Help! I have a red rash around my mouth

For a long time, I have had a skin problem —  inflammatory around my mouth that produces whitish substance when squeezed. I have tried a variety of drugs in vain. I guess the problem doesn't arise from facial hair or beards because they haven’t grown yet. Please help

Nick

Dear Nick,

You may be having perioral dermatitis, a skin rash around the mouth that comes and goes over time. The exact cause of this rash is not well known but is thought to be due to a combination of hormonal, environmental and genetic factors. It may also be triggered by use of steroid creams or using steroid inhalers for asthma treatment. It may be triggered by some cosmetic products, dental fillings, fluorinated toothpastes and chewing gum. It may be triggered by infections caused by bacteria, fungi or mites. The rash is best managed with the help of a skin specialist/dermatologist. In addition to getting rid of any irritants, treatment may include oral and/or topical antibiotics for several weeks. Other treatments may be used according to need, including immune modulators, Sulphur products, adapalene, tretinoin and photodynamic therapy.

The rash may also be due to acne vulgaris, which develops due to a combination of factors including hormonal changes, infection and the amount of natural oily substance (sebum) produced by your skin. It may be due to rosacea, a recurrent skin condition with no known cause, where the skin may look reddish and you may have small red bumps or pimples that have pus.

It is best to be examined by a skin specialist and to also have the skin tested. Also, clean your face twice a day; in the morning, and in the evening before bed. Use soap and a gentle towel. Do not scrub your face too much while cleaning it since it is already sensitive. Take lots of water, fruits and vegetables, and also exercise. Avoid pressing the pimples as this can lead to developing black marks. Visit a dermatologist for advice on medications you can use to control the pimples. For many people it takes a while before you get medication that works for you specifically, so be patient.

Why lymphoedema? Why me? Why now? How do I deal with it?

Steve

Dear Steve,

Lymphoedema is swelling of tissues from accumulation of lymphatic fluid due to damage to a part of the lymphatic system. The lymphatic system is a network of vessels that carry excess fluid and lymphatic glands/nodes that have immune cells and act as filters for unwanted substances. The lymphatic system is spread across the entire body, just like the blood circulatory system, and it drains excess fluid from the blood circulatory system. Lymphoedema mostly affects the arms and legs though it can affect other parts of the body including the abdomen, the chest, the neck and the genital area.

Symptoms of lymphoedema include swelling of that body part, heaviness, reduced movement, hardening or thickening of the skin and fluid leakage through the skin. Lymphoedema also makes it easier to get cellulitis - infection in the tissue under the skin in the affected area.

Damage to the vessels and/or the nodes can result in fluid accumulation in that part of the body. This damage may be a result of injury, infection (including parasitic/worm infestation), inflammation, reduced movement, cancer or cancer treatment. Rarely, lymphoedema can be a result of genetic abnormalities.

Lymphoedema is not curable. However, the swelling can be controlled, first by identifying and treating the underlying cause, if it can be treated. In addition, lymphatic flow can be improved by healthy diet and exercise, compression devices and specialised massage techniques. Surgical treatment may also be used.

Dear doc,

What is colitis?

Dear reader,

Colitis refers to inflammation of the inner lining of the intestines. It can occur for a short time (acute) or last for a long time (chronic). Acute colitis is usually a result of an infection or food poisoning or rarely due to poor blood flow to a section of the intestines. Chronic colitis may be the result of inflammatory bowel disease (ulcerative colitis or crohn’s disease) where there is inflammation of the intestinal lining and ulceration that develops due to immune overactivation or genetic factors. Colitis may also develop as a result of an allergic reaction to particular foods. You may also develop colitis if you have undergone radiation treatment.

Symptoms of colitis include abdominal pain, bloating, diarrhoea, constipation, blood in stool, vomiting, repeated urges to pass stool, fever and weight loss.

Depending on the suspected cause, diagnosis may be made through stool tests, proctoscopy and/or colonoscopy, MRI or CT scan of the lower abdomen, barium enema or biopsy. Chronic colitis is best treated by a gastroenterologist. Treatment depends on the cause of the colitis. There are supportive treatments for the symptoms and the rest of the treatment is specific to the diagnosis such as antibiotics for infection or immune suppressants for ulcerative colitis.

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