Can you tell me the causes of dry and itchy skin?

Many people suffer from dry skin. Lower legs, elbows, forearms and buttocks are the normally affected parts of the body. It is a big problem to many as it can spoil the quality of one’s life. The irritants can attack very easily on dry skin as there is no protective layer of natural lipids. The result is itching. Scratching gives pleasure for few seconds, but the after effects, bloody scratches and infections, can give further problems. If your skin is very dry and itchy your sleep can be affected. Another reason for dry skin may be some diseases such as diabetes and kidney diseases. Many medicines make itching worse. Therefore, it is advisable to consult with your doctor to find out the reason for this dry and itchy skin. If untreated, dry skin may lead to dermatitis which is inflammation of the skin with swelling and infection. Fortunately most of the causes are external.

There are many causes for dry and itchy skin and they include:

• Dry air – It is the most common cause. Winter, indoor air whether with heating or with air conditioners can make dry skin. You have to use a moisturizer. Do not heat the rooms in winter too hot. It is advisable to use humidifier in the rooms. Water in an open vessel can help. If you go outside in winter close your skin very carefully with hats, scarves, gloves and long socks.

• Exposure to water – prolonged exposure to hot water can remove the natural fats that protect your skin. The morning or evening shower can be few minutes with cold or lukewarm water and it is better to skip the hot water. Gently pat and dry your body with a towel. Immediately apply the moisturizer. Avoid hot and long baths.

• Soap - it is the number 1 enemy if you have dry skin. It removes the skin protective layer very quickly. Average persons need soap for the face, hands, feet, underarms and groin. The other parts of the body do not need soap and water is enough to keep them hygiene. Of course, playing children or workers need a mild soap for the whole body. Washing the hands and faces often must be avoided. Buy fragrance free soaps always. Treat your skin gently so that the fats remain there. Sponges or brushes or napkins are not necessary to scrub your skin.

• Clothes that itch – avoid clothes that brings you itching or that makes your itching more. If the irritant comes from your clothing then it is a continuous exposure. To wash your clothes use detergents without perfumes or other additives. Never use a cloth that brings or increases itching.

• Medicines and drugs - Many medicines and drugs have itching as side effects. Read carefully about the side effects. If you get dry skin or itching after taking the medicine for the first time contact your doctor immediately. He may prescribe another medicine with equal effect.

• Diseases – Diabetes, kidney problems, thyroid problems, particularly hypothyroidism, psoriasis, eczema, neurodermitis and other skin diseases can cause dry skin and itching. Approach your doctor for treatment.

• Old age - Getting older can bring dry skin and especially more women suffer from this. The levels of estrogens and menopause play a role here. The majority of old people above 65 suffer from dry skin.

• Malnutrition – it can be a good reason. Consult with your doctor or dietician to have diet with all necessary nutrients to your body. Eating disorders can also cause dry skin.

• Hereditary – your genes may be the culprit for dry skin and this is irrespective of your age.

Consult with your doctor. It may be mostly only a problem of skin care that could be rectified easily. Other diseases must be well diagnosed and treated properly.

Can Vitamin D supplements interfere with my prescribed drugs?

I do not know which medicines you are taking, but vitamin D supplements can interfere with certain medicines. Its level in the blood can increase. It is better to consult with your doctor before taking the supplement.

These prescribed drugs include:

• Estrogens – Hormone replacement therapy with estrogens can increase vitamin D level in the blood. This has a positive effect on calcium and bone metabolism. This benefit is lost when progesterone is added in the therapy
• Isoniazid – This is a drug used to treat tuberclosis, may raise blood levels of vitamin D
• Thiazide – Diuretics such as hydrochlorothiazide can increase the effect of vitamin D and can lead to very high calcium levels in the blood.
Vitamin D levels may be decreased if you take the following drugs:
• Antacids – long time use can affect the bioavailability of vitamin D
• Calcium channel blockers – These medicines are used to treat the high blood pressure and other heart diseases. They may decrease the production of vitamin D by the body
• Cholestyramine – This decreases the cholesterol. It interferes with the absorption of vitamin D
• Antiepileptic medications such as phenytoin, Phenobarbital and others may accelerate the body’s use of vitamin D
• Weight loss medications – Orlistat binds with fat and thus prevents the absorption of vitamin D and other fat soluble vitamins.
• Vitamin D may enhance the effects of doxorubicin, a drug used in treating cancers
• If you take digoxin, a drug used to treat irregular heart rhythms and vitamin D together, the high level of calcium can increase the drug to toxic ranges
• Corticosteroid drugs such as prednisone, used to reduce inflammation can reduce calcium absorption and impair vitamin D metabolism. This increases the risk for osteoporosis

Never increase the dose of the medicine by yourself. Even if you take food supplements talk to your doctor.

