IONTOPHORESIS

  IONTOPHORESIS
Galvanic current is used to create two significant reaction in esthetics : Chemical (Disincrustation)and ionic (Iontophoresis)
DEFINATION-
IONTOPHORESIS- GK=(Introduction of ions)is defined as the introduction , by means of an electric current , of soluble salts in to body tissues for therapeutic purposes.
Skin type-
-All skin types depending on substance used

-Dry dehydrated skin
-Dull sallow skin
PROCEDURE—
1.Ensure machine is in good working order and on a stable trolley.
2. Remove jewelry from patient and self.
3. Cleanse  patients face  and neck thoroughly and check for contraindication.
4. Explain routine procedure to patient and reassure about any sensation i.e. pricking metallic taste , and slight warmth.
5. Place inactive electrode in patient s hand.
6. Remove substance in to bowl and with help of brush  apply on patient's face and work round with one active roller electrode.
7. Place active electrode on patients forehead and another at base of neck. Check  intensity dial at zero. Make sure that the polarity switch is at negative. Switch on the machine and turn up the intensity dial gradually until patient feels pricking sensation.
8. For 2 mins, taking care not to lose contact with the skin and avoid over stimulation of an area.
9. After 2 mins switch off machine , turn intensity dial to zero and remove the active electrode from the skin.
10. Turn polarity switch to positive. Place the active electrode on electrode on forehead and the base of neck, and switch on machine and turn up the intensity dial as before. Move the electrode for another 8 mins, slowly over the face and neck.
11. Switch off the machine, turn off intensity and remove electrodes.
12. Tone and moisturize face , or blot and continue with other treatments.
13. No make up is to be worn for at least 2 hours or if possible for the rest of the day. If possible, for the rest of the day.  If make up is necessary, then apply medicated foundation and then the rest of the make-up.
14. Positive polarity is for penetration. Negative polarity is for opening up. So in cases of acne, boils ,pustules , give 8 min negative.For pigmentation , dryness , whitening, fairness give 8 mins positive.
DURATION—
2-3 mins( negative) and 6-8 mins(positive)
INTENSITY—
2-3 milliamps
BENEFITS-
CHEMICAL EFFECTS –
When the active electrode becomes +ve it attracts the –ve chloride ion.
This produces a chemical reaction whereby chloride ions react with hydrogen ions to form hydrochloric acid.This hydrochloric acid restores the acid mantle.
PHYSICAL EFFECTS—
-Restores acid mantle.
-Contracts skin tissue
-Tightness pores .
-Reduces vascularity.
-Overall refining of skin condition due to its astringent effect.
EFFECTS OF IONTOPHORESIS-
1. Beneficial substances for correcting different skin problems are penetrated into skin.
2. Opens the pores.
3. Stimulates circulations.
4. Generally improves texture and tone of skin.
IONTOPHORESIS IS SUITABLE FOR-
1. All skin types depending on substance used.
2. The contents of substances are specialized which are beneficial , pure, water soluble for various skin problems.
EXAMPLES:
1. Retinoic acid
Acne (0.05%)
Acne scars
Pigmentation
Fine lines
Dark circles
2. Glycolic acid(6%,12%)
Pigmentation
Fine lines
Oily skin
3. Kojic acid (2%) and VIT-C for periorbital melanosis.
4. Aloe + Vit E for dry and dehydrated skin
Seaweed jelly
Positive galvanic gel
Aloe vera gel
Contraindication
1 Hyper- sensitive skin,loss of skin Sensation
2 Excessive filling,metal pins,plates,coils
3 Epileptics
4 Diabetes
5 Patient with pacemaker
6 Pregnancy
7 Skin diseases,infection,sepsis
8 Cuts, abrasion,inflammations
9 Highly strung and nervous client
10 Highly Vascular skin
11 Defective circulation
PRECAUTION FOR IONTOPHORESIS
1 Check for Contraindications
2 Ensure machine is in good working order
3 Remove jewellary from clients and self
4 Explain to client about sensations which she will be feeling
5 Place correct Electrode on client’s face
6 Select correct polarity
7 Time treatment correctly
8 Do not remove electrode from skin when machine is still on
9 Avoid over stimulation of any one part of the skin
10 Try not to touch patient during treatment as the currently may be earthed by you .
11 Ensure machine is placed is safely on a stable trolley.
Disincrustations
It is used to facilitate deep pore cleansing ,to emulsify sebum, remove surface oiliness,
Blockage and help to regulate  secretion. During this process galvanic current is used to create a chemical reaction that emulsifies or liquefies sebum and debris.
When conducting disincrustation , the client holds the positive electrode, the positive polarity. The therapist uses the negative electrode (negative polarity) on the client’s skin surface. This creates a chemical reaction that transforms the sebum present in the skin into soap. When the electrical current interacts with the salts in the skin, it creates the chemical sodium hydroxide i.e this soapy substance helps dissolve excess oil, clogged pores, comedones and other debris on the skin, while softening it at same time
Skin type
Oily skin                                                  
Acne Prone skin
Combination skin
Post-acne scars
Products-
Saline solution
Disincrustation lotion
Negative galvanic gel
Duration-
6-8 min (Negative ) and 2-3 min (positive)
Intensity-2-3 milliamps
Procedure-
Ensure that machine is in good working order and placed on a stable trolley.
Remove all jewellery from client and self
Cleanse clients face and neck thoroughly and check for any contraindications.
Explain and reassure client of routine procedure,sensation(prickling and warmth ) she may feel
Carry out the thermal and skin sensitivity test on face.
-apply some petroleum jelly around the eyes
-apply the product with the help of mask brush
-give the client the bar electrode (with a damp cotton tissue wrapped around it) to hold . this is anode.
Make contact with the negative roller/cathode(covered with damp cotton) on the skin and turn up the currently gradually until the client feels a tingling sensation.
The movement should start from the chin and move towards the sides in overlapping strokes.Use slow,even,rhythmic movements all over the face.
Continue for 6-8 min
Lower the intensity and switch off the machine
Remove the product and proceed with extractions.
Reverse polarity for 2 min and then switch off the machine.
Benefits
Chemical effects-
When sodium chloride is dissolved in water,it produces sodium ions and chlorides ions.
The active electrode which is – vely charged , attracts +vely sodium ions.
This produces a chemical reaction forming NAoH, which is an alkaline that destroys the acid mantle on the face and emulsifies the sebum on the skin surface. It also neutralizes the sebum.

