bacteria such as E. coli or Pseudomonas may cause these. Furuncles can appear in normal individuals, or may present as part of a syndrome of defective immune states.

Cellulitis and erysipelas are skin infections of the dermis and the subcutaneous tissue that are characterized by redness, swelling and pain. While both staphylococci and streptococci may be responsible, a number of other bacteria play a role as well (e.g., Hemophilus influenzae type B in children less than 3 years of age). Patients present with fever and increased white blood cell count.

Understanding the basic principles leading to bacterial infections is useful in preventing these conditions. Good personal hygiene, especially in warm, humid weather is essential in decreasing colony counts of bacteria. Well-fitting clothes that preclude occlusion in the groin or buttocks are better than tight, ill-fitting ones. Whenever possible, one should avoid scratching, rubbing or manipulating the skin, as this destroys its integrity and compromises its defense. While boils may benefit from incision and drainage, patients are not advised to do this on their own. Non-aseptic techniques and dirty home instruments only serve to propagate the infection.

Management of skin infections entails use of antibiotics, which may be topical or oral. The elimination of the carrier state (as in the nares, in the case of Staphylococcus aureus) may greatly improve outcomes and prevent recurrences. Self-medication with antibiotics is discouraged, because of issues of efficacy, bacterial resistance and unnecessary expense. Early diagnosis and proper treatment, done by medical specialists, markedly decreases the risk of complications and recurrences.

Dr. Tec Sanchez-Tolosa is a fellow of the Philippine Dermatological Society. Founded in 1952, the PDS is the only recognized affiliate society of the Philippine Medical Association and the Philippine College of Physicians. The Society is committed to maintaining the highest ethical standards in the practice of dermatology through its mission-vision: to be a highly recognized society, locally and globally, striving toward excellence in the attainment of healthy skin for all, through humane service, information dissemination, training and research.

The rainy days have come upon us with a vengeance. The rains and its inevitable partner, the floods, present the skin with its own myriad of problems.

The skin is a wonderfully dynamic organ, quickly responding and adjusting to changes in the environment: excessive heat, sun and sweat in the summer, daily exposure to dust, smoke and soot, and dampness and soaking, during the wet season. The rainy days present the skin, particularly the feet, with the problem of prolonged soaking in water. Compound this with the fact that it is not water of the bottled variety but instead a malevolent mixture of bacteria, fungi, toxic chemicals and human and animal waste that soak or skin.

Soaked skin, particularly of the feet and legs, is prone to problems during the rainy season because of the following:

The skin of the palms and soles, although thick, are also dry and has a low lipid/fat content. Naturally occurring lipids make up an integral part of the skin barrier, and this relative lipid deficiency renders the soles more prone to injury from soaking, since water causes further lipid removal. As such, soaking from floodwaters further depletes the barrier capacity of the skin and makes it susceptible to injury.

The skin becomes hyper/over hydrated or water-logged. In this state, a parameter called relative humidity approaches 100%, resulting in rapid growth of bacteria producing thriving populations in a short period of time. This is made worse by the warm, occlusive “kulong/kulob” condition inside the shoes hence trapping the dirty floodwaters within the footwear and socks. It is common to find fecal coliforms ( bacteria indicating contamination from human waste) present in polluted water. In fact, health experts use the presence of these bacteria as an effective predictor of skin disease, even more effectively than gastrointestinal disease. Trench foot, mentioned in the annals of wartime history, was a disabling foot infection, brought about by the combination of soaking in wet trenches and constrictive footwear. It is written that it was a common problem among the US troops in the Vietnam war sometimes making the barefooted Vietcong more effective in the warm, wet tropical jungles. Aside from th he contaminated rainwater, other microbial sources include resident skin microorganisms normally found in areas like the toe webs, which harbor gram negative bacteria and yeast, which may overgrow and produce disabling foot infections.

Wading in floodwaters with closed footwear may compound the problem if water is allowed to seep in. This allows increased contact of skin with the dirty floodwaters, as well as providing the moist and warm environment conducive to microbial growth. Studies have proven that absorption of water pollutants through the skin is enhanced under these conditions, increasing the risk of contact allergies, skin irritation, and absorption of toxic substances so prevalent in the present- day environment.