What is osteoporosis?

Osteoporosis is a skeletal disorder characterized by a thinned and weakened bone which increases the risk of fracture. Bone density informs about your bone strength and demineralization of the bones causes osteoporosis.

Simple falls can make an osteoporotic bone more susceptible to fracture.

Primary osteoporosis can occur both in men and women, but more common in postmenopausal women and men get it normally when they are old.

Secondary osteoporosis is due to deficiencies or too much of hormones, steroid medication and chronic illness and there may be more other reasons which we may not know now.

The most important here is not the bone density or daily bone loss but the balance between bone formation and loss.

Calcium, vitamin D and estrogens play a vital role in osteoporosis. Healthy food, good lifestyle and physical activity is important to prevent it.

Uterus, functions and diseases

Uterus is an inverted-pear-shaped organ of the female reproductive system. It has three main functions: to prpare a bed for the fertilized egg, to nourish the developing embryo during pregnanmcy and deliver the child at the end of pregnancy.

Bladder, bowel, pelvic bones and organs are supported by uterus. The bladder is in its right position above the pubic bone with the help of the uterus. It lies over and behind the bladder. Normally it is tilted slightly foreward. It is 6 cm bis 8 cm long and about 6 cm across the top. Here on the sides the fallopian tubes enter it. At the other end is the cervix and it extends down into the vagina.

Endometrium, the uterine lining, a moist mucous membrane, changes its thickness during menstruation. It is the thickest during ovulation and is ready to accept the fertilized egg. The uterine wall is about 2.5 cm thick and expands and becomes thinner as a foetus develops inside. The cervix can expand to about 10 cm for the delivery of the child.

The function of the uterus is govened by the female hormones estrogens and progesterone and if the fertilization doesn’t take place the concentration of the hormones decreases.

Diseases of the Uterus are

• Chronic pelvic pain
• Endometrial Polyps
• Uterine Prolapse
• Endometriosis
• Fibroid Tumours

Chronic pelvic pain – due to large number of possible causes of pelvic pain, the diagnosis begins by process of elimination. Your doctor do a series of test to diagnose and treat you.

Endometrial Polyps – About 25% of all women experience uterine polyps, an overgrowth of tissues in the endometrium. These are also called endometrial polyps. These are usually soft, small, bulb-shaped masses of endometrial tissue attached to the uterus. The symptoms are abnormal uterine bleeding and in this case a visit to the doctor is a must because it may also be a serious condition of emdometrial cancer.

Uterine Prolapse – Uterine prolapse is sliding or falling of the uterus from its normal position in the pelvic cavity into the vaginal canal. Connective tissue, muscle and special ligaments in the pelvis keep the uterus in position. When these connectie tissues and muscles weaken the uterus drops. Vaginal births, aging and lack of estrogens during menopause may be the reasons for uterine prolapse. Chronic constipation can worsen uterine prolapse.

Uterine prolapse usually happens in women who have had one or more vaginal births. Normal aging and lack of estrogen hormone after menopause may also cause uterine prolapse, as can chronic cough (such as a smoker's cough) and obesity. Uterine prolapse can also be caused by a pelvic tumor, although this is rare. The symptoms include:

• Vaginal bleeding
• Backache
• Painful or difficult sexual intercourse
• Heaviness or pulling sensation in the pelvis
• Coming out from the vaginal openning
• Mostly a feeling of sitting on a small ball

A visit to your doctor is important for the right diagnosis and treatment.

Endometriosis – Because of its location and the different symptoms to every woman it is a elusive disease. The symptoms of endometriosis include:

• Pain before and/or after menstruation
• Severe menstrual cramps
• Irregular and heavy menstrual bleeding
• Painful intercourse and orgasm
• Infertility
• Cycles of diarrhea and constipation
• Nausea, bloating, vomiting
• Fatique
• Pelvic pain
• Bladder pain
• Lower back pain

The problem is also that some women with endometriosis have no symptoms. It is a serious condition and you have to go for diagnosis and treatment to an experienced doctor.