Physical effects-
Destroy acid mantle.
Soften skin tissue.
Open pores.
Emulsifies sebum and therefore aiding flow and drawing out impurities
Increase vascularity i.e produces erythema y the stimulation action of current. Therefore increases blood circulation, which nourishes the tissues and improves lymph drainage,which aids removal of waste products.
Overall improvements of skin condition due to its deep cleansing action.

MICRO-DERMABRASION

Microdermabrasion, or particle skin resurfacing, is the latest technology for skin exfoliation.
Micro meaning small ,minute
Derma meaning skin
Abrasion meaning removing,scraping
Types
Microdermabrasion can be done in two ways
1) Crystal (Aluminium Oxide)
2) Diamond
Defination
Microdermabrasion is micro peeling of the uppermost layer of the epidermis (stratum corneum) through abrasion thus reducing thickness of the same and allowing a brighter and smoother skin to emerge.

Crystal Microdermabrasion
The micro dermabrsion uses a controlled vacuum to move the sterile microcrystals to abrade the stratum corneum which is the layer of dead cells on the skin. The microcrystals and adraded skin are then vacuumed away thus leaving behind a smooth and shiny glowing skin.
After multiple treatments, this skin renewal procedure can eliminate pigmented spots. It improves post trauma scars and acne scars.
Microdermabrasion helps in removing dead and flaking skin cells to create an immediate improvement in your skin appearance. The unique approach stimulates the production of fresh young skin cells and collagen. It is the ultimate advancement in non surgical, non invasive skin conditioning.
Microdermabrasion is a safe non surgical approach to skin care when used alone, or in combination with other treatments.
BENEFITS:--
Gives the skin an overall fresh , healthy- looking glow
Improves blood circulation.
Non surgical , safe, effective lunch hour procedure.
Effective on all skin colors and types.
No anesthetic required.
Excellent activities can be resumed immediately.
Normal activities can be resumed immediately.
OTHER CONSIDERATIONS:--
Requires multiple sessions and maintence treatments.
Patients with good skin tone will show best results.
IN addition to the face, microdermabrasion can be successfully performed the neck , chest , hands, back, elbows, feet –just about anywhere! It is also beneficial for patients with darker skin types.
INDICATIONS:--
Acne scars , chicken pox scars
Uneven skin color
Dull or dry patches
Clogged pores
Blackheads
Open Pores
Fine lines
Rough, thick or dry skin
Sun spots
Age spots
Keloid scars from burns post trauma and post surgical.
CONTRAINDICATIONS:--
Herpes Simplex
Crystal Sensitivity
Diabetes
Active acne
Rosacea
Eczema and seborrheic dermatitis
Asthma
TECHNIQUE---
Microdermabrasion is performed with jet of fine crystals, which are propelled and  then vacuumed across the skin surface. Removing the damaged cells to reveal fresh , invigorated skin.resulting in a gentle abrasion or polishing process.
Each treatment takes from 30 mins to an hour. Approximately 10-12 sessions are required once in every 15 days . Maintenance of result required periodic repeat treatments after the initial regimen is completed.
PROCEDURE—
1. Cleanse the face and dry it completely.
2. Adjust the vacuum depending upon the indication.
3. Put cotton buds in the ears so that crystals do not enter in the ears.
4. Remove lens if you are using once as that crystals can abrade the lens
5. Crystal sensitivity test is done on the forearm.
6.Stretch the skin and quickly move the hand piece across the skin in horizontal and vertical strokes
without unnecessary pressure.
8.Clean the face with a wet tissue to ensure that all the crystals are completely removed from from the face.
9.Then apply hydrating or cooling masks for 20 mins.
10. Finally apply sunscreen.
DIAMOND MICRODERMABRASION
This also works on same principle of exfoliation. But here instead of aluminum oxide crystals particles of diamond are used. These particles are embedded on the tip of the wand like device. Diamond particles used are finest . They are gentle as well abrasive.
The exfoliated  cells of stratum corneum are collected on a cotton .
BENEFITS OF DIAMOND SKIN POLISHING OVER CRYSTAL
Can be done on sensitive skin
Can be performed on asthmatic patient.
Microdermabrasion can also be combined with various other procedures to obtain maximam results.
1) DSP with ultrasonic and or galvanic . Also called as ULTASONIC DIAMOND microdermabrasion.
2) AHA/ BHA masks for 20 mins followed by DSP and end the procedure with galvanicusing neutral products like vit.c serums ,aloe vera gel, natural lighteners containing licorice , vitamin, niacinamide etc.
Instructions :
⦁ Do not wash face with soap, can clean with plain water. Soap to be used after 12hrs.
⦁ As the crystals are sharp there is sensation of writing on the face.
⦁ Slight redness will be seen for 1-2 hours
⦁ There may be peeling of the skin on day 3,4 & 5
⦁ Feeling of heaviness and soreness which lasts for few hours
⦁ No make –up to be applied on the same day
⦁ No heavy exercises and swimming for 3-4 days
⦁ No direct exposure of sunlight. Sunscreen to be applied half hr before going in sun
Results
Poor health, diet ,ageing, stress, and  the elements of nature can slow down the skin’s cell turnover process. By speeding up the cellular turnover process, microdermabrasion brings you closer to healthier, younger looking skin. It allows you to gradually improve your skin without the risks, side effects, and down time of more aggressive alternatives. In as little as twenty minutes, this gentle, abrasive technique efficiently produces satisfying results. Further improvements in appearance and texture will occur with each treatment. Microdermabrasion can be used aggressively to achieve dramatic results, but does not take the place of surgical or laser procedures.
Best of all there is no “down time” One can resume regular activities immediately.
To achieve good results , several treatments 10-12 are recommended .treatments are typically scheduled two weeks apart . you will experience a progressive improvement throughout your treatment program.

