|What are Mabs and Nibs?
Incidence and prevalence of inflammatory skin diseases (eczema, psoriasis, vitiligo, acne etc) are on the rise. Most of these common inflammatory skin diseases are result of individual’s predisposing factors with environmental changes acting as precipitating factors.
One of the major predisposing factors is systemic oxidative stress. Oxidative stress results when free radicals released during metabolism overwhelm the body’s anti-oxidant system. One of the most important source of free radicals is carbohydrate (glucose) metabolism. This oxidative stress in turn leads to release of many cytokines (mediators of inflammation) which lead to cascading effects on various pathways of immune response.
Decades ago steroids were the umbrella treatment for these inflammatory diseases. With the advance in molecular biology, newer treatments targeting cytokines and their pathways, called monoclonal antibodies (Mabs) and inhibitors of various pathways (Nibs), are the new treatment options. However, these newer molecules offer limited benefits, without addressing the predisposing metabolic derangements resulting from modern dietary habits.
Skin is the largest and the heaviest organ of the human body, with a surface area of 1.5-2 m2 and contributing to 1/7 to 1/6 of the body weight. It is the body’s largest water storage site, containing almost 1/3 of the total body fluids. It holds 1/3 of our circulating blood, more than even the brain. It constitutes the major energy reserve, with skin fats providing storing energy enough to last 40 days.
It is also a major sensory organ, helping us to know the surrounding environment, to protect ourselves from the possible irritants, to maintain our posture and balance and to initiate a flight and fight response. The sensory function of the skin is so sensitive that it can discriminate the differences in weight of as little as 0.005 gms and react to temperatures between -18oC and +44oC and send nerve impulses with a velocity of 2 metres per sec, to the spinal cord and the brain.
Therefore, skin, along with its appendages and glands, is an organ of protection, perception, perspiration, perfusion, and it reflects one’s personality, boosts one’s performance, and powers metabolism of vitamins and hormones. Thus taking care of the skin is very important, lest the individual gets penalised! Respect your skin and the skin respects you. Don’t take it for granted!
Skin provides a fascinating theater of life in which, in contrast to all other organs, one can directly watch, dissect and manipulate key principles of biology and pathology in action. Environmental insults and ways of life leave unmistakable traces on the skin. A thorough professional examination of the skin can reveal many invaluable clues about a person’s general well being, internal disease, social, cultural and eating habits, psychological disturbances and occupation. Skin therefore provides ample information for the dermatologists and physicians alike, for the eyes that know to find them.
In recent years, the pattern of dermatological diseases have shown significant changes. Many diseases that were once very common, such as skin manifestations of nutritional deficiencies, skin infections, leprosy, sexually transmitted diseases etc., have become uncommon. On the other, problems such as acne, psoriasis, vitiligo, skin manifestations of systemic diseases and other autoimmune diseases have been on the rise, and many of these problems are being increasingly linked to diet and lifestyle changes.
Also, with the improvement in living standards, there is increased ‘demand’ for improving the health and feel of the skin. Dermatologists of the day are required to be equipped with the skills and tools to help the cosmetic needs of our people.
The practice of dermatology has been revolutionized in the past 2 decades. It is now a great blend of the art of medicine and the science of the most latest technology. The latest technological advances such as lasers, nanotechnology, phototherapy, cryotherapy, collagen induction therapy, photography and many more have joined the armament of dermatologists. Present day dermatologists are also trained in cutaneous surgery to treat many skin lesions and to help problems such as scars, baldness etc.
Melasma with photo ageing is a common problem, resulting from exposure to UV rays, glycation from excess sugars in the diet, free radical damage and genetic predisposition. It is managed with ideal sun screens, dietary modifications and anti oxidants. Image shows a case of melasma, improved with the use of sun screen and life style modification and supplements.