Skin Health

Topical steroid creams (betamethasone, clobetasol, mometasone) are prescription-only medicines but are widely sold without prescription at Indian pharmacies, often as fairness or skin-lightening preparations. Prolonged inappropriate use causes topical steroid-damaged face (TSDF) — a condition of steroid dependence where the skin worsens severely if the cream is stopped, causing redness, burning, pimples, and thinning of the skin. On the body, long-term use causes skin thinning, stretch marks, fungal infections (steroids suppress local immunity), and systemic absorption causing adrenal suppression in severe cases. In India, dermatologists see large numbers of patients whose original mild condition (acne, pigmentation, dermatitis) has been made far worse by years of inappropriate steroid cream use. Always use steroid creams only under dermatologist supervision and for the prescribed duration.

See a dermatologist promptly for: a mole that changes in size, shape, colour, or starts bleeding (possible melanoma — use the ABCDE rule: Asymmetry, Border irregularity, Colour variation, Diameter over 6mm, Evolution). A non-healing ulcer or sore lasting more than 3 weeks. Any rapidly spreading skin redness with fever and pain (cellulitis, necrotising fasciitis — surgical emergencies). Blistering rash covering large areas, especially if the skin is separating (Stevens-Johnson syndrome — a rare drug reaction that is life-threatening). Sudden widespread hives with throat tightness or breathing difficulty (anaphylaxis — call an ambulance). Scaly silvery patches with joint pain appearing together (psoriatic arthritis). Severe widespread rash following a new medication. Most skin conditions are not urgent — the above are exceptions that genuinely need same-day or emergency attention.

In India's high-UV environment, sunscreen is arguably the most important skincare product — it prevents tanning, worsens of melasma, premature ageing, and skin cancer. Choose SPF 30 at minimum (SPF 50 preferred in direct sun), broad-spectrum (covering both UVA and UVB). PA+++ or higher rating indicates UVA protection (important for pigmentation). For Indian skin tones: chemical sunscreens (avobenzone, tinosorb) are less likely to leave a white cast. Tinted sunscreens provide additional UVA protection through iron oxides. Apply 2 finger-lengths for the face and neck — most people apply one-quarter of the recommended amount. Reapply every 2-3 hours when outdoors. Sunscreen must be used daily (not just on sunny days) as UVA penetrates clouds. It is effective only if applied consistently and in adequate quantity — a thin daily application gives far less protection than the SPF number suggests.

Male and female pattern hair loss (androgenetic alopecia) is the most common cause — genetically influenced, driven by DHT (dihydrotestosterone) acting on susceptible follicles. But other causes are important to exclude: thyroid disease (both hypo and hyperthyroid cause diffuse hair shedding), iron deficiency anaemia (very common in Indian women, frequently causes significant shedding), post-partum hair loss (physiological, self-limiting), nutritional deficiencies (protein, zinc, B12, vitamin D), alopecia areata (autoimmune patchy loss), and chronic stress (telogen effluvium — a delay-triggered shed 3 months after major physical or emotional stress). A blood test panel (thyroid, iron studies, B12, vitamin D, complete blood count) distinguishes treatable causes from pattern hair loss before starting treatment. Treating a thyroid problem or iron deficiency resolves the shedding — treating those as pattern hair loss is ineffective.

India's tropical climate — heat, humidity, and sweating — creates ideal conditions for dermatophyte fungi (tinea species) and Malassezia (the yeast causing dandruff and pityriasis versicolor) to thrive. Tinea corporis (ringworm of the body), tinea cruris (groin — 'jock itch'), tinea pedis (athlete's foot), and tinea capitis (scalp) are among the most common dermatology presentations. Additional risk factors: tight synthetic clothing that doesn't breathe, shared towels and footwear, gyms and public pools, diabetes (fungal infections thrive in high-glucose environments), and overuse of topical steroids (which suppress local immunity and allow fungal overgrowth). The misuse of steroid-antifungal combination creams sold OTC is creating drug-resistant tinea — a significant emerging problem in India. Treatment requires the right antifungal for adequate duration (usually 4-6 weeks) — stopping early because the rash looks better causes relapse.