I have often talked about how powerful hormones can be. And hormonal diseases are frighteningly common. Polycystic Ovarian Syndrome affects up to 1 in 5 women in Asia and the Middle-East. It is a hormonal disorder with far-reaching consequences like infertility and uterine cancer. Unfortunately most women remain unaware of their disorder.

Although there is no cure, public awareness can lead to early detection and successful management, often with simple lifestyle modifications.

Polycystic Ovarian Syndrome (PCOS) was first recognized in the 1930s. In medical parlance, a “syndrome” refers to a group of symptoms and medical signs which occur together to characterize a particular illness. Most women with PCOS have multiple fluid filled cysts in the ovaries. While there may be several explanations for an ovarian cyst, it is the peculiar constellation of symptoms which occur together to establish the diagnosis.

The main symptom of PCOS is irregular and infrequent menstrual cycles (8 or fewer cycles in a year), starting from puberty or later in life. Other symptoms include weight gain, excess hair on the face and body, oily skin and pimples, thinning of hair on the top of the scalp, thickening and darkening of the skin over the body folds (neck, underarms, inner elbow and groin), decrease in breast size, enlargement of the clitoris and/or deepening of the voice. These symptoms can occur all at once, or one at a time; and most patients have only some of these symptoms.

An ultrasound scan of the pelvis may reveal multiple fluid filled sacs in the ovaries. Blood tests may altered hormonal levels in the blood. Blood insulin level often tends to be high, leaving the sufferer susceptible to diabetes. When left untreated, it can lead to infertility, abnormal bleeding from the uterus, and cancer of the uterine lining (“endometrial carcinoma”). There can also be long term complications of obesity and high insulin levels; like diabetes, heart disease, high cholesterol and sleep disturbances. In fact, PCOS is one of the most common cause for infertility in women.

So what causes PCOS? No one knows for sure. It seems to run in families. Women who reached puberty at a younger age (8-10) maybe at a higher risk of developing PCOS later in life. In many cases, weight gain and insulin resistance are said to be the trigger for hormonal upheavals. Insulin resistance is a condition where the body produces insulin but does not utilize it effectively, which in turn pushes the pancreas to produce even higher levels of insulin. In healthy women, the pituitary gland in the brain produces a hormone called follicle stimulating hormone (FSH) in the first half of the menstrual cycle, which stimulates hundreds of eggs in the ovaries to mature and grow within their tiny follicles. The growing follicles release Estrogen, the female hormone. Mid-cycle, estrogen levels in the blood start to peak, which signals the pituitary gland to produce a surge of hormone called luteinizing hormone (LH). Under the influence of LH, a single follicle becomes dominant, while the remaining follicles dissolve, and the dominant follicle then bursts to release one healthy egg. This process is known as ovulation. In women suffering from PCOS, LH levels are abnormally high at all times, and the mid-cycle hormonal surge fails to take off. Therefore none of multiple fluid filled sacs (seen as ovarian cysts on a scan) mature to release an egg, which explains the infertility.

After ovulation has occurred, the hormone LH directs the ovaries to produce another hormone called progesterone, which prepares the womb (the uterus) for an impending pregnancy. If conception does not occur, the womb sheds its lining along with the unused egg, roughly every 28 days, which we all know as menstruation. This fails to occur in PCOS, and a sufferer may not get her period for 45-90 days or much longer, until the uterine lining becomes so heavy that it breaks down under its own weight, leading to heavy and abnormal bleeding.

High levels of blood insulin and LH leads to increased production of male hormones (testosterone) from the ovaries and adrenal glands. High levels of testosterone also prevent ovulation and cause infertility. The male hormones are also responsible for the typical symptoms like acne, facial hair, weight gain and scalp hair thinning.

Most women remain undiagnosed as they may be unconcerned about their symptoms. However, PCOS which remains undetected and untreated for a prolonged period of time can lead to long-term medical complications. Your GP may refer you to a gynecologist or endocrinologist. The specialist doctor will take a detailed history about your menstrual cycle, check your weight and blood pressure, do a physical examination to detect signs of excess male hormones in your system, and finally order some blood tests and a simple non-invasive ultrasound scan of the abdomen and pelvic area. Patients who are having difficulty conceiving must be evaluated thoroughly, along with their partners. Only a subset of women suffer from infertility. Therefore one must always practice safe sex to avoid sexually transmitted infections and unwanted pregnancies.

Unfortunately there is no permanent cure for PCOS. In many young women, these hormonal upheavals tend to normalize on their own after marriage and child birth. Most women have only milder symptoms like irregular periods and weight gain. In that case, your endocrinologist may choose not to treat you at all. Exercise and weight loss alone can alleviate all symptoms of PCOS, regularize your cycles, and help you get pregnant! Long term weight control is also essential to avoid complications like diabetes and high blood pressure. A balanced diet, which is low on starch, free from saturated fats, refined sugars or processed food, can also go a long way in keeping your symptoms under control. In fact, lifestyle modification is the first line of treatment for PCOS. Many patients have reported benefit from yoga, quitting tobacco and switching to a vegetarian diet.

If your periods continue to remain irregular, your specialist may prescribe hormonal contraceptive pills. If you are plagued with acne and excessive facial hair, then anti-androgen medications are the drug of choice. It also helps women who suffer from hair thinning or balding. Diabetes medication like Metformin can help you lose weight faster, reduce blood insulin levels, and regulate menstrual cycles. For women who are trying to conceive, fertility medications are prescribed. Uncommonly,when fertility medications fail to work, your gynecologist may suggest a laparoscopic ovarian drilling procedure. Using a key-hole incision, your surgeon may insert a small needle to drill multiple holes in your ovaries using electric current. This is done to destroy small areas of ovarian tissue where testosterone is produced. This process can help induce ovulation, so that you may conceive.

With treatment, most women go on to conceive and have healthy babies. During pregnancy, women must be screened for diabetes of pregnancy before 20 weeks of gestation. If you do develop gestational diabetes, it is likely to recur in future pregnancies, and you are at high risk for diabetes later in life. In fact, all PCOS patients are advised to get their blood sugars tested on an annual basis.

Symptoms like acne, excess hair growth, skin tags and skin pigmentation can be effectively treated by a dermatologist. However, it is advisable to get onto hormonal medications for best results. Thoroughly discuss the pros and cons of hormonal medication with your doctor and your family, while keeping an open mind. Visit a physician at regular intervals for early detection and management of any untoward sequelae. Some of the symptoms of PCOS can cause severe depression, mood swings and loss of self-esteem. The hormonal fluctuations do not help. If a loved one is suffering from PCOS, shower them with compassion and understanding. Do not hesitate to approach a counselor or mental health professional if you feel the need.

As clinical studies shed light on our understanding of the human skin and its behavior, newer skin care regimes are constantly being modulated. Cosmetic giants spend millions of dollars every year, in the search and testing of promising new herbs, molecules and enzymes- each one touted to give us younger, lighter and healthier looking skin. For those of you who do not wish to undergo invasive and expensive dermatological treatments,You must often wonder- do any of these ‘miracle creams’ really work? How much is science, and how much is empty market hype? How much can I realistically expect out of my beauty potions? And are these creams safe to use? Let me help you make sense of the bombardment of new “ingredients” on the shelves of your favorite beauty store.

The first step towards taking care of your skin includes understanding your skin type. You’ll be surprised to know that Miami’s famed dermatologist Dr Leslie Baumann (‘The Skin Type Solution’ doctor) has identified 16 different skin types. Which is why, the toner or face cream that suited your friend so well, may not work for you at all. Is your skin oily or dry? Blotchy and tanned, or pale and blemish-free? Is your skin very sensitive, or resistant and hardy to any and all cosmetics? Is your skin wrinkled or taut? A quick and honest assessment can help you choose the right skin care regime for yourself. If you’re unable to be objective about your own skin, take Dr Leslie Baumann’s questionnaire at www.skintypesolutions.com/home and find out for yourself. Most women tend to buy all their skin care products from one particular brand. However your skin might need the cleanser of one brand, but the sunscreen of another brand.

For instance, if you have oily skin, use cleansers containing salicylic acid or glycolic acid. Toners and astringents can keep oil secretion under control, and tighten open pores. Use a gel or serum based moisturizer, instead of creams. And use sunscreen sprays (“sports” sunscreen), rather than sunscreen lotions. You can use a SPF containing compact powder, which will blot out excess sunscreen, and provide some additional sun-protection as well. There are various face packs and masks, which contain silica, talc or fuller’s earth, which can leave your skin looking fresh and matte, although only for a day or so. Chemical peels at a spa or a doctor’s office, can also temporarily reduce oil secretion on your face.

If you have dry skin, use non-foaming cleansers, and avoid toners altogether. If your skin is very dry, then you must avoid scrubs, and use thick moisturizers containing squalene, urea or NMF (natural moisturizing factor). Dietary supplements in the form of cod liver oil capsules, omega-3-fatty acids, evening primrose oil, EPA (eicosapentaenoic acid) and GLA (gamma linoleic acid), are all helpful in combating dry skin.
If your skin turns oily in the summer, and dry during winters, then you may have to change your skin care regime seasonally.

Walking into a beauty store, you might be confused by the sheer array of creams, serums and lotions, each one claiming to be “doctor recommended” or of “scientifically proven efficacy”. Flipping through the pages of a beauty magazine, you may find frightening pictures of needles pointed towards the eye of a model, along with innocent-looking jars of creams which claim to give you the same results in an inexpensive and non-invasive manner. So which one do I believe?