conclusion
microdermabrasion leaves your skin feeling SOFT AND SILKY
with a healthy glow .you leave the office with only a mild , temporary pinkness in the treated area.
FAQ(Frequently asked question)
What is microdermabrasion?
Microdermabrasion is a mini procedure that is used to rejuvenate skin , lessens the sign of scarring , and removes fine lines and the effects of acne . the top layers of dead skin is removed during treatment, while promoting the production of new cells in the deepest layer of skin.
How is it done?
The skin is sandblasted with aluminum oxide crystals through a wand –like device that suction itself. As the treatments are relatively painless , anesthesia is generally not administered. Treatments last about 20-30 minutes if only the face is being treated, and can last up to an hour if the neck and upper chest are included. Courses of microdermabrasion consist of 10-12 treatments at 2 week interval . all treatments can preformed at your doctor s office ,salon ,or spa.

What precautions are to be taken before the procedure?
Discontinue use of topical exfoliating creams for 3-4 days before &after the procedure .
Remove lens just before the treatment if you are using one as crystals can abrade the lens.


Recovery /post op expectations
Microdermabrasion has been branded with the cosmetic nickname , the lunch –time’’ peel because it can be performed in a short period of time and patients can return immediately to their daily routine including applying makeup . patients typically experience a slight irritation or wind – burnt sensation during treatment that can last for a few hours afterward. In addition , skin usually takes on a pink hue that lasts an a average of one day but can last three or more in severe cases.
complications
Almost all patients experience no complications associated with these types of treatments. With the more powerful, medical grade machines , there is a slight possibility of hyperpigmentation or bleeding , and if the machine is improperly sterilized, there is a risk of infection.
Am I A candidate
Good candidates for microdermabrasion have minor surface scars or slight pigmentation or acne problems and wish to have  have minor surface scars or slight pigmentation or acne problems and wish to have younger – looking healthier skin. Patients with severe acne, warts, recent herpes outbreaks, and other diseases are not the candidates for treatment.  
Is maintenance is required ?
Yes, maintenance is required once a month.

CHEMICAL PEELS

Peeling is the application of chemical agent to bring about exfoliation of the epidermis with remodeling of the collagen and elastic fibers in the dermis .
A peel removes several layers of sun damaged skin cells, leaving fresh skin, which has a more even surface and colour.
It may stimulate new collagen to be formed improving texture.
The result of the first peel may be disappointing, but after repeated peels, significant improvements is usually evident.

Principles of chemical peels
⦁ Exfoliation of superficial dead layer of skin (Stratum Corneum)
⦁ Promotes collagen production
⦁ Stimulates new cell growth
⦁ Cleansing of clogged pores
⦁ Reduces production of the sebum by the oil glands
⦁ Regulation of moisture level

Chemical Agents used for peeling
⦁ AHA----Alpha Hydroxy Acids- i.e Glycolic Acid ,Lactic Acid, Mandelic acid
⦁ BHA----Beta Hydroxy Acids- i.e Salicylic Acid
⦁ PHA----poly Hydroxy Acids – combination peel
⦁ TCA----Trichloroacetic Acid
⦁ Phenols----Carbolic Acid
Types of peels
⦁ Very Superficial ----Glycolic acid
⦁ Superficial ----Lactic acid
⦁ Medium ----PHA, Salicylic acid, TCA
⦁ Deep ----Phenols

Of these peels the Alpha Hydroxy Acids are the most commonly used.
Introduction –Benefits of AHA’s were first discovered by Dr. Eugene van scott in 1970.
AHA- Alpha hydroxyl acids----They are also called as fruit acids as they occur naturally in certain fruits.
 