Soaked skin leads to maceration. This is what the skin looks like when you spend too much time in the water and your skin becomes soft, white and wrinkled. Skin like this is prone to injury and blistering, specially if subjected to mechanical insult such as friction from shoes and socks, as occurs when wading through water or walking in soggy footwear. Needless to say, blistering opens the skin to the easy entry of microbial intruders and toxic substances.

As you walk through rainwater or boldly wade through the floods, you are unable to see what you are going to step on. This puts you in obvious jeopardy from punctures and lacerations from sharp objects on your path. These wounds require immediate attention and prompt anti-tetanus measures. Prevention of skin injury under rainy conditions is as simple as avoiding getting our feet wet. Very often however, we have no choice in the matter as we have to go to school/work, and are at the mercy of the miserable state of the city’s drainage and garbage disposal system.

Here are some useful tips to keep in mind during the rainy days:

Wear waterproof footwear when you have to wade in the floods. High cut boots are a good choice but make sure dirty water does not seep into them. Be sure to soap, rinse and dry dirty footwear thoroughly before wearing them again. Do the same to your feet.

Bring an extra pair of dry footwear and socks in a waterproof bag. After washing soaked skin with an antibacterial soap and thoroughly drying your feet, specially between the toes, change into dry footwear.

Do not brave the floodwaters if you have open wounds, existing skin infections or eczema, or have conditions which impair sensation in the limbs ( such as diabetes, leprosy, or stroke).

Cuts, puncture wounds or lacerations require immediate medical attention. Anti-tetanus prophylaxis and antibiotic therapy are also usually required.

Avoid obviously dirty areas that probably contain hidden hazards which may cause injury. Aside from skin injury, the rainy days may bring serious, life-threatening infections such as the rat-borne leptospirosis and mosquito-borne dengue fever.

Dispose of your garbage and (human) wastes properly. As the slogan goes … “ ang basurang tinapon mo … babalik din sa iyo…”

Examine your feet well. If after having been exposed, you develop wounds or lesions which become red, swollen and painful, more importantly those accompanied by fever or swollen lymph nodes (kulani), please seek immediate medical attention. A duly-accredited dermatologist will be able to help you with such a problem. Always remember that a serious disabling infection can result from exposure to polluted floodwaters if not treated promptly.

Nobody likes warts. Not only are they ugly and embarrassing, they can also interfere with daily activities ranging from walking to having a healthy sex life! Want to know more about this common skin condition? Read on. This article answers some of the most F requently A sked Q uestions ( FAQs ) on warts that the dermatologists of the Philippine Dermatological Society (PDS) encounter in their clinical practice.

Q: What are warts?

A: Warts are benign, infectious skin growths, caused by a virus, that appear on the outer layer of the skin or mucous membranes. This viral infection is caused by a family of viruses called human papillomavirus (HPV) which stimulates the skin cells to grow more rapidly than normal.

Warts are usually painless and don’t itch. They are mildly contagious from person to person and from one area to another on the same person.

Q: Are there different kinds of warts?

A: Yes, warts come in different varieties such as common warts , flat warts , plantar warts , and genital warts .

Common warts appear as small, hard, raised bumps on the skin with a rough, irregular or spiked surface and clearly defined borders. They are usually the same color as the skin, but sometimes darker. Common warts often grow on the fingers and on the back of the hands. They may also grow around the nails ( periungual warts ), or underneath them ( subungual warts ). They begin very small (1-3 mm) and may grow larger. They occur more frequently in areas of broken or damaged skin, for example, where fingernails have been bitten or hangnails picked. Common warts cause no discomfort unless they are in areas of repeated trauma.

Flat warts are smaller and smoother than common warts. These pinhead-sized, flat lesions can occur anywhere and are often numerous. In children, they are most common on the forehead and cheeks, and sometimes on the arms. As a result of irritation from shaving, adult men may have them on the beard area while women may develop these flat warts on their legs.

Plantar warts : are found on the soles of the feet. Clusters of these are called mosaic warts . Unlike common warts, plantar warts do not protrude above the surface because the pressure of walking flattens them back into the skin. When cut, the surface may present with small, black dots or bleeding points which represent the small blood vessels feeding the wart. Plantar warts are most annoying because they can become extremely painful and debilitating causing difficulty in walking or running.