First and foremost, even if you choose to undergo medical treatments, you will still be expected to continue using your skin care and anti-ageing creams. It is always good to start from your early 20s, so that those earliest wrinkles can be delayed till your 40s, rather than appearing in your 30s. A simple sunscreen is always the best anti-ageing cream that you can use, provided you get into the habit in your younger days. This is because sunlight is responsible for the maximum damage done to our skin, especially if you are light-skinned. If your skin is prone to pigmentation issues, then one must remember that sunscreens only protect you from ultraviolet radiation. However, your skin can tan even from infrared radiation, emitted by tube lights, lamps, radiators and microwave ovens. The present consensus among the medical community is that, antioxidants like Vitamin C and Vitamin E can provide sufficient cover against infrared radiation. So if you have freckles or blotchy skin, apply Vitamin E gel or Vitamin C serum to your skin, before you apply your sunscreen.

Another question that foxes many women is this- What should I apply first, moisturizer or sunscreen? Opinions may vary among dermatologists as well. But in my experience, most women use chemical sunscreens. Chemical sunscreens must come in direct contact with the skin and have to interact with the skin cells, in order to get activated. Therefore, the sunscreen must be applied before the moisturizer. If you are using a physical sunscreen (the ones that leave a visible white coat on your skin, i.e, talcum powder or zinc paste), it must be the last layer to go onto your skin. If chemical sunscreens irritate your skin or make your eyes water, then try using physical sunscreens or pediatric sunscreens.

Now what about skin-lightening creams? Baring Causacians, women of almost every other race, cherish and strive for lighter and blemish free skin. Bleaching creams ( aka ‘Fairness Creams’ in India) are a multi-billion dollar industry. Women must take solace in the fact that various sociological studies have proven that men are attracted to women with healthy, glowing, even-toned and blemish free skin, irrespective of the skin color. If you are an ‘experienced’ user of bleaching creams, you must have heard of molecules like Hydroquinone, Antioxidants, Licorice, Mulberry extract, Vitamin C, Kojic acid, phenol, AHAs, tretinoin, azelaic acid and arbutin. Then of course, there are face washes, soaps and face packs containing some of these ingredients. And now one hears of oral pills containing Vitamin C, pine bark extract, pomegranate extract, glutathione etc, which can lighten your skin. And to add to the confusion, we now have creams for underarm, genital and anal bleaching as well!

All of the ingredients mentioned above do work in most cases. However, hydroquinone, resorcinol, arbutin, tretinoin and phenols are too harsh on people with darker skin tones. It has been shown to cause skin irritation, paradoxical deepening of pigmentation, even skin cancer. Some women develop allergies even to pure turmeric paste and lemon juice. Creams containing licorice, mulberry extract, kojic acid and arbutin can be purchased over the counter. However, for all other skin lightening creams, you must first consult a dermatologist who’ll pick the right ingredient for you, and guide you on its proper and safe usage. These creams work best if you use a sunscreen as well, as sunscreens are the mainstay of pigmentation treatment. Skin lightening creams may not work on all women, and sometimes the pigmentation can recur. If so, consult a dermatologist who may recommend treatments like chemical peels or laser skin lightening. As a thumb rule, avoid all bleaching creams during pregnancy and breast-feeding. Avoid alternative medicine which may contain toxins like Mercury. Never purchase a cream if it does not carry an ingredient list, never mind claims to an exotic or “secret” ingredient. Oral supplements must never be taken without consulting a dermatologist first. If you have sensitive skin, creams containing Vitamin C, niacinamide or Kojic acid are better suited for you. Do not use bleaching creams meant for the face on underarm or genital skin, as the skin in these areas are more sensitive. And stay away from controversial therapies like glutathione intravenous injections, as they have been proven to cause liver damage in some patients.

Lastly, I come to anti-ageing creams and serums. Companies always claim that serums are more powerful than creams. While serums are absorbed into the skin better, the secret to efficacy lies in the ingredients, rather than the delivery system. Also, serums do not contain moisturizers, so a bland moisturizer maybe needed to combat any dryness or skin tingling caused by the serum. There are several medical studies to prove the anti-ageing efficacy of creams containing Retinol, antioxidants (like Vitamin C), Coenzyme Q10, Epidermal Growth Factor (EGF) and Alpha hydroxyacids (AHA). However, dermatologists are still not convinced about the efficacy of ingredients like peptides, collagen, Matryxl 3000, Tranexamic acid or hyaluronic acid applied to the skin surface, though these ingredients work very well when it is injected into the skin. Over the counter creams containing Vitamin E, allantoin, caffeine, cocoa butter and alium cepa (onion extract) work well on stretch marks and scars, especially if they’re fresh. Oral Vitamin A supplements can slow down ageing of the skin, but idebenone and seaweed extract are of unproven efficacy. Minerals like zinc, copper and tea extracts have limited efficacy. And please stay away from hormone containing anti-ageing creams.

As I summarize, I would like to stress upon you, that creams and lotions can only delay the ageing process and lighten scars and spots. And this is assuming that you’re a non-smoker who sleeps 8 hours a day and stays out of the sun! Most of these products are marketed as cosmeceuticals, which means they’re a combination of cosmetics and pharmaceuticals. However, according to the United States Food & Drug Administration (USFDA), “The term cosmeceutical has no meaning under the law. And cosmetics are not approved by FDA prior to sale”. In other words, cosmeceuticals do not undergo the same stringent testing that applies to drugs. Therefore these are no match to medical treatments. However they are inexpensive, non-invasive, easy to use and mostly free from side-effects. An antioxidant rich diet is even less effective than creams when it comes to anti-ageing, although it may be very helpful in keeping cancer away. It is wise to find products which suit you, and stick to them. Avoid changing your products frequently, or using too many beauty creams and salon treatments, as that could leave your skin irritated and overly sensitive.

Most of us visit the salon for relaxation and rejuvenation therapies, rather than for any real treatment. Services range from hair beautification to epilation, hand and foot care, massages and skin bleaching. A parlor visit is no longer the prerogative of the young, wealthy woman.

More and more older women, men of all ages and middle classes individuals are now visiting salons. As a result of this, spas and salons are mushrooming in every nook and cranny of our modern cities, often with unscrupulous and under-qualified staff who’re cashing in on the trend, to make a quick buck. This often leads to complications and side effects arising from treatments which are normally considered safe.

What are the common pitfalls to look out for? Which treatments are better avoided? And how can I minimize the risk of side effects?

Most of the parlor-related misadventures that I come across in my practice, are related to hair removal treatments. Waxing can lead to an eruption of boils on the skin, and skin burns on rare occasions. Post waxing bumps and boils are most frequently noted on the face, outer arms and thighs. This is probably because of the haphazard direction of hair growth in these areas. If you’re prone to waxing-induced bumps, boils and ingrown hair, then I suggest you use a mild apricot/walnut based scrub on your skin (while showering) for a couple of days before your salon appointment. Do not moisturize, and keep your skin dry before waxing. Only use hot sugar wax and disposable strips. Ask your beautician to ice your skin soon after waxing, and carry a tube of over-the-counter antibiotic cream like Fucidin®. Apply the antibiotic cream to the treated area twice a day for 3-5 days post waxing, and avoid hot showers for a day or two. Don’t pick on ingrown hair or you’ll be left with ugly cuts and scars. Wait for them to grow out on their own, then pull them out with a tweezer. Despite these measures, if the boils still recur each time you wax, then you may have to seriously consider laser hair reduction treatments. Laser treatment will not make your skin completely hair free, but it will make your hair grow slower and much thinner. Electrolysis is painful, expensive, outdated and risky.

If you’ve burnt your skin from the hot wax, then rub ice or run the affected area under cool running water. Rush to your local chemist for a medical grade antibiotic cream, which you can apply over the burn, 3 times a day, till you can get an appointment with the dermatologist. If you notice any blisters, do not pop them or dress them with bandaids. Your doctor will drain it using sterilized, disposable needles, and may prescribe oral antibiotics.
Some women find threading very painful, and certain viral skin infections like warts and molluscum can be spread to your face if the thread is infected. Unfortunately, these rarely go away on their own without medical treatment. Avoid any further plucking or threading until the lesions have completely resolved.

Problems related to bleaching and facials are also fairly common. If you have acne-prone skin, it is wise to avoid facials altogether, especially just before important events like weddings. This is because, if you are to develop a bad flare-up of acne from a facial, your dermatologist will not even have enough time to fix the problem before your big event. If you have sensitive skin, do not get bleach and facial done on the same day. Mild tingling is to be expected, but if you experience any irritation, itching or burning sensation during your treatment, then inform your beautician immediately. Make sure she stays by your side till the treatment is completed. If you notice a rash or excessive redness, then consult your doctor immediately. Do not use steroid creams on your face without a doctor’s prescription. After bleach or a facial, it is important to use a medical grade sunscreen on your face.
Hair coloring is an extremely popular and fashionable trend. Gone are the days when only the middle-aged graying person would sheepishly ask his chemist for “hair dye”. Lately even teenagers choose to color their hair, often experimenting with various colors and changing their color every few weeks. Unless your child is suffering from premature graying, forbid hair coloring till late teens at least. If you’re only using hair color as a fashion statement, give a gap of at least 3 months between each treatment. Beginners can first get highlights done, before opting for global colors. If you have grays, give a 6 week gap between root touch-ups. If this is your first time, insist on a “patch test”, where a small amount of hair dye is applied to your inner elbow for an hour. If there is no skin irritation or rash after 24 hours, then you’re not allergic. However, do keep in mind, that frequent hair coloring can eventually sensitize your skin over a few years. So it is always possible to develop hair dye allergies, even after years of safe usage. If you feel any burning sensation or rash on your scalp, forehead or around your eyes, consult your dermatologist without delay. I will add here, that it has been noted that allergic reaction to hair dyes applied at the parlor is less severe than that seen after home application, probably related to less spillage, and less eye contamination from post color hair shampooing. Frequent hair coloring can leave your hair dry and damaged, unless you use deep conditioning treatments. If you’re pregnant, avoid hair coloring, especially in the first three months of your pregnancy.