Different AHA’s with their sources-----
⦁ Glycolic Acid – Sugarcane
⦁ Lactic acid – Fermented milk
⦁ Mandelic Acid –Bitter Almonds
⦁ Malic acid – Apples
⦁ Tartaric acid- Grapes

Of these the Glycolic acid &Lactic acids are used generously.
Glycolic acid has the smallest molecular weight and is easily able to penetrate the skin. It is a weak acid. It has a keratolytic action .with higher pH it acts as a moisturizer . since it is a weak acid it does not a self neutralizing action by coagulation of proteins  hence it has neutralized with water or weak buffer.
Glycolic acid result in superficial skin injury and are well tolerated-the ‘lunchtime’ peel. They remove thin lesion on the skin surface, reducing pigment and surface dryness.
There are newer glycolic peels which are most potent and still do not irritate. These peels contain Strontium Nitrate. One such brand widely used is Refinity(70% glycolic acid+strontium nitrate) and Cosmoderm(50%glycolic acid+strontium nitrate)

INDICATION OF GLYCOLIC ACID
1) Acne
2) Hyperpigmentation
3) Freckles
4) Fine lines and wrinkles
5) Sun spot
6)Open pores
7) Clogged pores
8) Under eye dark circles
CONTRAINDICATIONS:
1)Active infection
2) Open cuts
3) Photosensitivity
4) Past reaction to peel
5) Facial surgery in three months
QUALITIES OF GLYCOLIC ACID:
Full face or spots
Very superficial
Expensive
Long life
Available as liquid
Difficult to prepare
PRMING:
Preparing the skin before the peel
Priming is done for period of 10 days daily with a lower concentration of glycolic acid (6%) applied only at night. Stop application on day  11,12,13th  and the pel is done on the 14th day.
BENEFITS OF PRIMING :
1) More uniform penetration of the peel
2) Reduces the risk of hyper pigmentation
3) Reduces wound healing  time
PEEL SENSITIVITY TEST:
It is done on the side of the neck to detect sensitivity to the peeling agent .During this first  apply 20% GA and watch for 3 mins. Patient  will feel slight burning or itching sensation. If this sensation is mild with no redness on the area for 3 mins that means the patient can tolerate the peel on face. So wash the peel with cold water and proceed for the face.
On the hand if after application you notice redness with 1-2 mins then immediately neutralize the part . Dilute the peel with 2 drops of rose water , repeat the test patch on other side of  neck. If patients tolerates this then do the diluted peel on the face.
On the day of peel:
Materials Required for peel----
⦁ Required peel
⦁ Neutraliser
⦁ Measuring cups x2
⦁ Brush x 2
⦁ Cleanser
⦁ Vaseline
⦁ Ear bud
⦁ Head band
⦁ Cotton
⦁ Rose water
⦁ Eye pads
⦁ Mask
⦁ Sun screen
PROCEDURE:
1)Elevate the client's head by 45 degrees.
2) Tie  Head band
3) Cleanse of the face with pre- peel cleanser ( to be used according to the skin texture , I. e. oily, normal , dry etc)
4)Apply Vaseline to sensitive areas like outer and inner canthi of eyes , angle of month and nose with ear bud.
5) If client is about to undergo peeling  for the first time, then a Peel  Sensitivity Test should be performed.
6) Apply 1 ml 20 % Glycolic acid  in stroke with peel brush . As you touch the peel brush on face start the timer. Strokes should be outward to inward , single stroke application approximately  time of application should be 45 secs, and peel to be kept for 3 mins only. This 3 mins includes your time of application also.
7) Mild itching and burning sensation is experienced, which is normal.
8) After 3 mins, dab the under eye and upper eye with cold water 1st then neutralize the rest of the face with 2ml of neutralizer.
9) Neutralization of peel can be done 2-3 times in same manner  During  neutralization patient feels warm sensation. This is due to acid base reaction.
10) Then clean the face with cold water and give cold compress the face when patient complaining of any of any burning .
11) Apply face mask for 20 mins.
12) Remove  the mask and apply sunscreen according to the skin type .
Precautions: While doing peel if there is unbearable burning , stinging , frosting immediately neutralize the peel with cold compress.
POST PEELING CARE –
1) Can wash with plain water after 2 hours. Soap can be applied after 12 hours.
2) There will be mild redness for 1-2 hours.
3) Avoid direct sunlight . Apply sunscreen 20 min before sun exposure.
4) Avoid swimming and sweating for 2-3 days.
5) No facial bleach , treading , waxing ,plucking for 7 day before and after peel.
6) Avoid make up for 12 hours.
7) Do not use medicated cream 2days before and after peel.
8) Do not pick, Picking delays healing causes scarring.
9) Moisturize- use moisturizers after peel.
OTHER PEELS-
1 ) BETA HYDROXY ACID – SALICYLIC ACID –
Salicylic acid is derived from sweet birch , willow bark and wintergreen leaves. It is lipophilic and act as a keratolytic agent by dissolving the intercellular lipids, surrounding the keratinized epithelial cells. Due to its lipophilic nature it acts on the sebaceous follicle, has excellent comedolytic activity and hence is very useful for acne. It has anti inflammatory and antimicrobial properties.
 INDICATIONS:
# Active pustular acne
# Open pores
PROCEDURE—
Salicylic acid is used only as spot peel.
DO NOT USE ON FULL FACE.
Used in A combination with glycolic peel.
2) POLY-HYDROXY ACID PEEL-
Also called as body peel .To be used only on body.
INDICATION:
Fine lines and wrinkles
Rehydration of skin
Dark back ,elbow , forearms
Pigmented feet , hands
PROCEDURE-Same as glycolic acid. Only in this case test patch not required as we are doing on body. Cleaning, application, timer ,neutralization remains the same. Post Peel Instructions remains same for all peel procedures.
SKIN WHITENING PEEL—(PEEL BOOSTER)---