Genital warts : often appear as pedunculated cauliflower-like growths seen primarily on moist, non-hair bearing areas of the skin. They tend to be small and flat but can be thin and raised. They vary in color (gray to pink) and size. Unlike some other types of warts which are rough and scaly, genital warts are usually soft. They can occur within the vagina or on the cervix in women, or on the genitalia, around the anus or within the rectum in both men and women.

The virus that causes genital warts rarely causes warts of the hands and feet but can cause warts in the mouth. The incubation period (the amount of time between the actual infection and the appearance of the wart) has been estimated at 4 to 6 weeks from the time of contact, and it can be as long as 2 to 3 months before any symptoms are identified. People can be infected with and transmit the virus without having any symptoms at all!

Q: How does one get warts?

A: Warts are acquired from other persons by direct skin contact, although sometimes they may be spread indirectly. Warts may also be spread to the one and the same person by auto-inoculation: this means that if a person scratches his/her wart, the viral particles may be spread to another area of the skin. It may take as long as 12 months for the wart to appear from the time of first contact.

While the risk of catching hand, foot and flat warts is small, genital warts, on the other hand, seem to be more contagious. Genital warts are very common in the sexually active population. Thus, it is important to use precautions (such as use of condoms, examination of sexual partners and early treatment) to limit the spread of genital warts to one’s sexual partner.

Q: Do all people develop warts?

A: The development of warts depend on the degree/frequency of exposure to the virus. Warts are more likely to grow on skin that has already been damaged, which explains why warts occur more often in children who bite their nails, scratch their hands or pick at their hangnails.

Some people are more prone to catch the wart virus than are others. Patients with a weakened immune system due to drugs or a medical illness are particularly susceptible to developing wart virus infections.

Q: Do all warts need treatment?

A: Sometimes, the treatment can be more uncomfortable and troublesome than the wart itself. Thus, many people just leave their warts alone. Besides, warts in children tend to disappear spontaneously, with 90% often resolving within 2 years of appearance.

In adults, warts do not disappear as easily and spontaneously as in children. Treatment is warranted especially in cases of long-standing genital warts which have the potential to develop into cancerous lesions. Women with genital warts have an increased risk of developing cancer of the cervix. These women should have a complete gynecologic examination including regular PAP smears, even after treatment.

Q: How are warts treated by dermatologists?

A: Depending on the type of wart and age of patient, dermatologists often use a variety of treatments for warts.

Common warts in young children are treated by topically (externally) applied chemicals such as cantharidin or mixtures of salicylic acid and lactic acid , which are applied on a regular basis for several weeks until favorable results are obtained. This causes little discomfort but treatment should be temporarily discontinued if the wart becomes sore. Salicylic acid plasters that can be cut to approximate the size of the wart are also used.

For older children and adults, cryotherapy (freezing the wart using liquid nitrogen) is generally preferred. This treatment is less painful and rarely causes scarring. However, it may be uncomfortable for a few minutes and may result in blistering for several days. Repeat treatments at one to three week intervals are often required. Electrosurgery/electrocautery (burning using electrical pulses) is also a common office procedure done by dermatologists to remove warts. Carbon dioxide and pulsed dye lasers have also been used in the treatment of warts.

Flat warts can be treated with either electrosurgical techniques under local topical anesthesia, or peeling with either salicylic acid , tretinoin or other surface peeling preparations . Peeling is especially recommended if the warts are numerous.

Plantar warts are difficult to treat because the main portion of the wart lies below the skin surface. Treatments include scraping the wart down and applying a salicylic acid plaster which penetrates and breaks down the wart. Another method usually reserved for very stubborn foot warts in adults is to prick or inject the wart with a chemical called bleomycin , after numbing the area with a local anesthetic. Surgical methods of removing plantar warts also include laser surgery , electrocautery or excision . Lastly, the dermatologist may recommend a change in footwear or the use of a corn-pad with a hole cut in it to reduce pressure on the wart when walking. Methods to reduce foot sweating are also used.