If you are allergic to hair dye, but would like to continue hair coloring, you may have to choose options like natural henna and vegetable dye based colors. Black henna and ammonia free hair colors also contain the dye which is responsible for allergies.

Hair waving and straightening procedures involve the use of certain chemicals that alter the shape of the hair. These chemicals weaken the hair shaft by about 17% every time the shape of hair is changed. This leads to split ends, hair fall and breakage, which is particularly severe if you’ve had a permanent straightening done. Hair and scalp burns can also occur, especially with use of hot combs. Hair extensions must be chosen correctly and placed with care, or they can cause hair fall and leave bald patches on the scalp. Fortunately, most of this hair damage is reversible once you stop getting these treatments done.

The focus of hand and foot care is usually on the nails. The steps of manicure and pedicure include soaking the hands and feet in warm soapy water, rubbing off dead skin with pumice stone and emery boards, pushing back of the cuticle, massage of the parts, and finally application of nail paint. The instruments used must be properly sterilized. Certain instruments such as nail files cannot be sterilized, so make sure your salon is using disposable files. Thorough cleansing in boiling water with antiseptics like bleach can kill most bacteria and fungus, but viruses tend to stay back. These can give rise to warts on the palms and soles. So if possible, try to buy and create your own personalized pedicure kit. This should consist of a nail clipper, nail file, cuticle pusher, foot file, emery board, gel toe separators, nail buffer, nail brush, foot brush and pumice stone. Replace your emery board, buffer, nail file and pumice stone after 5-6 uses. These are easily available in most local beauty stores. Prolonged soaking and use of artificial nails can lead to nail splitting, fungal infections of the nail and inflammation of the nail folds. Infections are more common if you’ve shaved your legs with a razor before your pedicure.

Aromatherapy is a form of therapy that uses volatile essential oils from plants and flowers for the purpose of affecting a person’s mood or health. The most commonly used essential oils are tea tree oil, lavender, jasmine, eucalyptus oil, peppermint oil, lemon oil, orange oil, clove oil, oil of Bergamot and Citronella. While tea tree oil has shown anti-bacterial properties in lab studies, the benefits of other essential oils are anecdotal and not medically proven. Certain essential oils cause skin allergies, skin pigmentation and sun burn like reaction. Some of these allergies can even be caused by pesticides, if the original plants are cultivated. Some of these oils can be extremely toxic, if ingested orally; therefore children must be kept out of reach. If you experience any skin rashes following use of these oils, contact your dermatologist, and if possible, carry the oil with you, so that your allergic reaction can be confirmed with a repeat-open-application-test. This goes for massage oils as well. Inexperienced masseuses can burn or bruise your skin with hot oils and stones.

To summarize, choose your beautician and your beauty treatments wisely. Ensure that only high grade cosmetics are used, and insist on checking the expiry date. Before enlisting yourself for any treatment, have a thorough consultation with your beautician. Inform her about pre-existing allergies and skin conditions. Consult a dermatologist to find out what beauty treatments are safe for your skin and hair type. As far as possible, use disposable instruments or carry your own. Experience and training matters, so do not have a casual approach towards the quality and hygiene standards of your salon environs.

Its travel season again, and outcome the cameras as well. You can’t wait to show off your travel pictures, but Alas! Sun burn, chapped lips, puffy eyes and insect bites have left your skin an unphotogenic mess. A few tips and tricks on a simplified and easy-to-carry skin and hair care regime can make your skin look healthy and radiant while you travel.

Our wanderlust takes us to various cities and townships- urbane, remote or exotic. For some of us, our professions require us to live out of a suitcase. Any wise traveler would want to travel light and pack efficiently. An intelligent traveler will do his homework on his destination. You can easily search the internet for the weather conditions of your travel destination. Is it hot and dry? Hot and humid? Cold and windy? Snowy? Rainy? Are you traveling to a tropical country, planning a camping trip, taking a trek or making a desert safari? Knowing your environment is very important to plan the right clothing and carry the right skin care products.

Air travel, especially long flights, can leave you looking like a wreck. The severe air-conditioning and low cabin pressure makes the cabin air especially dry. One also tends to drink less water during a flight, to avoid several visits to the loo. Most airlines do not allow passengers to carry liquids and sprays on-board. Check your local skin stores for skin-care travel kits, which usually contain a cleanser and moisturizer with SPF, in smaller sizes, usually 50-60 ml. Alternately, you can also create your own travel kit using a zip-locked pouch with small capped bottles, into which you can transfer your regular beauty and bath products. Bottles containing less than 100ml of liquid are usually permitted in hand baggage on most airlines. Carry a stick or jar lipbalm instead of a tube. Try the Sebamed or Neutrogena lip balms which contain SPF and protect your lips from sunburns, chapping and cold sores. Chose a stick deodorant over a spray as they are easy to carry and gentler on your skin. Pack perfume samples instead of full-sized bottles. You can also raid the beauty counters of your local mall for free samples of night creams or sunscreens, which usually are smaller sized tubes which are easy to carry while you travel. If your dermatologist’s clinic has a skin store as well, you could request your dermatologist for free tester tubes of skin care products. Unless you have sensitive skin or dry, colored or damaged hair, you can always rely on the bath products provided by your hotel. Do not use hotel soaps and moisturizers on your face, as they’re usually unlabeled, contain lanolins and are perfumed. These products can clog the pores of your facial skin and create acne and whiteheads.

Before boarding your plane, chose a heavier moisturizing cream (one containing sodium hyaluronate or squalene) over a gel moisturizer with a matte finish. Use a caffeine or Vitamin K based under eye cream for the skin around your eyes. Dress warm and use a urea-based hand cream to keep your hands and feet soft. When you’re in your seat, use the warm hand towels provided to you, to first wipe your hands, then your arm rests and food tray. Do not use hot towels on your face, as they can dry out your skin very fast. At the end of your flight, use a face scrub with gentle microbeads (avoid walnut and apricot scrubs), to unclog pores and thoroughly cleanse your skin.

Drink enough fluids to keep yourself well hydrated. You can have water, green tea, sodas and juices, but avoid caffeine and alcohol as they dehydrate your skin and your body. You can even carry an empty water bottle and fill it up at the boarding gates, once you’ve cleared the security checks. To calculate the correct amount of water to drink per day, divide your weight in pounds by half, that’s your fluid intake per day in ounces. So if you’re an adult woman weighing 120 pounds, you need to drink 60 ounces of fluids in a day. On a long flight, stand up, stretch your legs and take a walk up and down the aisle every 90 minutes. If that’s too bothersome, then flex your feet, rotate your ankles and do heel raises while staying on your seat. This is especially important if you’re an overweight person with heart issues, have varicose veins, or using birth control pills. This will prevent swollen feet and clotting inside your veins, which tends to occur when one sits in the same position for several hours at a stretch. If your legs feel red, hot and painful, ask for emergency medical care as soon as you land.

Irrespective of the climate of your travel destination, a medical-grade sunscreen is a must. Sunlight can penetrate tinted car windows, reflect off sand and snow, and penetrates water as well. So whether you’re on a beach, desert, national park or snow-covered mountains, you can and you will get sunburn if your skin is unprotected. Wear a cap, carry a scarf to protect your face, wear protective sun glasses and comfortable shoes. If you’re traveling to the States or the United Kingdom, you can buy some “sunscreen wet wipes”. These are easy to carry, and quick and non-fussy to apply, especially for children. Do not use sunscreen on children less than 2 years of age. It is safer to dress them in a cap and full-sleeved clothes.

Is the weather hot and dry? If so, apply moisturizer over your sunscreen, or chose a moisturizer with an SPF of 25 or above. Is it hot and humid? If that case, you can avoid moisturizers altogether. Use a sports sunscreen (like Banana Boat) which comes in the form of a light spray with water-like consistency. Shower at least twice a day with cool water, use talcum powder over your skin creases, and carry a calamine or camphor based soothing cream to keep prickly heat at bay. Aloe vera gels have soothing and healing properties on sunburns. Avoid toners while traveling.
Are you on a camping trip? Full length jeans or cargo pants are more sensible than shorts. Use an insect repellant cream, and carry a 1% hydrocortisone cream (available without prescription) to treat pesky insect bites and rashes from poisonous plants. Wear water-proof shoes or boots, but chose open-toed rubber footwear with Velcro backstraps, if you’re trekking through rainy or leech-infested terrain. Wear appropriate leech socks and spray your shoes with vinegar to keep leeches away. Invest in a good quality insole for more comfortable uphill climbs. Carry some baby-wipes with you for nature calls when running water is not accessible.