INDICATIONS
*Tanned skin
*Pigmented skin
*Melasma
*Dark underarms , hands, feet…
PROCEDURE:
 *Elevate the clients head by 45 degrees
*Tie hand –band
*Cleanse of the face with pre-peel cleanser( to be used according to the skin texture .i.e.oily ,normal dry etc.)
* Apply Vaseline to sensitive areas like  outer and inner canthi  of eyes, angle of mouth and nose with ear bud.
*Take 1 ml of peel booster in a measuring cup and with the brush apply it in same direction on the entire face. NO TIMER is required .After application let it dry completely.
* After drying now over the booster apply 1ml of glycolic acid 20% ( here timer is necessary)
* Time for 3 mins if patient is comfortable then neutralize after 3 min.
2)LACTIC ACID PEEL:-
INDICATIONS:
-Sensitive skin
-Dehydrated dull skin
-Under eye dark circles
4) DARK CIRCLE PEEL:-
INDICATIONS:--
⦁ Under eye dark circles.
⦁ Periorbital melanosis
⦁ Fine lines, wrinkles
⦁ Open pores.
5)ANTI ACNE PEEL:-
INDICATIONS:-
*Acne
*Boils ,Pustules.
*Folliculitis
DIFFERENCE BETWEEN AHA and  BHA
          AHA                                                                                        BHA
1) They are water soluble                                             1)They are lipid soluble
2) Has keratolytic action.                                              2) Anti-inflammatory, anti-microbial,comedolytic
3) Requires neutralization                                            3) No neutralizer required
4) No frosting occurs                                                    4) Pseudo  frost occurs
5) Glycolic                                                                       5)Salicylic
6)For pigmentation                                                      6) For acne
7) Prepared from sugarcane                                      7) Prepared from  
                                                                                      Sweet birch, willow bark,
                                                                                             Wintergreen leaves.
Combination Peels – Multiple peeling agents in combinations are used to compliment their synergistic activity and inhance their efficacy and depth.
E.g. Salicylic acid with a Mandelic acid targets the Seborrhea, residual acne, post acne pigmented early grade 1 scars as well as textural improvement. Mandelic acid has antibacterial properties and is safer for dark skin types.
Sequential Peels – One peel is printed and terminated and followed sequentially by another peel in the same sitting which can be termined or left on slow release peel.
E.g. Salicylic acid followed by Mandelic acid, Glycolic acid or Retinol peel. Salicylic acid peel followed by a TCA obtains moderate depth effects.
Switch Peels – Includes usage of different peeling agents in rotation in subsequent sittings. E.g. Salicylic acid or a Retinol peel in comedogenic or Inflammatory acne switched over after clearance to Glycolic , Mandelic or phytic in subsequent sessions to improve scars and texture.
Slow Release Peels – Some peels works on controlled (gradual)release of the product progressively and ensures complete penetration and full action of all components in the solution. Easy phytic peel composed of three hydroxyl acids with phytic acid, 3 AHA are glycolic acid, lactic acid and mandelic acid.

Skin analysis

1) Normal skin ( pH 5.5 to 5.6)
This type of skin is rather unfortunately rather rare . It is balanced between the dry and oily skin , but tends to go drier as years go by. The normal skin is firm with good muscle tone. It is soft and smooth and has a healthy colour. The pores are tight and the skin tends to have a translucent glow.
2)DRY SKIN
There is a lack of lubrication caused by an under secretion of sebum from the sebaceous glands. The dry skin can also become dehydrated due to lack of moisture content. This skin condition can be easily recognized by fine line around the eyes and mouth.
The skin is often rough and flaky on the nose and cheeks . Creepiness of the throat is characteristic.
Those with dry skin are spared the problem of acne and spots, but as they get older the lack of skin lubrication and moisture dehydration can lead the early wrinkles and loss of elasticity.
3) SENSITIVE AND ALLERGIC SKIN
This skin is very fine in texture and usually have a tendency to broken capillaries on the cheek and sides of the nose, where   the skin is tightly drown and very thin. It shows a great tendency to become blotchy or break out in rashes after a too severe treatment or irritation  through strong preparations. Very sensitive to cold , heat and wind.
4)MATURED SKIN
These skin shows the characteristics of a dry skin but to a greater extent . They may look very parched , saggy and dehydrated if no skin care has been practiced during the younger years. There has been quite possibly negligence in proper cleansing and nourishing and also poor diet. The matured skin is deeply lined and loose due to lack of moisture and over  relaxed facial and throat muscles.
5)OILY SKIN
Oily skin is coarser and thicker than the other types and have a greater tendency to develop open pores, blackheads and pimples. These appear especially around the nose and chin . They are generally caused by the sebaceous glands being clogged which in turn is caused by sluggish circulation. The very dilated pores, give the skin an orange peel like appearance due to the excessive production of sebum, which prevent the pores from closing.
6)COMBINATION SKIN
The skin is quite common and is rather  difficult to treat . It is usually characterized by  an oily center panel or T- zone ,with pores and slight oiliness in these areas.

