Q. My 15-month-old daughter has cough and runny nose. She was taken to the hospital for febrile seizure. I have noticed that her skin is bluish; her face is pale but her mouth and feet are bluish. She acts normally, she is still as actib\ve as she has been and eats normally. The doctor didn't seem to be too concerned about it. Please advise.

A. If the hands and feet are really blue all the time and specially if it increases during a bout of cry, it is a good idea to check her oxygen saturation by pulseoximeter, which would be available in any of the hospitals in your locality. If this is fine, you can ignore it.

Q. My 11 months old daughter has been getting blisters on her hands and feet since she was 4 months old. She gets these whenever she crawls or walks. The dermatologist says that this is due to friction of the tender skin. He says that her upper layer of the skin is very sensitive, which leads to these boils. Is there a permanent cure for this?

A. Your child as well as wife are having epidermolysis bullosa simplex (EB simplex). It is a genetic inherited disorder. Diagnosis is made by histopathology, salt-split technique of immunofluorescence, electron microscopy, and immunoblotting technique. Blistering in hands and feet will improve with age but it never goes off completely. Fresh blisters should be drained after puncturing them with a sterile disposable needle as they extend if left alone. The blister roof should be left in situ. Ideally, the footwear should be made of very soft leather, with minimum number of internal seams. Towelling type of sport socks may be worn. It is sometimes useful for the patient to wear two pairs of socks as this helps to reduce friction. It is important that clothing does not have rough internal seams and that it fits loosely, especially at the neck, wrists and ankles. Avoidance of high environmental temperature is a helpful measure. Short courses of oral prednisolone to reduce blistering temporarily may be considered in any type of EB under the supervision of a doctor.

Q. It's been several years that I have had bad odour around the penis area. I have a white skin around the head of the penis. I have gone to doctors and I only get a cream to put around it. I would like to know what this is?

A. It is probably smegma, which is the normal secretion of the glands. if not cleaned every day it will give off a bad odour and also act as a medium for bacterial and fungal growth-leading to further bad smell.

Q. I am 35 years old. Last week, I scratched myself near the neck. But over the last few days this has developed into a reddish patch, about 2.5 cm in area. The skin is sensitive and aches with burning sensation when I turn my neck. There are 3 small white tipped blister kind of formations on it since last night. I have been putting Neosporin H over it. Please suggest an ointment or a suitable dermatologist I can consult?

A. You may be suffering from Folliculitis. It is an inflammation of one or more hair follicles. Folliculitis starts when hair follicles are damaged by friction from clothing, blockage of the follicle, or shaving. In most cases of folliculitis, the damaged follicles are then infected with the bacteria – like Staphylococcus aureus.

Features include:

• Rash (reddened skin area)
• Pus filled lesions located around a hair follicle
• Itchy skin
• Sometimes pain

Q. I have 2 problems. First, I have a rash like thing on my left arm and it hasn't gone away in almost 4 years, sometimes it itches and at times it doesn't. I only get it on my left arm, neck and back of the neck. Doctors have given numerous creams and steroids and it goes away for a while but comes back. The other thing is that under my arm I have these little blackhead like things and the doctor said that he has never seen anything like that. I try to squeeze them and it comes out but how do I get rid of them for good? This is embarrassing because I have them in the inside of my thighs and it makes my skin look dark. What can I do?

A. It is unfortunate that three different doctors have not been able to make a diagnosis. It is also true, that at times it is not possible to make an accurate diagnosis on clinical examination alone. In such situations, one comes up with different possibilities which are then worked upon. Skin biopsy settles the issue in most cases. Without all the clinical details it is difficult to hazard the possible skin disorder you have.

Round circles can be seen in number of conditions which can respond to topical steroids. Some examples: chronic eczema, neurodermatitis, localised psoriasis, granuloma annulare, etc. Dark skin in body folds can result from chronic friction, acanthosis nigricans etc.

Prognosis depends upon the diagnosis.]

Q. My 8 years old cousin has white patches visible all over his body. One dermatologist said it is para-psoriasis and recommended photo therapy, while another dermatologist said that it is Pityriasis lichenoids chronica and advised to apply coconut oil or a moisturiser on the whole body, and it may take 6 months or 2-3 years for it to heal. Whose advice should we follow?

Q. When I was 5 years old, I was climbing a wall when I slipped suddenly. My left cheek was poked and cut by a metal fence on the wall. It was very severe and a lot of blood oozed out from the wound. I was taken to the hospital immediately. The doctor put 14 stitches on my left cheek to seal the hole. I am 20 years old now and I have a scar on the left cheek caused due to the stitches. The scar is about 1 and a half inches long and resembles the alphabet 'J'. I don't have any itching or pain in that area and the stitches have come out. But the stitches have left a mark on my cheek. Why did this happen? How can I get rid of this scar? Is there any medical or cosmetic treatment for this? Can any beauty parlours or health clubs help me get rid of this mark? Should I go for plastic surgery? What would be the cost? Can laser treatment heal this? Is plastic surgery the only solution?

A. This is a common problem, which happens quite often. The scars of a wound or stitches are permanent but if done with lots of care initially they are as minimal as possible. The scars are of the wound as well as cross hatches of stitches.

The scars can be reduced by plastic surgery where in the thickness and size is reduced and is placed in such a way that would not be very apparent. Health clubs and cosmetic clinics will not help but you could camouflage the scar with the help of some cosmetics but if it is depressed or elevated then it needs to be revised.

Laser can help smoothen the skin a little more after the scar revision is done to give you added advantage.

Q. I have some strange type of pimples on my face which turn black after they appear to have calmed down. Kindly tell me the reason and the cure.

Q. I am a 24 years old male, suffering from some sort of itchiness in my inner thighs, which increases more due to sweat. I have already consulted a skin specialist at Ganga Ram hospital and was recommended to apply Statum lotion and Abzorb talc on the affected area and to take Dermonorm tablet thrice a day. This helped me but after taking a regular course for about 6 months, the problem again appeared when I stopped taking the tablets. Please advice me whether I should again start the same course and what all care should I need to take in order to prevent this.

A. Ringworm infection, erythrasma and seb. dermatitis are the usual conditions which affect the inner and upper part of the thighs and the adjacent areas. The area is discoloured, itches and usually occurs or gets worse in the summers.

The first two conditions, if treated properly will not reccur if proper preventive measures are carried out. The third condition usually comes and goes. Treatment for all of them is only partly similar. Dermonorm is effective in only the ringworm infection and one months treatment is more than enough for most of the cases.

A review of your condition is suggested.