When it comes to footwear, most women do not choose comfort over fashion. This can prove to be foolish if you’re on a trek or walking on Asia’s dirt roads or even the cobble-stoned streets of Europe. Flip-flop sandals are ideal in the tropics or on the beach. When using covered shoes, pad them with soft cotton wool if required, especially near the toes. If you end up with painful shoe bites at the end of the day, soak your feet in iced water, and apply an antibiotic cream or powder on your wounds (easily available at the chemist, even without a doctor’s prescription). Do not paste a Band-aid over a fresh blister, this will make it worse.

It is important to keep your scalp and hair clean while you travel. If you hate carrying bulky bottles of shampoo and conditioner, then try the Lush shampoo soap bar, which doubles as soap AND shampoo. Carry a small tube of leave-on conditioner to keep your hair from getting dry and frizzy. Set your hair dryer to a cool-air setting. Safely secure your hair using clips and scrunchies. Electric shavers are more convenient during travel, though they do increase your baggage weight. If you forgot to pack your shaving cream, then shave after a hot shower. Your hair will be softer after a bath, and you can manage to shave using just a bar of soap.

Ladies, if you’re on a personal tourist trip, keep your make-up light. Compact powder, concealer-stick and lip balm is all you need. I smudge lipstick on my fingertips and rub it onto my cheeks for a flush of color. A single eye pencil will also double as an eyebrow pencil for a dressy night. Avoid using mascara on long flights and cold climates. Like they say, “He who travels happily, must travel light”.

If you’re strapped for cash, or just allergic to most cosmetics, then you must try your hand at creating your own make-up at home. All it takes is a cup of imagination, a dollop of scientific common sense, a pinch of chemistry know-how, and a quart of creativity. From home-made eye liner to lip balms, lotions and shampoos, the sky’s the limit!

I often meet students, housewives and youngsters in their first jobs who are strapped for cash, but would still like to look good. They often ask me if it’s okay to try and make their own make up and if I have any reliable recipes. So I’ve thought long and hard about the pros and cons of handmade cosmetics, before I went about looking for and trying out various recipes.

The Upside –

1) They’re definitely inexpensive to make
2) They’re chemical free and organic. Therefore they’re environment friendly and gentler on mama nature
3) Unlike store bought make up and cosmetics, your home made cosmetics will not have an ingredient list that runs into 15-20 items!
4) You are not suffering from a funds crisis. But you’re an animal rights advocate, and would like to be absolutely sure that your cosmetics have not caused any cruelty against animals
5) Some people are allergic to all cosmetics. Even herbal cosmetics and the allergy-tested, top-of-the-line branded ones. These allergies are generally caused by preservatives, so home-made cosmetics are your best bet at looking good without itches or rashes
6) Make up that “is” natural, “looks” natural
8) Your hand-made cosmetics will heal and repair your skin while making you look good
9) Home-made cosmetics smell natural and amazing without using any artificial fragrance or perfume. Imagine smelling like chocolate and cinnamon
10) Last but not the least, if you’re an artistic person, then this will really satisfy your creative urges. Mothers and daughters can bond over DIY make-up projects.

The Downside –

1) Sterility and bacterial contamination is a major concern. This is the downside of preservative free cosmetics
2) For the same reason, these cosmetics do not have a very long shelf life. And it’s often not possible to make only a small amount, so consider giving away excess stuff to your friends and family. Or sell it for a tidy profit. You might still end up with a lot of wastage.
3) Just like any other art form, creating your own make-up will require patience and practice to find the perfect colours and consistency. You may not get all your measurements right from your first attempt.
4) Many ingredients are hard to find. It took me a lot of time and research to find the simplest and most reliable recipes. You will have to search online to buy ingredients like white bees wax pellets. You could also use shavings from a beeswax candle. However these candles are generally made of yellow beeswax. And most candles are made of paraffin wax, which don’t work as well.
5) Finding the right storage containers is a pain. You may have to develop the habit of saving old cosmetic containers. Wash them thoroughly and sterilize them with spirit and Savlon. Or try Amazon.com to buy fresh lip balm containers and tubes. You can also use pill boxes and small jewellery boxes to stores lipsticks and balms.

Recipe for home-made lipsticks – You can make lipsticks out of non-toxic wax crayons. Just pick a crayon colour that you like- pink, peach, orange, red, maroon, lilac or brick. Cut out a 2 inch piece of crayon and take off the paper wrapper. Fill a stainless steel pot with 2 inches of water. Set it on a stove at low-medium heat. Place a small glass bowl in the middle of this pot. This bowl will act as a melting pot. Now place 1/2 a teaspoon of solidified coconut oil into the melting pot. Use only 1/4 teaspoon if you want a matte finish lipstick. When the oil melts, place your crayon in it. Once the crayon melts and fuses with the oil, let it cool a little and pour into a small clean plastic jewellery box. Do not take your eyes off the concoction while it’s cooling because the wax will solidify quickly. You can use your finger or a lipstick brush to now apply your new lipstick. These lipsticks actually last a very long time.
If you do not suffer from allergies, add a little lavender oil for fragrance. And if you have thin lips, you can add a little cinnamon oil. This is the secret ingredient in most lip-plumping glosses. You can also add 7-8 drops of pure cinnamon essential oil to your regular lip gloss container, for instant plumping of thin lips. Make sure the oil gets evenly mixed with the gloss.

Recipe for home-made eyeliner – To make the coal, burn some dried almond flour (ground almond powder) on high flame. You can use unsweetened cocoa powder to make brown eyeliner. Use a mortar and pestle to grind it to a fine powder. Add a little olive oil to this powder, till you get the right consistency. Store this mix in a pill container, and use a fine brush to apply to your lid margins

Recipe for home-made mascara – Use the burnt almond again as coal. Add some Manuka honey to the coal. Mix and stir as you add till you get a thick soupy texture. Place this mix in a microwave for 10 seconds till it is liquid. Pour this mix into an old mascara tube once it cool. Make sure you cleaned and sterilized the old tube and brush with Savlon.

Recipe for home-made coloured lip balms – Take 1/2 spoon solidified coconut oil, 1/3 spoon shea butter, 1/4 spoon mango butter and 1/2 spoon of beeswax pellets. Place all ingredients in a bowl and heat it in the microwave for 10 seconds till liquid. To add colour, you can use iron oxide powders and pigmented mica powders. Mix and match various micas till you get your desired shade of pink, red, maroon or nude. If you can’t find mica, then just use sliver of your favourite lipstick. Or add a small piece of your favourite shade of nontoxic wax crayon and blend it with the oils over a melting pot. Quickly pour the hot mixture into a lipbalm tube or a small pill box. Keep in the fridge till it solidifies.

Recipe for home-made bronzer – You need cinnamon powder, nutmeg powder, unsweetened cocoa powder and cornstarch. Making the right shade of bronzer will take time, practice and perfect measurements. Mix varying ratios of the powders till you get the right shade for your skin tone. You can use it directly. Place in a clean container and apply using a brush. If you want a cream bronzer, then mix equal amounts of the coloured powder with shea butter to turn it into a cream. You can add 10 drops of essential oils for a fragrance of your choice.

Recipe for home-made body lotion (for winters) – Take 3/4 cup of coconut oil (liquefied) in a glass bowl. Pour one tablespoon of white beeswax pellets into the oil. Place the bowl in a pan. Add about 2 inches of water to the pan and heat the pan over low heat. The beeswax will melt into the oil. Once melted, take out your bowl from the pan and allow it to cool for a few minutes till you see the wax hardening slightly around the edges. Now, pour a cup of potable water in a blender and turn it on in high speed. Slowly pour the oil-wax mixture in. You could also use a hand-held immersion blender and a mixing bowl. The mixture will first get lumpy (natural reaction of mixing oil with water) but as you keep blending, it will emulsify and turn smooth and white. Keep blending till you get a creamy white lotion. This could take some practice! Now add 30-50 drops of essential oil – lavender, cinnamon or rosehip oil. Turn the blender on for just 2-3 seconds as you pour in the essential oils. Finally, add this cream to a clean dry container. Store it in the fridge to make it last longer.

Recipe for home-made sunscreen – Take 1/2 cup of extra virgin olive oil, 1/2 cup of extra virgin solidified coconut oil, 2 teaspoons of Shea Butter and 1/4 cup of white beeswax pellets. You can also add a teaspoon or carrot oil or Vitamin E oil to this mix, but this is optional. Mix all the ingredients in a pot, place a lid over it, and heat in a pan of water on low-med heat. Once it’s completely melted, add 2 tablespoons of zinc oxide powder. Stir a few times as it cools to make sure the powder is incorporated. You can add more powder for a thicker consistency. A drop of vanilla extract will impart some fragrance. The lotion must be used within 3 months and has an SPF of 15. Can’t find Zinc oxide powder locally? Chicco talcum powder is made up of zinc oxide and rice starch powder and can be used instead. Keep in mind that carrot seed oil alone holds an SPF of 35-40.

Recipe for home-made dry shampoo – This is a great innovation for anyone who travels frequently, or post-surgery, or for anyone who needs to shampoo everyday (say, an athlete) but wants to avoid shampoo-related dryness and split ends. These are not easily available in the Asian and Middle Eastern markets, but are simple to make at home. You need 1/8 cup of corn-starch, 1/8 cup of unsweetened cocoa powder, 1/8 cup of cinnamon powder and 3-5 drops of scented essential oils like lavender. Mix the powders in a dry bowl and then add the essential oil and continue mixing. The cocoa and cinnamon impart antioxidants, minerals and antibacterial properties. The essential oil gives fragrance. Store it in a dry air tight container. Comb and de-tangle your hair before use. Use a makeup brush to dust the powder to your roots (not directly onto your scalp). Comb it through your hair, from root to tips to ensure that the powder has been distributed evenly. Wait for 10 minutes, and then brush off any excess powder. Simple!