Sometimes spots appear in these areas as well as clogged pores and blackheads. The cheeks and areas and throat are often quite dry.
Skin Type Sensitivity Reaction To Sun Example
1 Sensitivity Always burns, Never tans Red Haired, freckled
2 Sensitivity Always burns, minimal tan Fair skinned, blue eyed
3 Sensitivity Burns moderately, tans gradually Darker Caucasians, Indians
4 Normal Burns minimally, Always Tans Mediterranean, Indians
5 Normal Rarely burns, Tans profusely Middle Eastern, Latin, American, Indians
6 Insensitive Never burns, deeply pigmented Negroid, Indians
Woods Lamp Examination
A wood lamp is a mercury vapor ultraviolet lamp with an incorporated woods filter that is opaque to all wavelengths except those between 320 and 400 nm. The 360 nm wavelengths from the mercury vapor lamp is primarily emitted by the lamp. The woods lamp is an important investigative tool in the diagnosis of many dermatoses.
Estimation of extent of pigmentary disorders
The woods lamp easily accentuates the distinction between slightly hypo pigmented and normal skin areas. Pityriasis, versicolor, pityriasis alba and of ash leaf macules tuberous sclerosis all show up clearly under the woods lamp, especially in light skinned individuals. Similarly the extent of lesions of vitiligo which may be difficult to detect in fair skinned individuals is clearly visible under woods lamp.
In case of hyper-pigmented lesions the woods lamp accentuates epidermal memanin pigment as in freckles and most cases of melisma. In dermal pigmentation such as nevus of ota, post inflammatory pigmentation and some cases of melisma the contrast between pigmented and normal skin is diminished.
Thus it is possible to localize the site of pigmentation using the woods lamp.

SKIN ANATOMY

As you must be knowing skin is the largest organ of the body. The surface area of skin is 1.7sq.m. and constitutes 16-20% of total body weight .Human skin is of two types :1) Glabrous  skin (non- hairy ) e.g. Palms & Soles2) Non Glabrous (hair bearing )Skin is divided into 3 layers- 1) Epidermis 2) Dermis 3) Subcutaneous layerEPIDERMIS=Epidermis is outer most layer of skin , which forms an outer protective covering of the body . Contains no blood vessels but has many small nerve endings . Consists of stratified epithelial cells. Varies in thickeness  on palms of hand and soles of feet, but thin and delicate on eyelids.The free surface of the epidermis is marked by linear furrows and ridges of variable size.It is arranged in five layers :1) Stratum corneum2)Stratum lucidum3) Stratum granulosum
4) Stratum spinosum5) Stratum germinativumSTRTUM CORNEUM OR CORNEAL CELL LAYER-It contains dead flattened cells. Cells are generated in the stratum germinativum and old cells from the surface of stratum corneum . The function of stratum corneum is to keep the skin water proof and prevent the skin cracking and becoming open to bacterial infection . The continuous outward movement of epidermal cells constitutes a barrier for the agents which tend to penetrate the skin from outside. It takes 30 days for the cells to be reproduced in the stratum germinativum  and move upwards to replace the cells on the skin surface.STRATUM LUCIDUM- It is thinner than stratum corneum and is almost transparent This layer acts as a barrier controlling the it function is transmission of water through the skin. STRATUM GRANULOSUM OR  GRANULAR CELL LAYER -This layer is varies in the thickness e.g. It is  thickest in the palms of hands  and soles of feet . These flattened cells have evidence of kerotophyaline granules .which reflects light and give the skin shiny look.STRATUM SPINOSUM OR CELL LAYER OR MALPIGIAN CELL LAYER-It contains very fine filamentous structure called Tonofilaments, which consist of long chain of amino acids. The cells in the layer have specialized cell wall structure called the Desmosomes, through which they are attached to each other as well as to the cells of basal cell layer. Tonofilaments are attached to desmosome and form a Criss  cross pattern in the cytoplasm of the cell and provide a sort of skeleton to the cells.
Stratum Germinativum This is the deepest layer of epidermis, which is in contact with the dermis below from which it gets nutrient fluid from the blood capillaries. This layer is regenerative . one in very 10 cells are melanocyte which produce melanin. Melanin the substance that gives colour to the skin is series of chemical reaction with the amino acid tyrosine. Melanin protects the underling layer of skin from harmful effect of certain U.V. Rays. It is the innermost layer of skin also called the True Skin . it is tough , flexible and highly elastic.it is thicker on palms of hands and soles of feet but is exceedingly thin and delicate on eyelids. It consists of connective   tissue with elastic and collagen filbers and numerous blood vessels, lymphatic vessels and nerves. It also contains sebaceous glands, hair follicles etc.Dermis is arranged in 2 layers :1.Papillary Layer;2.Reticular Layer
1.Papillary LayerIt contains more elastic tissue than collagen fibers . but it contains projections of elastic tissue that point upward into epidermis called the papillae , which contain blood capillaries (small blood vessels) and nerve endings and nourish the epidermis. Collagen a protein based fibrous substance , the skin elastin to create tone& elasticity.2.Reticular LayerIt lies in between the papillary and the subcutaneous layer . it contains more collagen fibers and less elastic fibres. It contains following structures , in the network .
i. Fat cellsii. Blood vesselsiii. Lymph vesseliv. Sebaceous  Glandsv. Sweat Glands vi. Hair Folliclesvii. Arector pilli muscles 

