Ask Dr. Rachna Pande

Doctor, I have many whitish spots on my hands and feet that just appeared mysteriously. What causes this and how do I remove them?

I have white spots on my feet



I have many whitish spots on my hands and feet that just appeared mysteriously. What causes this and how do I remove them?





Dear Lydia,

You have not specified whether the spots are increasing in number and size slowly, are they itchy? White spots appearing recently can be due to fungal infection. Fungal spores prevail in atmosphere and one can get infected by wearing damp clothes, damp shoes or walking barefoot on wet surfaces. The patches may be associated with itching. People with uncontrolled diabetes are more at risk of developing fungal infections early on exposure and in more severe forms. The rashes may reduce spontaneously in number and reappear but will not be cured until specific antifungal treatment is taken.

One can get whitish spots due to psoriasis. It is a immune reaction of the body, triggered by factors such as streptococcal sore throat or skin infections, cut or abrasion, drinking too much of alcohol, smoking, exposure to cold weather, among others. It is manifested by silvery white patches more on the backside of limbs and back, which can flake off. The patches are itchy and tend to be aggravated during the dry season.

Vitiligo is yet another condition which can cause white patches. It occurs due to depletion of the skin pigment melanin which provides normal color to the skin. It is mostly hereditary.

White patches can also be due to allergy. The substance provoking allergy may be something present in the environment like dust or pollens or it may be something being consumed or applied over the body.

Excess dryness of the skin or exposure to sunlight can also at times cause patches on the limbs.

It is advisable for you to consult a dermatologist to know the precise reason of the patches and get it treated.


My legs swell when I stand for long


My legs get swollen when I sit or stand for a long period. What causes this and how can I prevent it from recurring?



Dear Erica,

What is your age and since how long you are having this problem? Swelling occurs over legs on standing or sitting for long time due to accumulation of fluid and stasis, called as edema which can be due to multiple causes.

Women can have swelling over legs around menopause due to increasing levels of progesterone. It can also be due to hormonal treatments. Swelling can be due to advanced pregnancy.

Deficiency of thyroid hormones also causes swelling over feet as one of the manifestations. Non steroidal anti inflammatory drugs like ibuprofen, naproxen used for pain relief can cause swelling over legs as adverse effect. It can also be due to some drugs used for treating hypertension or diabetes. Long term use of corticoids for any reason can cause leg edema as secondary effect. Sitting for a long time continuously causes stasis of circulation in the legs leading to swelling. It can also be due to obesity as extra body mass tends to reduce circulation of blood in legs causing stasis.

It can also be a sign of protein deficiency. Chronic thiamine (vitamin B1) deficiency also manifests as swelling over legs. Among serious disease conditions, one can have leg edema due to liver failure, kidney failure or heart failure.

If you are in the age of menopause but there is no associated breathlessness, sense of fatigue, decreased urination or yellow discoloration of eyes, maybe you should wait and watch. Reduce intake of salt in food as that tends to augment accumulation of fluid. If obese, try to reduce weight. If swelling is much, drugs called diuretics are used to remove extra fluid from the body. If edema persists, then get investigations done, minimum of which should include a cardiac echo, X-ray chest. Kidney and liver function tests, thyroid function tests. serum proteins and serum thiamine levels where possible. Any of these conditions can be treated or controlled easily.


Why does my baby cry a lot at night?


My one-year-old daughter cries a lot at night, yet she is always jolly during the day. At first I thought she had some sickness but when I took her for a check-up I was told she was fine. What could be the problem and how do I go about it?



Dear Imbabazi,

It is common for many small babies and toddlers to cry in the night. There are several reasons a small child cries in the night without any apparent medical problem. Since they are not able to express their discomfort or need by speaking, crying remains the only outlet for their discomfort, pain or some physical or emotional need.

Children at this age have a developing digestive systems, hence digestion is weak. They tend to consume more of milk than fiber in the diet. This can cause flatulence and uncomfortable sense of bloating in the stomach, making them cry. Acid reflux can also cause this problem. Constipation adds on to this problem. Toddlers depend on their parents for feeding them and are not able to express their sense of satiety after meals. If they are overfed, the resultant indigestion wakes them in night crying. If underfed, they may feel hungry and cry in the night.

A small child may have slept enough in the day time and may get up in an hour or so, after being put to sleep. He wants to play at that time, whereas parents want him to sleep . Also the sleeping hours of a baby is reduced as they grow up, hence if put to sleep in day time, they would not get sleep for long hours in night.

Sometimes it may be just an emotional need to be held and given due attention. This can happen in situations where both parents are working and the child is left in day care centers or with nanny in the day.

Try spending more time with the baby in the day and do not let her sleep much in day time. Give her some solid food in night that shall ensure a full stomach and prevent her from being hungry in the night at an odd time. Food should include fresh vegetables, whole grains and fruits, so that she gets enough nutrients as well as fiber. It is useful for digestion as well as preventing constipation. This can be given either as soups or in any semi liquid form which can be eaten by her easily and relished. Freshly prepared food is always better than ready to eat cereals and baby foods.

Make her play and be active as per her age in the evenings. With adequate physical activity, she is bound to get a good undisturbed sleep in night. Try to put her to sleep and wake her up at fixed time, so the body’s clock gets set. Keep her bed room quiet with no distractions like a T.V. or bright lights or conversing adults. When she gets up and cries, you can ignore it for few moments. If it is only for attention seeking, she will become quiet after some time. If the crying continues, assess her for any flatulence. Compression of the belly by a soft lukewarm towel or lukewarm hot water bottle helps in relieving the discomfort. Drinking small quantity of water mixed with asaefotida or carom is also useful. Constipation can be cured by using glycerine suppositories or just pushing little glycerine inside the rectum with a clean finger.

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