If you have naturally healthy and blemish free skin, then you can choose to go 100% natural like in ancient times. Use beetroot juice or blueberry juice to tint your lips. Use coal to colour the inside of your lids. You can use cocoa powder and shea butter to create bronzer and bronze eye shadow. A little beetroot juice or raw turmeric juice can be used as a blush (depending on your skin tone). Try henna to paint your nails. And rub some crushed strawberries and sea salt to your teeth to make them look whiter. You will look made up and yet perfectly natural!

Over the last couple of decades, there has been a definite change in our attitude towards ageing and body image. Various media outlets will have us believe that youth is a sign of strength, beauty, virility and vitality, and therefore ageing can no longer be viewed as a natural and acceptable change. Our age is first reflected on our face, and our face also happens to be our identity, our image and our “introduction” to the world.A relaxed, refreshed, symmetrical and youthful face will radiate an aura of good health, and send across positive and lovable vibes.

Across the world, as health and economies improves, life expectancy has been increasing. More and more countries now have a growing population of middle-aged and elderly individuals. This has created an enormous demand for anti-ageing and skin rejuvenation treatments. Unfortunately, this has also lead to a boom in the number of inexperienced and unskilled aestheticians who are in to make a quick buck. A good Dermatologist and Plastic Surgeon will individualize your treatment schedule based on your age, ethnic background, degree of skin damage, your psychological make-up, and even your budgetary constraints. A responsible doctor knows which patient needs to be turned down or discouraged, and which individual must be referred for psychological counselling.

What changes does the skin undergo as we age? The surface of our skin develops blotchy pigmentation, areas of redness, scars and open pores. You may notice the appearance of unsightly moles, freckles, skin tags and blood vessels. The deeper layer of the skin forms fine wrinkles, which over time, progress to form deep wrinkles. The skin loses its ‘snap’ and elasticity, and begins to sag. We lose fat from our face and the bones of our skull begin to shrink, making our face look sunken and asymmetrical. The hair on our scalp begins to grow thin and grey, older women may notice hair growth on their chin and cheeks, our lips lose volume and look pursed and angry, and our eyes show lines and bags and dark circles. There is an overall “droop”, especially in the middle of our face, and the neck loses its firmness. Middle-aged women do not feel confident leaving the house without any make-up on. And elderly women can no longer use any foundation as their make-up will now begin to crack and cake.

The ageing body develops pockets of sagging, cellulite and excess fat accumulation, especially under the chin, on the arms, flanks and abdomen.

Pregnancy and childbirth leave their own “trophies”, otherwise known as stretch marks in plain language.

Ageing is more dramatic among individuals who have spent a lot of time outdoors in their youth. Stress, smoking, heavy drinking, poor nutrition, frequent weight fluctuations and poor sleep patterns are other causes of early ageing.

As Douglas MacArthur famously quoted, “Age wrinkles the body. Quitting wrinkles the soul”. Most of us don’t FEEL as old as we look. Developing a healthy skin care routine early on in life, is the first step towards delaying the ravages of time.

In the second decade of life, it is important to follow the mantra of “cleanse, tone, nourish (moisturize) and protect (sunscreen)”. Go easy on the sunbathing and tanning beds. Live a healthy lifestyle, follow the right diet, drink 2-3 liters of water everyday, get 7-8 hours of sleep every night, and say no to tobacco, alcohol and substance abuse. Your eyes always give away your age, so invest in a pair of good quality sunglasses with Polaroid and UV filters.

In the third decade of life, one needs to start using age-delaying moisturizers which contain antioxidants like Vitamin C and Vitamin E, fruit acids (also known as Alphahydroxy acids or AHAs), peptides and growth factors (look for these key words in the ‘ingredient list’ when you shop for skin care products). Take vitamins rich in omega fatty acids, antioxidants and idebenone. Alternate between a refreshing chemical peel and a skin polishing microdermabrasion every month, to keep away pigmentation, fine lines, adult acne and open pores. A nonablative radiofrequency treatment done every 3-4 months keeps the skin firm and taut. These treatments are safe, effective, non-invasive and have minimal to no downtime (time required for your skin to recover).

In the fourth and fifth decade of life, you will notice that your skin is more dry, wrinkled and losing its natural youthful glow. Change your cleanser from a gel face wash to a more creamy face wash. Use anti-ageing moisturizers containing retinol. Continue getting regular chemical peels and skin polishing. By this decade, you will also need to treat your skin to resurfacing lasers, which will banish fine lines, remove excess pigmentation, tighten your skin and encourage natural healing and rejuvenation of your skin.Resurfacing lasers, skin tightening lasers and radiofrequency devices, encourage the production of fresh collagen in your skin. This is the tissue fiber which is responsible for the youthfulness and elasticity of your skin. Nonablative lasers are safer in Asian and Meditteranean skin, though they require multiple sessions over prolonged periods of time, to maintain the skin tightening effects. A laser photofacial also keeps the skin blemish free, shrinks unsightly blood vessels and brightens the complexion.

You are now at an age where you notice that your frown, forehead lines and laugh lines have become deeper. Crows feet begin to appear at the corners of your eyes. Your lips lose their natural pout and the corners of your mouth begin to sag. These changes can make you appear tired, angry, worried or stern, even when you are not feeling any of these emotions. This is the age when most men and women notice the signs of ageing for the first time in their lives. Botox® (the popular name for Botulinum Toxin) and dermal fillers like Restylane, Juvederm and Esthelis are now becoming increasingly popular treatments to relax facial wrinkles, soften age lines and “fill out” areas of volume loss. Temporary fillers are safer than permanent or semi-permanent fillers. Dermal fillers show instantaneous results and Botox shows immediate (meaning, within 3-7 days) correction of wrinkles. Botox can also be used to tighten the jaw line, soften neck lines, slim the face and relax over-animated muscles. Fillers can also be used for brow lifts and to create fuller softer-looking lips.

These treatments involve injections to the face using a very fine needle, and an anesthetic cream is used to numb the area, so the patient remains comfortable throughout the procedure.

The idea is to only “soften” the lines, as complete amelioration of all facial lines can give the face an overstretched, frozen or unnatural appearance. Therefore, careful selection of your dermatologist is an obvious choice for these procedures. Trust only well-trained, experienced and qualified medical practitioners who stay regularly updated on these treatment techniques. In the correct hands, Botox and Fillers are amongst the safest and most successful anti-ageing treatments presently available in the market. However, these treatments are expensive and the results are temporary (meaning, you will have to undergo the treatment at regular intervals to maintain results).

After the fifth and sixth decade of life, the wrinkles and sagging are usually more severe, and will require surgical intervention at the hands of a competent Plastic Surgeon. Face lifts, thread lifts, ribbon lifts, breast lift, tummy tucks (for “mommy make-overs”), fat transplants to the face, and liposuctions must always be performed by a plastic surgeon only. Facelifts can help correct poor muscle tone, and removes excess fat and loose skin in the lower half of the face. Endoscopic facelifts are now becoming increasingly popular due to the minimum trauma involved and faster healing time. Beware of experimental and unproven treatments like lipolysis or mesotherapy.

For unsightly moles, bumps, warts and skin tags, your dermatologist will either use a Carbon dioxide laser or radiofrequency ablation to vaporize them without any bleeding or scarring.

The ageing eyes – Your peepers are the windows to your soul, and they also age the earliest. As you grow older, your eyes start to develop bags or dark circles, show wrinkles, and your eyebrows and eyelids begin to droop. It is important to start using under eye creams from your late 20s to slow down these changes. Botox can remove crow’s feet and recreate the youthful arched eyebrow. Fillers can fill sunken eyes, and a surgery called ‘the blepharoplasty’ can remove eye bags and fix droopy lids.

The ageing mouth – As men and women age, their lips tend to lose volume, the youthful pout is lost, lines begin to appear on the upper lip, and the corners of the mouth begin to droop, to give one a tired and melancholy look. Filler implantation can restore the natural pout and cupid’s bow of the lip, and lift the corners of the mouth. Very small amounts of Botox can also relax the droop of the mouth and remove perioral wrinkles.

The ageing hands and feet – Our hands and feet are exposed to a lot of chemicals, detergents, harsh weather, dirt and grime. Even the most meticulous woman may forget to apply sunscreen and moisturizer to her hands and feet. As a result of this, a person’s wrinkly and blotchy hands and feet can give away their age, even when the face is spotless thanks to years of care and protection! Do not forget to apply sunscreen on your extremities, and use moisturizers meant for the hands and feet. These products usually contain urea, salicylic acid or glycolic acid to exfoliate tough dead skin, and encourage the formation of new healthy skin. To keep your tootsies looking fresh and clean, get regular manicures and pedicures, wax packs and exfoliating treatments with pumice, oxygen bleaches and fruit acids. Nibble fish pedicures don’t just keep your feet super-soft, they can even treat certain skin ailments like eczema and psoriasis.