3. Subcutaneous Layer  1) Lies  below the dermis 2)It  is a thick layer of loose connective tissue and fatty tissue.This  tissue is also called adipose tissue.3)This  fatty tissue varies in thickness according to the age, sex and general health of individual.4)It  gives smoothness and contour to the body.5) It stores fat  for use of energy. 6) It serves as an insulating layer.7)It acts as a protective cushion for the outer skinFUNCTION OF SKIN=1) Barrier function: a) Permeability Barrier    b)Barrier of penetration of micro organisms and chemicals.   c) Mechanical barrier2) Regulation of body temperature. 3) Sensory functions. 4) Immunological function.5) Vitamin D synthesis.6) Social and sexual communication.

DIPLOMA IN COSMETOLOGY & DERMATOLOGY LASER THERAPHY .

DISTANCE  LEARNING COURSE (ONLY FOR REGISTERED DOCTORS)
DIPLOMA IN COSMETOLOGY & DERMATOLOGY LASER THERAPY .
Affiliated to ICM &IBCM .
Details -Course Co-ordinatar - WNHO CLINIC ,
TILAK ROAD ,
PUNE 411030.
Ph. No.-(020)4121108,
(020) 24463540,
Mobile No- 9822006427.

Course covers following contents:

Anatomy and Physiology of the skin, Basic skin lesions, bacterial infections, cutaneous
fungal infections, cutaneous viral infections, Parasitic infestations, Papulosquamous
diseases-psoriasis, lichen planus etc, Eczemas, Bullous disorders, Connective tissue
disorders, Pigmentary disorders, Acne, Hair disorders, Nail disorders, Nutritional
disorders, Mucosal disorders, Skin tumours, Basic Dermatopathology, principles of
dermatological practice- Topical therapy and commonly used drugs, drug reactions,
Introduction to skin surgeries,
Cosmetology
Peels-Basic & Advanced.
• Crystal Microdermabrasion.
• Diamond Microdermabrasion.
• Iontophoresis.
• Electroporation.
• Electrolysis & Thermolysis. (Blend)
• Photo Rejuvenation.
• Pigment reduction.
• Acne & vascular treatment.
• HIFU
• Resurfacing by fractional lasers.
• Dark circle reduction.
• Scar reduction.
• Stretch marks reduction.
• Non-surgical facelift. (Microcurrents & Superpulse)
• Radio Cautery for skin tags, moles, warts.
• Mesotherapy /Micromesotherapy.
• Anti-wrinkle treatment & Fillers and PRP
• Earlobe Repair. (Surgical, Non-surgical)
* Basic PRP. (Crow’s feet, Forehead lines, Frown lines) & Advanced.
• Advanced PRP. (Nefertiti lift, Platysmal bands, Perioral lines,
Meso- botox)
• Basic Fillers. (Naso labial folds, Frown lines etc.)
• ACellulite. (Crow’s feet, Forehead lines, Frown lines) & Advanced.
• Periorbital Melanosis.
• Patterned Alopecia.
• Striae.dvanced fillers. (Lip, Chin and Cheek augmentation etc.)
Hair Structure
• Investigations.
• Nutrition & Hair.
• Hair & Scalp disorders.
• Androgenetic Alopecia.
• Alopecia Areata.
• Cicatricial Alopecias.
• H• Scalp Stimulation therapy for hair fall.
• Hair Volume enhancement treatment.
• Hydrating therapy for chemically
damaged hair.
• Medical Management of Alopecia.
• Non Surgical hair PRP
--------------------------------------------------------------------
DISTANCE  LEARNING COURSE (ONLY FOR REGISTERED DOCTORS)
DIPLOMA IN SEXUAL MEDICINE & PSYCHO SEXULAL THERAPY
Affiliated to ICM &IBCM .
Details -Course Co-ordinatar - WNHO CLINIC ,
TILAK ROAD ,
PUNE 411030.
Ph. No.-(020)4121108,
(020) 24463540,
Mobile No- 9822006427.

