As monsoon arrives, it invites a host of skin problems and infections. Here, Dr. Kiran Godse advises on the approach and treatment of commong skin issues and shares simple preventive measures that can be advised to patients.

Monsoon may be everyone's favourite season, including mine. Why wouldn’t it? Long drives, cosy evenings with loved ones, dancing in the rain, watching rain-drenched landscapes, and on top of that garam chai with hot pakodas. Can’t get better than this, right? And that’s how I used to think about it too! But as a dermatologist rain brings much more than that. It brings tons of skin problems with it.

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Factors favoring skin disease during monsoon

Excessive humidity, fluctuating temperature, excessive sweating, phototoxic effect of sun, friction of clothes, synthetic innerwear- all lead to increased chances of various bacterial and fungal infections, and other skin diseases. Immunosuppression in HIV, diabetes mellitus, congenital immunodeficiencies, and corticosteroids and immunosuppressive drug usage also make patients prone to skin diseases during the season.

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Most common skin disease in monsoon

Fungal infection

Tinea is one of the most common and dreaded fungal infections because of its increasing prevalence and antifungal resistance. It is caused by dermatophytes and involves the skin, hair, and nails. It is characterised by itching. Family history is positive in these patients. Erythematous annular plaque with central clearing, raised border with pustules and vesicles present on flexural area, face, genitals, scalp, nail, between the inter digital spaces.

The patient should be asked to use mild soaps. Avoid sharing socks, towels, inner wear and wearing closed foot wear. Skin should be kept dry and regular and more frequent baths should be taken. Public toilets should be used carefully due to hygiene concerns. Patient should be advised to go to a doctor in such cases and over the counter steroid creams should not be taken as it increases the resistance and patient suffers from prolonged infection. Patient should be started on antifungal agents and progress should be monitored.

Folliculitis

It is the inflammation of hair follicles caused by bacteria or fungi. It is most commonly seen on the face and appears as erythematous papules and pustules present near the hair follicle. After identifying the cause, appropriate antifungal and antibacterial should be used for these patients.

Skin allergies

They increase due to the increased level of pollution, especially in the metropolises. It most commonly affects the upper back, hands, and feet. It presents as erythematous papules, plaque, and vesicle with scaling and is usually seen in patients with a history of skin allergies, hay fever, and asthma. They should be treated with antihistaminics and the triggering allergen should be found and avoided.

Athelete’s foot

Athelete’s foot is fungal infection that occurs between the toes. This is a contagious infection that can spread by walking barefoot in the gym locker room, near the pool, or even the bathroom. Culprits are also closed footwear and socks. Foot care should be initiated. Patient should be advised against using closed footwear and sould be told to pat dry the feet. Appropriate antifungals should be started.

Hyperhidrosis

Hyperhidrosis or excessive sweating is a medical condition which gets worst during the monsoon and is characterised by increased sweating in the armpits, palms, soles, face, or scalp which also increases the chances of other infections. Patient should be investigated further to find out the cause.

Hyperpigmentation

During the rainy season, even though it may be cloudy, blue sky is seen more often. Phototoxic effect on the skin leads to increased production of melanin and leads to hyperpigmentation, most commonly seen on face. Hence, it is very important to use a broad spectrum sunscreen irrespective of the season. Depigmentory agents can be used for such patients to reduce the pigmentation.

Dull and fizzy hair

It is a woman’s worst enemy and increases during monsoon because of the presence of moisture in the air. This makes the hair dry. Hence, the patient should be advised to use a gentle shampoo and avoid excessive use of chemical products as it further dries out the hair.

Acne

Breakouts are commonly seen in patients with dry and oily skin. Early treatment should be advised to prevent pigmentation and scarring. Topical and systemic retinoids, topical clindamycin, topical benzoyl peroxide, topical azelaic acid, oral doxycycline etc are the commonly used drugs.

Insect bites

They are common during monsoon and present from few erythematous papules to urticarial angioedema. Angioedema is an emergency condition which should be treated immediately to prevent laryngeal oedema.

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What do we advise to our patients?

1. Due to the humidity in the environment, skin tends to become dry and hence moisturisers play an important role. Cosmetic moisturisers available over the counter should be avoided as they are the most common cause of aggravation of allergies.
2. Body should be hydrated by drinking plenty of water- a minimum of 10 to 12 glasses.
3. In general, comfortable and loose clothing should be worn. The body sould be wiped dry properly after a bath- especially the skin folds such as between the toes, under the breast, behind the knees, between the buttocks, and the underarms. Tight accessories like headbands and belts should be avoided.
4. Foot care is very important during monsoon. It should be advised to not walk bear feet. Slippers should be worn in the bathroom as well. Closed shoes should not be worn as it increases the chances of fungal infection.
5. Feet should be pat dried every time after getting home. Socks should be regularly changed. Antifungal dusting powder should be used after bathing, before wearing socks, and in the evening before retiring to bed.
6. Allergens like dust, dirt, pollen, and animal fur should be avoided. Experimenting with artificial jewellery should also be avoided as the metal may lead to allergic contact dermatitis.
7. Patients should be checked for underlying disease such as diabetes and thyroid.
8. Any patient with itching should be given antihistaminics to prevent the auto-inoculation of the disease and provide relief.

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Conclusion

It is of utmost importance to follow skincare routine to prevent infections. Increasing awareness of these preventive methods will help reduce the prevalence of skin disease to a great extent.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.