Unwanted facial hair in women usually appear after menopause due to a drop in the level of female hormones in the blood. Laser hair reduction is now replacing conventional hair removal methods like waxing and threading, due to its long lasting results and hair thinning benefits. While Nd:YAG and Diode lasers work best on black and brown hair, blonde hair can be treated using Ruby lasers, while electrolysis is still the best bet with grey hair. Middle aged men and women can also using hair growth medications like Rogaine® to combat hair thinning and balding.

In conclusion, there is a wide range of treatments now available to repair, relax, restore, resurface and redrape the ageing skin. Meet more than one dermatologist to discuss your options and work with a doctor with whom you share the best rapport. Be open to the idea of a psychological evaluation before you take the big step. And finally, do it for the right reasons. A nip or a tuck will not mend a broken heart and may not get you that dream job. A well informed and realistic patient is ultimately the most satisfied patient.

Men and women with colored skin have distinctive skin characteristics and disorders which affect skin care. Indian and Mediterranean skin can vary from the alabaster to olive to cinnamon or the deep mahogany skin tones. Though opinions vary, as a brown skinned woman myself, I consider brown and olive complexions to be the most visually and aesthetically pleasing to the eye. This skin type is also the easiest to care for, ages late and ages well, carries all colors, and is not as vulnerable to skin cancers. Besides this, Indians and Arabs are known to love henna and perfumes, and use various herbs and botanicals to beautify their skin. Although most cosmetic industry giants spend millions of dollars in research, most of the studies done in this area, revolve around care for the lighter Caucasian skin. Many of these skin care products and even dermatological procedures (lasers, chemical peels etc), may be too harsh and detrimental on darker skin tones. If you are a brown skinned person, you must be aware of the special needs and peculiarities of your skin type, in order to care for your skin in the best manner.

What does ‘beautiful skin’ mean by scientific and aesthetic definition? Beautiful skin has an even tone, smooth texture, is clear, soft, supple, has no red or brown areas of discoloration, no open pores, and no greasy or flaky patches. Indian and Mediterranean skin may or may not burn in the sun, but tans uniformly and deeply. Our complexion has often been described as the ‘goddess’ or ‘sun-kissed’ skin type. Your skin can be classified as normal, dry, oily, combination or sensitive skin, pigmented or non-pigmented, and wrinkled or non-wrinkled skin. Each skin type requires a different skin care regimen and a different set of skin care products and cosmetics. If you are unsure about your skin type, I would suggest you to take Dr Leslie Baumann’s questionnaire at www.skintypesolutions.com/home.

Men and women with brown skin tone do not wrinkle early in life, but uneven skin tone and pigmentation problems are more common in brown skin than white skin. Pigmentation problems include brown blotches, sun spots and little brown moles and warty growths which appear in the early 30s, and increase with age. If you have spent several years in the sun (athletes and travelers), and if you are a smoker, your skin will age faster.

The principles of skin care are cleansing, toning, moisturizing, scrubbing or exfoliation, protection and nourishing.

Cleansers are needed to clean the skin and remove dirt, bacteria and dead cells. Cleansers can include soaps, detergent- or fat free cleansers, cleansers containing exfoliating beads, and acne-fighting cleansers which contain ingredients like salicylic acid or tea tree oil. Avoid using scrubs or loofahs, as they may irritate your skin.

Toners are astringents designed to remove soap residue and oils from the skin surface. Toners must be avoided by individuals with dry, sensitive or sun burned skin. Brown skinned people should avoid toners which contain irritants like witch hazel, alum or resorcinol.

Contrary to popular belief, moisturizers are essential for ALL skin types, and not just for people with dry or sensitive skin. Dry and dehydrated skin is more likely to burn in the sun and pigment. Choose products which are labeled as ‘dermatologically tested’, ‘hypoallergenic’ (less likely to irritate the skin), ‘non-comedogenic’ (less likely to create or aggravate acne), ‘fragrance-free’, ‘preservative-free’ and ‘alcohol free’ (for sensitive skin). Women with oily skin must look for water based or gel moisturizers, and prefer lotions over creams for their lighter texture. ‘Oil-control’ moisturizers contain oil absorbing substances like talc, silica, calamine, clay or starch, and are helpful in hydrating the skin without leaving it greasy. Women over the age of 35 can use anti-wrinkle moisturizers containing sunscreens, peptides, antioxidants, hyaluronic acid, Coenzyme Q10 and/or alpha-hydroxy acids, for added protection. Read the product/cosmetic labels to find these ingredients.

Exfoliants slough away dead skin and can help minimize acne, blackheads and open pores. These come as face washes, exfoliant masks and clothes/wipes. A home microdermabrasion kit is also apt for your skin polishing needs.

For protection, it is essential for all brown skinned men and women to use a sunscreen with SPF (Sun Protection Factor) of 30 or higher. It is a common misconception that sunscreen is only required if you have white skin, if you are an athlete, if you have a family history of skin cancer, or when you are living in a geographical zone which has a hole in the Ozone layer. It is now a scientifically established fact, that a sunscreen is required by ALL individuals, over the age of 2 years, irrespective of skin color, gender, lifestyle or geographical location. Your sunscreen is the best anti-ageing cream you can use. Most people hate using sunscreens because of its oily texture, and the whitish film left on the skin. It is true that the higher the SPF, the heavier or oilier the sunscreen tends to become. But these days, sunscreens are available are sports-sprays and liquids, which are becoming popular and well accepted by all.

For the nourishment and nutrition of your skin, drink 8-10 glasses of water everyday and have a diet which is rich in vitamins and antioxidants. For this, a simple tip is to add ‘color’ to your food, especially the green and yellow/orange fruits and vegetables.

Normal skin is the easiest to care for as it needs only a simple cleanser, toner and moisturizer. Oily and acne-prone skin is the most difficult skin type. It requires anti-acne cleansers, toners, exfoliants, face packs, non-comedogenic moisturizers and sunscreens. Dry skin requires mild cleansers, and rich creamy moisturizers. Combination skin requires astringent in the oily or shiny zones and moisturizers for the dry areas. If you have sensitive, pigmented, allergy-prone or reactive skin, you must consult a dermatologist for a skin examination, allergic patch testing and recommendations on skin care regime. A change in your hormonal status (puberty, pregnancy or menopause), and change in residence or climatic conditions may require a change in your skin care regimen. If you require any dermatological treatment for acne, pigmentation, scars, age-reversal or skin rejuvenation, please consult a dermatologist who is well-trained and experienced in the treatment of colored skin.

The recent trend towards skin lightening and bleaching creams is especially worrisome. Certain bleaching agents like hydroquinone, resorcinol, arbutin and phenols are too harsh on darker skin tones. It has been shown to cause side effects like skin allergies, paradoxical deepening of pigmentation, and even skin cancers. Some of these products are easily available over the counter (always check label for ingredients, and do not buy unlabelled products). Vitamin C, Kojic acid and Licorice-containing whitening creams are safer to use on brown skin. Nonetheless, learn to love your natural skin tone because brown is beautiful! So care for your skin, in order to keep away skin diseases, and maintain its youthful glowing appearance.

1. Why does our body need sunlight?
Our bodies require a certain amount of natural sunlight to produce Vitamin D, in order to keep our bones strong and support our immune system. Sunlight also has great healing properties, protects against dementia and has psychological benefits as well. In fact, sun exposure is beneficial in the treatment of certain immune mediated skin ailments like Psoriasis and Vitiligo.

2. What is Sun Protection Factor (SPF)?
SPF is the ratio of the minimal ultraviolet dose required to produce skin redness with and without a sunscreen. For example, if it takes 10 minutes for your skin to become sunburned without any sunscreen, then by using a sunscreen with SPF rating 15, you could stay out in the sun 15 times longer (i.e. 2.5 hours). This is provided, of course, that you have applied the sunscreen properly and in adequate quantity and thickness to receive the full SPF benefit.
In terms of percentages, SPF 15 blocks approximately 93% of all incoming UVB rays, SPF 30 blocks 97% and SPF 50 blocks 99% of incoming ultraviolet radiation.

3. What are the various kinds of sunscreen available in the market?
Sunscreens can broadly be divided into two categories- Physical and Chemical.
Physical sunscreen works by deflecting or blocking the sun’s rays, therefore they must be the last layer to go onto your skin (if used along with moisturizers, serums, insect repellants etc. with the exception of makeup). They are far more stable and effective but they are thick, opaque and leave a white tint on the skin. Thus they are preferred by athletes but are inelegant for day to day use. Physical sunscreens contain ingredients like Zinc Oxide and Titanium Dioxide.
Chemical sunscreens contain filters which absorb the sun’s rays. These must be applied directly onto the skin in order to be activated. They’re cosmetically elegant but can cause skin irritation and eye watering in some individuals. Chemical sunscreens contain ingredients like Avobenzone, Oxybenzone and Salicylates.
Choose a sunscreen that offers both UVA and UVB protection (labelled Broad Spectrum). UVB radiation is the primary cause of sunburn and skin cancer. UVB radiation causes premature ageing and skin wrinkling.

4. How should I use my sunscreen?
Sunscreens must be applied 20-30 minutes before stepping out into the sun. Sunscreens do not stay effective for more than 3 hours, so reapply in case you are out in the sun for longer hours. Water Resistant sunscreens maintain their SPF level after 60-80 minutes of water (or sweat) exposure. There is no such thing as a “water-proof” sunscreen. This would be false labeling. Do not forget to apply sunscreen to the back of your neck and your ears. Lips get sunburned a lot faster, so use an SPF containing lip balm.
UVA radiation can penetrate through monsoon clouds, get reflected off snow and sand, and can pass through water and glass as well. So sunscreens must be used on cloudy, rainy and snowy days as well.