Fibroid Tumours – 25 to 50 % women have this problem and it is confirmed in more than 80% after the tissue analysis.

Fibroid tumours are estrogens dependent. The problem could come only after a woman starts to menstruate, thus after the production of estrogens, the female sexual hormones. That is why during menopause fibroid tumours disappear automatically. Its growth during pregnancy is very fast because of the very high levels of estrogens.

The syptoms are excessive uterine bleeding, a feeling of pelvic pressure which brings urinary and bowel problems and painful intercourse. There are different kinds of fibroid tumours. But, it is extremely rare that these tumours are cancerous. It is about 0.002 t0 0.003% only.

Subserosal fibroids grow on the outer wall of the uterus and usually there are no symptoms. The symptoms will be there if they grow large and interfere with other organs.

Here also it is a must to go to the doctor for diagnosis and treatment.

Before taking a decision for hysterrectomy it is always better to get an second opinion if you have no life-threatening situation because many doctors see uterus is only an orgen to get a child. Since hysterectomy has long-term effects on woman’s health and sexuality it is vital to understand all possible consequences. It should be done when it is necessary to save your life.

Hysterectomy is a must in the following conditions

• Invasive cancer in the uterus, cervix, ovaries, fallopian tubes or vagina
• Severe and uncontolled bleeding
• Severe infection which does not respond to medicines and treatment
• Complications during childbirthe, for example a ruptured uterus

In all the other conditions such as endometriosis, fibroid tumours, severe pelvic infections, uterine prolapse and others your medical condition is the basis for the decision for a hysterectomy.

What is the relationship among calcium, estrogens and vitamin D?

It is very simple, for the absorption of calcium from our intestine to blood we need estrogens and vitamin D. If you have deficiency of estrogens, vitamin D or both you can also have less absorption of calcium which may lead to osteoporosis.

It is more difficult to keep the absorbed calcium in our body and several factors such as, the amount of calcium or the amount of vitamin D, or sodium or protein has a good or very bad influence on it. Too much from these food or nutrients are bad for calcium metabolism.

The estrogens production is slowly reduced during the pre-menopausal period and in post-menopausal the concentration is very low. Estrogens replacement therapy or enough vitamin D intake is, therefore, very important for women’s health.

The phytoestrogens from soya beans or other vegetables can also replace estrogens replacement therapy.

Calcium

About 99% of the calcium in our body is present in the bones and teeth. The remaining 1% is found in blood and has very important functions.

If we have less calcium in our blood then automatically it will be taken from the bone. It is good one side but also dangerous because in course of time the bone mass density can come down.

Calcium plays an important role in nerve conduction, muscle contraction and blood clotting. Therefore, it is very important to take enough calcium to maintain the amount in blood as well as in bones.

Osteoporosis is the disease which calcium deficiency brings. Here the bone mineral density decreases and the bones become porous. Increased risks of fractures are the result. It affects the women after menopause.

The recommended amount of daily intake of calcium is as follows:

Age Daily intake(mg) Females (mg) Males (mg)

Infants:
0 to 12 months 250 - 500
Children:
1 to 3 years 600
4 to 6 years 700
7 to 9 years 800
10 to 12 years 900 1000
Adolescents:
13 to 14 years 900 1000
15 to 18 years 800 900
Adults:
above 19 years 800 800
Pregnant +400
Breastfeeding +400

The foods rich in calcium include:

Milk and dairy products
Legumes
Mustard
Cabbage
Dark green leafy vegetables
Salmon & sardines

The substances which decrease calcium absorption include:

Oxalic acid – spinach, Soya beans and some other vegetables also
Phytates – in some plant foods
Dietary fibre – plant foods
Excess of phosphorous – also need vitamin-D for absorption.
Laxatives – no time for calcium absorption.
Tannins – present in tea, can bind with calcium.
Medicines – long time use of corticosteroids and anticonvulsants

There is an important relationship between calcium, estrogens and vitamin D. For calcium absorption we need vitamin D and/or estrogens. That is why after menopause when the estrogens level drops women may have problem. It is much more complicated as we think.

Is the advertisement in Indian television correct with calcium+D? It is a very good question. In India, calcium+D tablets are not needed. Here we have enough sunlight. So there will be no problem for vitamin D production. This calcium+D are produced for Europe and other countries where there is not enough sunlight. Better buy something where there is only calcium, that also only if it is absolutely necessary Food is the good source for calcium. If you supplement calcium you must know several things thoroughly. Otherwise, you could bad to your health.