Genital warts are perhaps the most difficult to treat because of their location. All genital warts must be identified and located. External warts are more visible and therefore easier to diagnose by sight. Warts on the vagina and cervix in women are not visible: therefore, actual screening and diagnostic tests are required via colposcopy . Examination of the rectum in both sexes is mandatory. Research has shown that 60-90% of partners exposed to genital warts will develop growths. If no signs of infection are found during an initial examination, subsequent periodic screenings are advisable. Periodic treatments with acids or freezing may be needed.

Podophyllin or imiquimod cream which can be used at home may be prescribed by dermatologists. One of the various surgical treatments may be done to treat very stubborn or very large genital warts. It is important that the patient’s sexual partner also be examined . Genital warts are often very difficult to cure and successful treatment is not guaranteed even with multiple treatments.

Q: Can I treat my warts without seeing a dermatologist?

A: Although some wart remedies are available without a prescription, you might mistake another kind of skin growth for a wart. You could end up treating a much more serious condition as though it were a benign wart. And remember: early and correct diagnosis is what allows for higher success rates when treating more serious skin conditions. If you have any doubts about either the diagnosis or the right way to treat a wart, it is best to seek a dermatologist’s advice. As with any skin concern, self-diagnosis and treatment is not advisable.

Q: How can I prevent myself from getting warts?

A: First, avoid direct skin contact with another wart. Always protect your skin from injury and wash hands frequently. Do not wear other people’s shoes. Also, make it a point to wear footwear in public locker rooms or showers. To keep from spreading warts, don’t scratch them! Warts spread readily to small cuts and scratches. With regards to genital warts, the best way to not pass them on is to not have sex. Otherwise, use a condom or ask your partner to use a condom for protection as this may help slow its spread. Always bear in mind that some carriers of warts do not even have any symptoms at all!

Q: What are the most common complications encountered after wart treatment?

A: After removal by cryosurgery or electrocautery, infection may sometimes reappear at the treatment site. Also, warts may not disappear completely after treatment. In addition, new warts may appear again or spread after treatment. Minor scarring or formation of keloids in redisposed persons may also occur after removal.

Q: Can a wart grow back?

A: Yes, especially if treatment has been inadequate. Sometimes it will seem as if new warts appear as fast as old ones go away because the old warts have shed the virus into the surrounding skin before they were treated. This will result in new “baby” warts growing up around the original “mother” warts. The best approach is to treat new warts as quickly as they develop to prevent the shedding of the virus into the nearby skin. An examination by your dermatologist can help assure that the treated wart has resolved completely.

The skin, apart from being the protective covering that shields us from the environment, is a dynamic organ that periodically restores itself. New skin cells are constantly produced in the epidermis’ basal layer and as they move up towards the surface, they transform themselves to produce keratin and are eventually shed off. An immunologically driven alteration of the cell kinetics of these keratinocytes is the principal abnormality in psoriasis, a skin condition that affects millions of people worldwide..

Psoriasis is one of the most important skin disorders because of its frequency and recurrent nature. It is a chronic, debilitating skin condition that develops when the ordinary life cycle of skin cells accelerates. Instead of the usual four weeks, layers of skin cells are shed off in a matter of days. This causes a build-up of “silvery scales” on the skin, which are an almost constant feature of the disease. Psoriasis comes in many forms but typical lesions consist of sharply marginated, bright red, papules and plaques with silvery-white scales. These lesions are of various sizes and shapes and arise on different parts of the body. The most commonly affected areas are the scalp, elbows, knees, front legs and the buttocks–places most often exposed to pressure and trauma–often appearing on the same places on both sides of the body. Other areas of the body may also be affected like the nails, producing small pits on the surface. Some patients may develop arthritis. Itching may be prominent.

Despite advances in research, the cause of this condition is still unknown, although several factors are said to aggravate it: illness such as pharyngitis or sore throat, emotional stress, certain medications, as well as trauma secondary to rubbing or scratching may elicit more lesions. Men and women are equally affected by it. Psoriasis may occur anytime from infancy to old age, although it is commonly noted to begin during the second decade of life.

There are many myths on psoriasis. Although a percentage of patients do have a family history of psoriasis, we cannot predict who among the offspring of parents or ancestors with the condition will develop this disease, if at all. This author believes that psoriasis patients must not deprive themselves of the joys of life and of having children.

Psoriasis is not caused or exacerbated by food. There is no need to restrict the intake of certain foods. It is not infectious. Patients do not need to be isolated from other people.