5. How much sunscreen do I need to apply?
You will need to apply more than half a teaspoon (about 3ml) of sunscreen to each arm, 3ml for the face and neck, and just over 1 teaspoon to the chest, abdomen, back and each leg. This would mean if you’re out on the beach in your trunks, you would need about 33ml of sunscreen to cover the average adult body with a coating thick enough to reach the full SPF rating. And mind you, most sunscreen bottles contain only 50-60ml of sunscreen. Most of us find this impractical, and apply only 20-60% of the sunscreen needed. Using half of the required thickness of an SPF 30 sunscreen gives protection equivalent to a mere SPF 5.5. To that end, it might be wise to use sunscreens with a higher SPF rating.
The lighter your skin tone, the higher the SPF you need. When used correctly, SPF 15 is adequate for most Indians, SPF 30 for the beautiful Middle-Eastern olive skin, and SPF 50 for Caucasian skin.

6. Can sunscreens be used on children?
Sunscreens should not be used in infants less than 6 months old, as their skin is very thin and the chemicals of the sunscreen might get absorbed into their blood stream. In fact, it is best to avoid sunscreens altogether in kids below 2 years of age. Use a physical (or chemical-free) sunscreen for kids. Adults who are allergic to sunscreens can also switch to a physical sunscreen. Do not depend on sunscreens alone for protection. Use caps, umbrellas, shades and clothing to protect your child’s delicate skin. Avoid the mid-day sun between 11am to 4pm.

7. So how can I ensure that I’m getting enough Vitamin D?
15-20 minutes of sun exposure anytime between 7-9 am is all the sunshine your body needs to synthesize adequate amounts of Vitamin D. If you’re a Caucasian of Celtic origin, then even a few minutes of unprotected exposure in the sun might do the trick. For those with extreme sun sensitivity (usually a symptom of Lupus), Vitamin D oral supplements may be required to meet your nutritional needs.
Is widespread sunscreen usage leading to a D deficiency pandemic? No. Vitamin D deficiency is a pan-continental concern, but this is mostly due to a deficit in Vitamin D fortified foods. Also our darker skins have a harder time getting enough Vitamin D naturally, as the high levels of melanin in our skin absorbs most of the UV radiation. Milk, cheese, eggs and fatty fish are rich sources of Vitamin D.

8. Cream, lotion, gel or spray- which formulation should I choose?
Cream sunscreens are the most effective and are well accepted by those with dry or mature skin.
Water proof sunscreens are usually available in lotion formulations.
Gels, sprays, wet wipes and powder/mineral based sunscreens are lighter and do not block pores. They’re preferred by athletes and people with oily, sensitive or acne prone skin. Gels can also be used on hairy areas. Sticks are good to use around the eyes.
However sprays, wipes and powder based sunscreens are least effective in providing adequate sun protection. Inhalation of nanoparticles is an added concern. Sunscreen containing shampoos do not protect against premature greying of hair.

9. Will sunscreens really protect me from cancer and skin wrinkling?
Besides strict sun avoidance, broad spectrum sunscreens are your best bet against skin cancers, and are the first line of defense against premature ageing of skin. Anyone (irrespective of skin color) who spends more than 30 minutes a day (overall, not just at a time) in sunlight needs to use a sunscreen. If you’re a Caucasian, if you live in a tropical country, or have a personal or family history of skin cancer or pre-cancerous skin growths; then regular use of sunscreen is non-negotiable.
But do understand the limitations of sunscreens and do not let it give you a false sense of security in strong sunlight. I will once again stress upon the importance of reapplication, using adequate quantity of sunscreen, and additional sun protection measures (clothing, etc) to be truly protected from harmful radiation.

10. What role do antioxidants play in sun protection?
It is now understood that infrared radiation from sunlight and other sources (lamps, laptop screens, microwaves etc) can also cause skin damage by producing free radicals. Sunscreens do not provide any protection against infrared radiation which accounts for 54% of solar energy. IR radiation damages skin tissue by producing free radicals.
Antioxidants (applied locally or ingested orally) act as free radical scavenger and provides greater protection against radiation damage. More and more dermatologists are now recommending use of an antioxidant serum (containing Vitamin C, Vitamin E and/or Ferulic acid) along with sunscreen for added protection. Many newer sunscreens have added antioxidants, but these don’t work as well as chemical sunscreen can produce free radicals on their own!

Every Dermatologist knows that acne can be stubborn, is very likely to recur, and needs prolonged treatment and care. Most patients do not understand this though. Most of the dumb “beauty tips” I have heard online are also related to pimple management. Read on to understand the 20 most common causes behind acne that refuses to tame..

1) It’s all about hormones!
I have met women in their fifties who tell me that they have been waiting to outgrow their “pimply phase” for the last three decades! Hereditary factors and hormonal influence is the most common cause for persistent and stubborn acne that refuse to tame over the years. This does not necessarily mean you have an imbalance that needs to be sorted out using medication. In most cases, this simply means that your oil glands are extra sensitive to your monthly hormonal cycle. Since women go through monthly cycles along with well-defined life changes that feature major hormonal shifts, they are likelier than men to develop adult onset acne. Most women with acne complain of a flare up around the time of their period. Teenagers who abuse birth control pills and the emergency contraceptive pill, may also experience acne as a side effect. Puberty, pregnancy and the peri-menopausal years are particularly difficult. If you suffer from irregular periods or ovarian cysts, then you’re very likely to have stubborn acne as well.
Chronic stress, lack of sleep, irregular eating habits and excess sugar and carbs in your diet can also mess up your body’s hormonal harmony.
Yoga, meditation, weight control, diet control and the expert advice of an endocrinologist are all just as important as the dermatologist’s prescription.

2) Stress
Stress does not just refer to emotional or psychological stress. Chronic illness or lack of sleep can cause physical stress. Our body releases hormones like adrenaline, cortisol and thyroxine which help our mind and body to cope with the crisis. Our body learns to resist insulin, leading to higher blood sugar levels, to increase energy and alertness. However when our body is in a chronic state of stress, these very hormones start to wreck havoc on our system. Acne is just one of the side effects of stress on our body.

3) Diet
Excess sugar, starch and dairy intake can lead to acne. This is especially true for women who are already overweight or suffer from hormonal disorders like ovarian cysts. On the other hand, increasing your intake of probiotics, yoghurt, carrots, pumpkin, fish, buttermilk, flaxseed and spearmint tea can be helpful in long term acne management. Oral Zinc, Vitamin A, Kiwi seed extract and guggul supplements are sometimes prescribed by dermatologists in patients who cannot tolerate oral antibiotics.

4) Skin picking
Most women seem to believe that popping a pimple will help it dry out faster. This is not true because you are irritating an area which is already inflamed. This is also counter-productive, because picking on your zits will leave your skin with blemishes and scars.

5) Over-washing
This is a common misconception about acne. People believe that washing their face several times a day is all that’s needed to keep acne under control. Over-washing your face will only aggravate your oil glands into producing more oil. It will water-log your pores and worsen the inflammation.

6) Wrong choice in skin care
Most sunscreens, especially high SPF formulations, can in fact cause acne. Cream based moisturizers which contain fragrance, parabens, vegetable oils, squalene etc can also create whiteheads and acne. Toners are over-rated and daily use of scrubs can damage your skin by causing micro-abrasions. Cream, fluid and oil-based make up can also lead to acne. As can most low-grade cosmetic skin care products. Everybody needs sunscreen and moisturizer, even those who suffer from acne. But you must choose gel or water-based formulations which are non-comedogenic. Consult a dermatologist for advice.

7) Using baby oil to remove make up
This is a common mistake made by most women. Dancers and performing artists often use several layers of heavy foundation, which can only be removed using baby oil. If you belong to this category, you must ensure a second, more thorough wash, using a medicated anti-acne face wash.

8) Getting facials and steaming done to treat acne
“Anti-Acne facial” is an oxymoron. The steam, scrub, massage and comedone squeezing done during a facial can often trigger fresh acne. Anti-acne facials usually involve the use of benzoyl peroxide containing scrubs, tea-free oil containing masks and perhaps a salicylic acid based chemical peel as well. This must ideally be performed by a trained dermatologist and not an aesthetician. Every Dermatologist has met harrowed brides who have suffered a fresh bout of acne just days before their wedding, following an ill-advised facial!

9) Your hair
Yes. How you wear your hair and the products you use can determine the state of your skin. Fringe hairstyle, dirty hair, hair mousses, waxes or pomades, hair oils, hair styling products that contain oil, silicone or plasticizers, and certain hair conditioners can leave acne on your forehead and nose. Do not leave hair oil on your scalp for several hours a day.

10) Applying body lotion on face
Bad idea. A lot of women use body lotion on their face in the interest of saving some money. However, body lotions are generally thicker and greasier. They are designed to cover large parts of your body, where the skin is dry and not as sensitive as the facial skin. Using them on your face can cause irritation, acne, open pores and darkening of facial skin.

11) Your work-out regime
Not showering or washing your face after a sweaty work-out can lead to acne. Whey protein containing supplements work by increasing the blood levels of hormone Testosterone in both men and women. They can cause acne and hair fall. If you’re using anabolic steroids to pump your muscles, then you may suffer from severe acne and hair thinning as a consequence.