Normally a healthy person need not take calcium tablets. If he eats normal food he gets enough calcium. We need the supplementation only in later life, i.e., for the postmenopausal women and aged persons. Consult your doctor or dietician

Supplementation:

Postmenopausal woman …..1500 mg
Aged persons, 65+ ….....1500 mg

Do not take more than 500 mg at a time and after 4 to 6 hours only the next dose, since calcium absorption occurs very slowly. The supplement should be taken in between two meals. Otherwise calcium can interfere with the absorption of many essential elements including iron.

Is it so simple to supplement and increase the amount of calcium, thus the bone mineral density? If one reads it sounds so simple but it is very complicated. I have worked more than 20 years with calcium and its problems. I have conversed with thousands of women about their food habits to understand their calcium intake. The conclusions are very interesting that they take more than recommended calcium. But there are more points that they should know.

• If you take too much of calcium from your food and supplementation then the body excretes also much more calcium.
• If you take more sodium, then more calcium is excreted.
• If the urine becomes acidic from too much intake of protein, then also much calcium is eliminated.

If too much of calcium is there, then sodium and potassium have problems and we are often tired. It is better to have a counselling to make it tailor-cut calcium intake for you.

The birth control pill or oral contraceptive pill

The oral contraceptives contain different levels of estrogens and progesterone or progesterone alone. It is prescribed by the family doctor after considering the family history and medical records of the woman. These pills stop the ovaries from releasing eggs every month. They also make the lining of the uterus thinner so that the fertilized egg could not attach there.

The disadvantages are that the pill must be taken everyday without any break. Even if you have vomiting or diarrhoea the effect of the pill is gone and you can become pregnant. If you forget to take the pill for a day then also the risk of pregnancy is there. Every year you need three months interval for the regeneration of the hormone household of your body, otherwise infertility may be the result. There are many side effects from these hormone pills.

Side effects:

If you have the following symptoms, go to your doctor and talk to him. These include severe headache, severe vomiting, speech problems, dizziness, faintness, weakness or numbness of arms or legs, coughing up blood, shortness of breath, crushing chest pain or chest heaviness, double vision, partial or complete loss of vision, bulging eyes, pain, warmth or heaviness in the back of the lower leg, severe stomach pain, jaundice, loss of appetite, extreme tiredness, weakness or lack of energy, fever, dark urine, pale stool, swelling of the hands, feet, joints and lower legs, mood changes and depression, unusual bleeding, skin rash and menstrual bleeding which is unusually heavy or that lasts more than 7 days in a row.

The other side effects are nausea, vomiting, stomach cramps or bloating, diarrhoea, constipation, swelling of the gum, increased or decreased appetite, brown or black skin patches, acne, hair growth in unusual places, white vaginal discharge, swelling, redness, irritation, burning or itching of the vagina, breast tenderness, enlargement or discharge, painful or missed menstruation, changes in menstrual flow, bleeding or spotting between menstrual periods, weight gain or weight loss and difficulty in wearing contact lenses.

Oral contraceptives may increase the risk of developing liver tumours and breast or liver cancer. The risk of getting a heart attack, a stroke or a serious blood clot may also be increased. Consult with your doctor about these serious effects.

Cigarette smoking increases the risk of serious side effects from oral contraceptives, including heart attacks, blood clots and strokes. If you are older than 35 years or smoke 15 or more cigarettes per day, then the risk is higher. If you take birth control pills, you should not smoke.

Caution:

Oral contraceptives will work only as long as they are taken regularly. You may need to use a backup method of birth control if you vomit or have diarrhoea when you are taking this drug. You can consult your doctor to choose the correct backup method and for other advices.

The women who have family histories of diabetes, high blood pressure, migraines, blood clots and breast cancer should not take this. It is same with the progesterone-only pill also. Although both pills are 99% effective if taken properly these are not suitable for women who change their partners often because they give no protection from HIV virus and other sexually transmitted diseases (STDs).

The patch - it is a big plaster with hormones of the combined pill oestrogen and progesterone and is applied on the skin. The hormones reach the blood through the skin. Apart from the side effects of the birth control pill here is the possibility of red skin and rash are there.

The advantages and disadvantages are the same as the birth control pill. The same precaution should also be taken as the oral pills.

This a prescription drug, but in India…..