To a certain extent, sunlight has proven to be beneficial in improving lesions of psoriasis. A fifteen to twenty minute daily exposure under the early morning sun from 8 t o 10 am may help. Intense and prolonged sunlight exposure may lead to sunburns, which may aggravate the condition.

Dermatologists frequently arrive at a correct diagnosis by means of a thorough history and physical examination of patients’ skin, scalp and nails. At certain times, a skin biopsy may have to be done to confirm the diagnosis.

Therapy of the condition is varied and is tailored to suit the individual requirements of every patient based on his or her health, age, lifestyle and the severity of the condition. Topical agents such as steroids, tar products, and synthetic vitamin D may be used by themselves or in combination with exposure to ultraviolet light either from the sun, or better yet, from artificial sources delivering controlled doses. For severe cases, oral medications may be needed to control psoriasis, such as methotrexate, retinoids and cyclosporine. New medications such as biologic immunotherapies have also been developed. It is important to emphasize the need to consult a dermatologist for initiation and maintenance of therapy, as these medications may produce side-effects if not used properly.

Although there have been many promising breakthroughs in the research of psoriasis treatment, currently, no treatment permanently “cures” it. Therapy is aimed at achieving improvement and remission of the condition, although recurrence is still likely. The greatest challenge, then, is to minimize the physical and emotional disability associated with psoriasis in a manner that is both effective and safe for the long term.

As John Updike—also a psoriasis patient– aptly put it, to have psoriasis is to have “the sense of another presence co-occupying your body and singling you out from the happy herds of healthy, normal mankind”. Truly, patients have a “sensation of anxiety and shame, a sensitivity acute beyond usefulness, as if the nervous system, flayed of its old hide of social usage, must record every touch of pain.” Because of the inextricable ties of physical appearance and the sense of personal identity, the psychological effects of this condition, coupled by its chronic nature and tendency to recur, are profound.

There are now several support groups in various hospitals and skin centers to address the emotional impact of the condition and the needs of patients to maintain a good quality of life. The National Support Association for Psoriasis Patients, Inc. (NSAPPInc) has also been established, and, in cooperation with the Philippine Dermatological Society, holds its National Assembly annually where a variety of topics and issues regarding the condition is discussed.

The search for better treatments continues. In the meantime, we urge our patients not to give up on life and their dreams.

Founded in 1952, the Philippine Dermatological Society (PDS) is the only recognized affiliate professional group for dermatology of the Philippine Medical Association and the Philippine College of Physicians.

The PDS Secretariat is at rm. 1015, Front Tower, Cathedral Heights Building Complex, St. Luke’s Medical Center, E. Rodriguez Avenue, Quezon City, with telephone number, 727-7309; and website, www.pds.org.ph.

“A thing of beauty is a joy forever; its loveliness increases; it will never pass into nothingness.”

Those were the famous lines of the great British poet, John Keats.

Hence, since time immemorial, people of all ages and sex have continuously aspired to be beautiful, in body, heart, mind and spirit.

Today, with the ceaseless media commercials, there has been more emphasis on physical beauty and younger looking skin. More and more people are constantly reminded to use various beauty products and avail of services offered by health and beauty spas and clinics to remedy skin imperfections, like having wrinkles removed, dark spots lightened, or blemishes reduced, to name a few.

Yet, what appears to be “beautiful skin” may not necessarily be “healthy skin”. How can one therefore have both healthy and beautiful skin?

“If you want to treat skin problems and enhance your appearance, you should choose a properly-trained dermatologist, or you may end up with sham ‘skin experts,’ who prey on gullible individuals,” advised the Philippine Dermatological Society (PDS).

“Evaluate and choose the right skin expert,” cautioned the PDS, the country’s leading organization of professional dermatologists committed to providing quality and ethical dermatological care.

To achieve a healthy skin and stay beautiful, the PDS recommends the following pointers to consider.

First, know the ‘real’ dermatologists from those who claim to be ‘beauty and skin experts,’ or those who claim to be one that did not even specialize in dermatology nor finish residency training in dermatology. A real dermatologist does more than give advice on enhancing and improving the cosmetic appearance of the skin. He/She is a doctor of medicine who specializes in the care of the skin, hair, nails and mucous membranes. Anything that has something to do with the skin, whether pathological (skin diseases) or cosmetic, is the province of a dermatologist.