12) Poor facial hygiene
This seems to be fairly typical for most teenagers. Using old or dirty make-up applicators, wearing make up for more than 8 hours a day, going to sleep with make up on, working out with make-up, covering your face with untidy or unwashed scarves, and using dirty headbands – These are poor habits which could lead to resistant acne. Innocent looking objects like a dirty helmet or dirty pillow covers could also cause facial acne.

13) Constipation
There seems to be a link between chronic constipation, excess weight, excess dietary sugar, lack of exercise, yeast overgrowth in the gut, lack of dietary fibre and hormonal imbalances. Oral intake of probiotics and maintaining regular bowel movement can also help in clearing up those zits.

14) Sweat and Friction
Trunkal acne (pimples on the shoulders and back) is often linked to sweat, humidity and friction from heavy backpacks. Have cool showers twice a day and apply talcum powder or cornstarch on your back to minimize hair follicle irritation from friction.

15) Dirty cell phones and dirty hands
Pimples which seem to only appear on one side of your face can be linked to holding your cell phone on that side of your face over long telephonic chats. The surface of your cell phone will always remain dirty. Touching your face with dirty hands could also cause pimples. Invest in a hands-free headset, and keep your hands off your face.

16) Vitamin B12 Injections
Some studies have shown that excess Vitamin B12, when taken in the form of oral supplements or injections, can cause acne by altering the gene expression of the skin bacteria that causes acne. Some other studies have shown the exact opposite – indicating that Vitamin B12 has anti-inflammatory properties. At this point, we do not have conclusive evidence about the link between acne and Vitamin B12; but physicians and dermatologists have been observing the phenomena in their personal practice.

17) Irritants
Using irritants like lemon juice, garlic and toothpaste are generally not very helpful and sometimes counter-productive. Do not use milk cream or vegetable oils on your face if you suffer from acne.

18) Epilation
The oil glands of the skin are attached to the hair follicle. This is why hair follicle irritation is closely linked to the formation of acne. Waxing, threading, shaving, and even laser hair removal treatments could trigger acne or acne-like rashes.

19) Drugs that cause acne
Birth control pills, oral steroids, anti-epilepsy medication, certain anti-depressants and anti-tuberculosis medication can also trigger acne. The acne will continue to relapse as long as you continue to take these medications.

20) Long term use of antibiotics itself
Dermatologists treat Grade III acne and cystic acne using oral antibiotics. They are generally prescribed for 4-12 weeks. Some doctors may even prescribe antibiotics for 6 months to a year. However, long term use of antibiotics can cause a condition known as ‘Gram Negative Folliculitis’. This is an acne-like eruption on the face and body caused by gram negative bacteria, which grow in abundance when the gram positive bacteria on the skin are completely eliminated by oral antibiotics.

In most men and women, acne becomes a chronic and recurring problem. Effective and long-term treatment requires time, patience and all-round efforts by the patient as well as their doctors.

While we are willing to spend good money on shampoos, anti-ageing creams and skin lightening serums, we do not consider soaps and cleansers to be an important part of our beauty ritual. How much can a cleanser do anyway??

Soap or face wash? Foam or gel? Store-bought or hand-made? Does it even make a difference? Is cleansing really an important step towards good skin? Is it worth splurging on a face wash, when it is only going to be on our skin for a minute?

Cleansing is a very basic yet important requirement for healthy and glowing skin. And here’s why..

1) Cleansing removes dirt, grime, excess oil and make up.
2) It allows your skin to breathe and prevents clogging up of pores and formation of blackheads and whiteheads. It allows skin oils to seep through to the surface, instead of building up beneath your pores and inviting bacterial overgrowth.
3) As we grow older, our skin does not self-exfoliate as well. Cleansers and scrubs help wash away dead skin cells.
4) It allows better penetration of skin care products like serums and moisturizers.
5) The right face wash can help your skin maintain optimum pH levels, which is necessary to retain moisture and remain hydrated.
6) Cleansing is essential for those who suffer from acne. And the right cleanser can help a person suffering from Eczema or Rosacea.
7) Cleansing is an emotional experience as well, where one feels refreshed after ‘washing away the rigours of the day’. Cleansing is an important ritual before offering prayers, in most customs and religions. Bathing and cleansing are a source of sensory pleasure as well.

When you skip washing your face with an appropriate face wash, your skin will begin to darken, turn dry, flaky, thick and leathery. Moisturizers will not hydrate your skin long enough. Open pores begin to enlarge and you might notice the appearance of acne and blemishes.

Finding the right face wash for your needs might take some trial and error. Most people need different cleansers for the face and body. Your face may be oily while your body might be dry. For others, the skin on their chest and back might be thick and oily while the face may be dry and sensitive. Knowing your skin type is an important step towards picking the right face wash. Consult a dermatologist for guidance.

If you have dry skin – Select a soap-free cleanser like Cetaphil cleansing lotion. Or a cream based face wash like Avene Gentle milk cleanser. Cream based cleansers are also effective in make-up removal when used with a soft cotton pad. Avoid toner, or face washes with high alcohol content. Select a soap which contains ingredients like milk cream, shea butter, coconut oil or aloe vera. Look for products that contain the word ‘hydrating’ or ‘replenishing’ on the label. Exfoliate once or twice a week with an apricot or oat-meal containing scrub.

For oily skin – This kind of skin is more prone to acne and open pores. Select a gel or foam based face wash like the Sebamed Clear Face foaming face wash. If you have acne as well, pick a face wash that contains Salicylic Acid or Benzoyl Peroxide. Look for products that carry the terms ‘exfoliating’, ‘keratolytic’ (skin dissolving) or ‘non-comedogenic’ on the label. Use a toner soon after cleansing. Wipe it across your face using a cotton pad. You can also use salicylic acid containing face-wipe pads, for all the times when water and face wash are not within reach. The Neutrogena Rapid Clear Treatment Pads, for instance. Hand-made soaps containing charcoal work well on such skin. It is important to use a scrub twice a week. Look for a scrub that contains sea salt or walnut.

If you have normal skin – You are blessed because your skin is not very difficult or demanding. However, soaps for dry skin might leave your skin oily, and soaps for oily skin might leave your skin dry. You can chose Herbal soaps, or liquid cleansers like Neutrogena Liquid, followed by a good toner. Choose a Syndet over a Soap, for example Dove soap, which isn’t actually a soap.

For combination skin – This skin is overall healthy and easy to maintain. Use Glycerine and/or Rose water based soaps or cleansers. Gel or foam based cleansers work well on your skin. Micellar water, like the Bioderma Sensibio H2O is perfect for your skin type. It works as a cleanser as well as make-up remover. You can also use fragrance-free cleansing wipes.

If you have sensitive skin – Ideally you might need to consult a dermatologist before choosing your face wash. ‘Dove Sensitive’ soap is easily available over-the-counter and is relatively inexpensive. Look for cleansers which have the terms ‘hypoallergenic’ or ‘for intolerant skin’ on the label. Look for a pH balanced formulation. Select a product that is fragrance-free and paraben free.

If you have dry skin with acne – Choose an anti-bacterial face wash that contains Cetrimide. Lactic acid containing face washes are a good fit as well.

If you have oily and sensitive skin – Use a soap that contains Bentonite Clay or Kaolin Clay. The Dermaceutic Advanced Cleanser containing Xylitol and Urea is a good choice. Avene Cleanance Gel is another great example. Choose natural ingredients like tea tree oil, apple cider vinegar, citric acid or rosemary oil in your face wash or hand-made soap.

If you have tanned skin – Use a face wash which contains AHAs (alpha hydroxyl acids) like glycolic acid or lactic acid. Natural ingredients like turmeric, saffron, orange peel or berry extracts would work well if you wish to seek a soap-maker for customized soaps.

If you are outdoorsy or suffer from excessive sweating and body odour – Use antibacterial or deodorizing soaps and body washes. Hand-made soaps made of turmeric, neem oil, geranium oil and gram flour are excellent choices as well.

A lot has been said about home-made soaps and their natural goodness. Soap makers are naturally vitriolic against commercially available cleansers and their ‘harmful, cancer-causing and hormone-disrupting chemicals which are poisonous to your skin as well as the environment’. This venom is in fact, driven by their own business interests. It is not possible to make soap without lye, which is a highly caustic alkali, although the ‘saponification’ process renders it safe. The Food & Administration authorities only approve ‘melt & pour’ soaps made from hot process, for commercial sale. These soaps are more popular due to their translucent appearance, but these do contain synthetic chemicals and are not “all natural”. Cold compress soaps can be prepared using only natural ingredients. However, most hand-made soaps contain essential oils and fragrances which can irritate sensitive skin. Many others do not fulfil the label claims as they are not tested in any lab. For instance, a soap claiming to be made of lavender, might in fact only contain lavender scented oil. So buyers beware.

What is the correct way to use a face wash? Wet your face and hands. Take a small amount of the cleanser – cream, gel, foam or lotion, on one palm, rub it between both palms, and gently massage it into your skin in upwards and outwards movements. Wait a few seconds to let the cleanser do its job, then rinse off and gently pat dry.

On a parting note, I would advise all readers to consult an experienced dermatologist if you are not able to correctly identify your skin type and find a suitable cleanser for yourself. There is no such thing as THE perfect soap or cleanser. Despite expert medical advice, if you suffer from sensitive skin, it might take some trial and error before you find the perfect cleanser for your skin.