Course covers following contents:
*Introduction
*Basics
*Values in Sexuality
*Anatomy &Physiology
*Seual Responce Cycle
*Psychology of Sexual Responce
*Neural Mechanism of Sex
*Hormones in Sex
*Sexual Problems
*History Taking
*Physical Examination
*Investigations
*Counseling
*Psyhotherapy
*Sex Therapy
*Sensate Focus
*Pharmacotherpy
*Coital Postures
*Man-Women =Similarities &Differnces
*What Man / Women Wants?
*Masturbation
*Homosexuality
*Oral &Anal Sex
*Unconsummation
*Sex Factors Helpful in Treating Infertility
*Male Infertility
*Myths & Misconception
*FAQ
*Hypoactive Sexual Desire
*Sexual Aversion Disorder
*Male Erectile Disorder (Impotence)
*Premature Ejaculation
*Male Orgasmic Disorder
* Female Sexual Arousal Disorder (Frigidity)
* Vaginismus (Painful Coitus)
*Dyspareunia
*Sexuallity in the Ageing
*Sex in Some Common Conditions
*Premarital Guidance
* Sexuality Education
*Sharing with You
..............................................................................................................................................................
INSTITUTE OF COMPLEMENTARY MEDICINE(ICM)
Affiliated-IBCM-INTERNATIONAL BOARD OF COPMLEMENTARY MEDICINE &                                               GLOBAL EDUCATION(WNHO) AUTONOMOUS                      
EDUCATIONAL TRUST REGISTRATION NO.382/11985GBBSD BPT 1950F-10581,MUMBAI.
APPLICATION FORM
I wish to apply for online certificate courses
1) Diploma in cosmetology and Dermatology , Laser.
2) Diploma in Sexology and Psychosexual medicine.

Name-.............................................................................................................
Age  ....................... Address...........................................................................                                                                                                       .........................................................................................................                                                                       .............................................................................................................                                                                            .............................................................................................................
Date of Birth-...........................................Mob-..............................................
Email-..................................................................................

                                       DECLARATIONS.
I hereby declare that the above information is true.I have read the                                                                     rules of discipline.I agree to fully abide by them and also rules made                                                  by the authorities of the institute from time to time .I know that fees                                          once paid will not be refund or transferred on any account. further I,                                                   wish to begin this unique course for my Skill enhancement . I cannot                                                                                  prescribed any medicine unless and until I had registration in that                                                     Branch.

Signature of student.



Address
Course Co-ordinator
WNHO clinic,Sadashiv Peth,Opp ICICI Bank,                                                                                                              3 Dhanwantari Building,Tilak Road,                                                                                                    Pune-411030 ,   Mob-9822006427                                                                                   Email:drrameshm2@gmail.com

Principles of prescribing in Dermatology

(DO’S AND DONT’S)

1.      Detailed history of allergy due to drugs taken in the past     should be taken before prescribing any drug. Also history              of ingestion of other drugs must be obtained to avoid drug   interaction.

2.      Nature of treatment depends on the stage of the disease. More acute the condition less strong the local applications

e.g. lotions for acute conditions, creams for subacute conditions , creams or ointment for chronic conditions.

3.      Vehicle in which the medication is incorporated requires careful consideration as does the manner of application.

          Use of incorrect form of medicament will aggravate rather

          Than improve the condition by causing sensitization.

4.      Areas near the eyes and genitals should be treated with mild remedies because of increased percutaneous absorption.

5.      Adhesive plaster should be used with caution and not close to an acute skin lesion.

6.      Patent or proprietary preparations should be used only after studying their composition, side effects and contraindications.

7.      Ultraviolet therapy should be used with discretion in local treatment as wrong use of it may aggravate the condition.

          It should be avoided in cases with a history of photosensitivity and in lupus erythematosus or antifungal treatment.

8.      H/O previous application of corticosteroids can change the clinical picture of the disease.

9.      X-ray therapy in skin diseases should be left to the expert.

10.    If malignancy is suspected biopsy should be done before starting any treatment.

11.    Associated diseases like diabetes, hypertension, pepticulcer or pulmonary tuberculosis should be excluded before prescribing certain drugs such as corticosteroids.

12.    Avoid all drugs in the first trimester of pregnancy. Use minimum unavoidable drugs in later pregnancy. Strong steroid ointment should be avoided since if applied for a long time. They are absorbed into the blood. Ask for epilepsy as drugs given for the same may interact with some antifungal drugs.

13. Additional drugs may have to be incorporated in the prescription to counteract the side-effects of main drug prescribed antacids when corticosteroids are used.

14. Patient who has been fully treated should be re-examined at frequent intervals to observe renote untoward effects of drug prescribed and to check a release.

15.In contagious skin disease, not only the patient but all the family members and contacts should be examined and if found infective, should be treated simultaneously for scabies.

16. Treatment should be divided into two parts:


Local.    
Systemic.


 

Topical therapy is the mainstay in dermatological practice. Understanding the principles of the therapy is important.

 

17. Many topical agents penetrate the skin barrier and enter the blood circulation. Absorption is more in infants and children and this must be kept in mind with corticosteroids.

18. Hydration of skin before topical application enhances absorption. If local application is not applied in correct strength it may give rise to side effects like irritation, burning.  

Posted by Dr. Ramesh Maheshwari, Wnho Clinic, 2014 sadashiv peth, Tilak road, Pune. Free to call for further information.