You should be able to distinguish so-called “dermas” who are actually cosmetologists, beauticians, aestheticians, or even general practitioners who may just have taken a few training courses on skin treatments here or abroad, from real dermatologists- medical doctors who have undergone three years of specialized training in dermatology in an accredited training program.

The emphasis on training and background, the PDS cautioned, is only meant to weed out the ‘sham’ beauty and skin experts, and not discriminate among practitioners. Further, it is basically meant to protect the well-being of patients, who will be put under the care of the practitioner.

Simply, base your choice of a dermatologist on qualification, not on advertising, the PDS noted.

Thereafter, once you made the choice, politely ask your dermatologist the various skin treatments that she or he would employ.

But before anything else, the dermatologist should note down your complete medical history, including lifestyle, as your overall health condition could affect your response to skin treatments or procedures, such as how fast your skin would heal afterwards.

Thereafter, the dermatologist should discuss thoroughly with you the appropriate and needed treatment procedures, including the recovery or healing stage, and the entire duration to achieve the desired result. All the treatment options should be presented, and all the pros and cons of each option should be thoroughly explained.

Likewise, politely ask about adverse side effects, if any. Never assume that all procedures done on your skin are harmless or innocuous, and the dermatologist should be honest enough to discuss with you any adverse reactions. This is the hallmark of a properly trained dermatologist who shows deep concern for the well-being of her or his patients, and that he or she could manage any complications that may arise.

Take some time to decide before going through any treatment procedure, especially if it’s cosmetic. Be sure that you are thoroughly and correctly informed before giving your consent.

For instance, your skin imperfections may be treated well with the use of the latest laser technology. On the other hand, the same skin problem may be adequately treated by employing a less expensive procedure. Or your skin problem may be simply solved with a prescription of appropriate topical products or preparations.

Beware therefore of any practitioner who is so eager to promote one particular treatment or promises unrealistic results. The treatment procedure may be popular, but it may cost you a lot in the end, and worse it may not solve your skin problem.

Hence, politely ask your dermatologist if the treatment would actually do what it claims to do for your skin.

Overall, you should know which types of procedure the dermatologist would employ, how many and how often. Whatever procedure you may undergo, it is for your best interest that your dermatologist would provide the right, quality treatment.

Beauty may be skin deep, but skin treatment or enhancement procedures are not. When done improperly, they can have dire consequences.

In fact, there have been reports of patients who accidentally died as a result of skin peeling done by non-dermatologists, and non-doctors at that. That is why it is important to seek qualified professionals for any concern about the skin, or regarding any part of the body for that matter.

Thus, don’t put into nothingness, as John Keats put it, your skin treatments.

If you want your skin to be healthy and beautiful, seek and visit real and qualified dermatologists. And enjoy forever your newfound beauty.

Founded in 1952, the Philippine Dermatological Society (PDS) is the only recognized affiliate professional group for dermatology of the Philippine Medical Association and the Philippine College of Physicians .

The PDS Secretariat is at Rm. 1015, Front Tower , Cathedral Heights Building Complex, St. Luke’s Medical Center , E. Rodriguez Avenue , Quezon City , with telephone number, 727-7309; and website, www.pds.org.ph.

Do you have pimples or acne? If so, and you are desperate for effective treatment, do read on. As one of the most common skin problems, myths and misconceptions about acne—what it is and how to treat it—abound. As with any skin condition, understanding the truth about your acne is the first step to treating it effectively.

Here, then, are answers to some of the F requently A sked Q uestions ( FAQ s) regarding Pimples or Acne that the dermatologists of the Philippine Dermatological Society (PDS) most often face, as well as facts to nullify the most common misconceptions about this condition.

Q: Is acne caused by dirt trapped in the pores? Can I get rid of blackheads and whiteheads by staying clean, washing as often as possible, and scrubbing the face vigorously with abrasives?

A: No, acne is not caused by dirt. Notice that even the cleanest person who stays in an air-conditioned room without pollution can develop acne. Genetic factors are important to consider since there is a hereditary tendency for dead skin cells to have an abnormal stickiness in the pores of the skin, thereby causing blackheads. Blackheads, or open comedones , are open follicles (the pores from which hairs grow) trapped with dead skin cells (or keratinocytes ) plus oil gland secretions and bacteria.

The dark colour of blackheads is due to deposits of skin pigment or melanin, and is not caused by dirt or lack of hygiene. No matter how much you try to wash and scrub your face, therefore, the blackheads remain. Washing the face too often, especially with harsh medicated or abrasive cleansers, may in fact actually make the acne worse.

When the pores are closed, whiteheads form and are therefore called closed comedones . When increased oil is secreted by the oil (or sebaceous ) glands, and this combines with bacteria called Propionibacterium acnes , the interaction produces the pus that accumulates in the pimple. If not treated, cystic and even hard nodular (lumpy) lesions develop which may cause scarring.

Q: Is acne specifically an adolescent problem? When I am out of my teenage years, will I no longer suffer from acne?

A: Acne is NOT just a problem for teenagers. In fact, there are several kinds of acne ranging from types affecting the newborn (first four weeks of life), infants, children of various ages, adolescents and definitely a variety that appears in adulthood. The common acne, acne vulgaris , is the type most adolescents develop. Statistics show that 90% of teenage boys and girls will come up with some type of acne during puberty. The reason for the eruption in this period is the surge of hormones (called androgens ) that causes an increase of the oil secreted by one’s sebaceous glands.

Unfortunately, adults may also get acne lesions for a number of reasons such as use of comedogenic (acne-causing) products and cosmetics, increase of hormones due to stress or menstruation, use of certain drugs and many others. Do not be surprised, therefore, to see people in their 30′s, 40′s and even 50′s with acneiform (acne-like) lesions.

Q: Will eating oily food, such as peanuts and chocolate, cause an eruption or increase of pimples?

A: There are no scientific studies proving the relationship between food and pimples. The oil glands of the skin are under the influence of the nervous system which is dictated by hormones. Hence oil secretion is triggered by intense emotion or stress, sleeping late, menstruation . . . not food. However, if the acne seems to get worse when eating a specific food, it is best to avoid that food. Furthermore, it is always advisable to eat nutritious food and a balanced diet to ensure a healthy glow inside and out.

Q: Can I save a lot of time, pain and money by pricking or squeezing out my pimple on my own or by self-medicating?

A: One absolute no-no in dealing with acne is manipulation by untrained hands. Trying to remove these deep-seated lesions on your own (pricking, squeezing or picking at them) causes even more damage. These efforts may cause ice-pick scars or unwanted hyperpigmentation (skin darkening) that both cost more, in terms of both time and money, to treat.

Various medications are recommended for the different types and stages of acne—open and closed comedones, lesions with pus, cysts, nodules (lumps) and severely scarring types. It is best to first consult a dermatologist for proper advice rather than to self-medicate. Dermatologists should also

be sought for procedures such as acne removal or surgery wherein each lesion is manually extracted with a specifically designed, appropriate and sterilized tool, or wherein a steroid injection is given to flatten large, solid lesions. It is not advisable to be “treated”, for example, in a beauty parlor. Once scarring develops, other procedures such as chemexfoliation (peeling), dermabrasion or laser resurfacing, and specific medications may be tried.

Q: Will my acne disappear immediately and never return once I start treatment?

A: One important thing to realize regarding acne is that it takes time and effort to stay pimple-free. With just one treatment or application, the eruption will probably come and go depending on circumstances. For example, in females, break-outs may be evident before menstruation or during exams for students.

Some medications are used as maintenance while others are applied only as dictated by the type of acne present. Be patient with topical medications (applied to the skin’s surface, not taken internally).

Stick to the regimen your dermatologist gives you, no matter how tedious it may sometimes get. Also, stay clean, get enough sleep, eat the proper types of food and drink enough water daily for sustained inner health and outer glow.

When in doubt, or when all else fails, your dermatologist will be more than willing to help you with your problems regarding acne, answer all your questions and suggest a treatment strategy individualized for your needs. Instead of hiding in shame because of acne problems, be patient, do not panic, keep the facts presented above in mind, and seek out a trained and accredited dermatologist to find the proper treatment regimen best for you.