Doc, why do my lips and hands have white patches?

Dr Flo,
Some parts of my skin have turned white. This is especially so for my lips and hands. The condition started about five years ago and it has been spreading over time. The areas are not itchy or painful. I have tried ointments that do not seem to be working. What is wrong with me? Is there a permanent solution to this?
Kip

Dear Kip,
What you have is called vitiligo, a disorder where white patches occur on the skin due to destruction of melanocytes. Melanocytes are the cells that give skin colour/pigment. It can also affect areas that are covered by mucus membranes instead of skin such as inside the mouth or nose. The exact cause of the disorder is not known. It may happen due to someone’s genes, and someone who has it is more likely to have a relative who has it. It may also be due to a person’s immune system attacking the melanocytes, which is called an autoimmune disorder. People with other autoimmune disorders, such as those affecting the thyroid gland, are more likely to have vitiligo, but this is also not a must.
Vitiligo can affect anyone, but is more obvious in those with darker skin. It can affect any area of the body, but is more common in areas that are exposed to the sun like the arms, the feet, the face and the lips. It can also affect the eyes, and the hair and you may notice that your hair becomes white earlier than others. Some people get the patches, and they never spread. For some, it spreads slowly over a long time, while for others it spreads very fast. In some people, the patches spread after a period of stress.
Once you have vitiligo, it cannot be cured, but it can be managed. Use sunscreen to protect your skin, you can use make up to cover up the patches, and if the white patches cover only a small area, tattooing can be done to cover it up.
Visit a skin specialist to help you figure out how to best manage the condition. You may be given some creams to apply, and phototherapy and laser therapy may be used to help the skin get back some colour. Specialised surgery can also be done in some people.

Dr Flo,
My hands and feet usually sweat so much that I am always afraid of shaking people’s hands and my feet are always smelly. What can I do?
Wanjala

Dear Wanjala,
Sweating is one of the ways the body manages excessive body heat. When the sweating is too much, in excess of what is needed for temperature regulation, it is called hyperhidrosis. Hyperhidrosis can affect the whole body or specific sites such as the face and head (craniofacial hyperhidrosis), the palms (palmar hyperhidrosis), the armpits (axillary hyperhidrosis) or the feet (plantar/pedal hyperhidrosis).
The excessive sweating is not considered dangerous. The constant wetness of the palms and feet makes it easier to get other skin conditions like fungal infections, eczema and even cracking. The excessive sweating in most cases is caused by overactive sweat glands due to miscommunication from the nerves. In a few people, there may be other health problems like hormonal disorders, blood sugar disorders and anxiety.
Take a lot of water and wear cotton socks and leather shoes. You can change socks and shoes halfway through the day, if possible, and change to open shoes in the evening. You can also apply aluminium chloride/chloral hydrate solution to the palms and soles to be prescribed by the doctor or from a chemist. If the sweating continues to be excessive, you can be seen by a dermatologist for iontophoresis, which means that a mild electric current is passed to the feet and the hands through water. Some medications or injections may also be given by the dermatologist.
Because the sweating may be triggered by emotional responses such as anxiety, fear and excitement, it would also be beneficial to learn relaxation techniques to help reduce the sweating.

Dr Flo,
My girlfriend and I have been in a relationship for almost a year now. However, I have noticed the smell of her private parts is not good. This started last year. She has gone to the hospital and has been given drugs, but there is no change. Please help me out. Even herself esteem is going down.
Cy

Dear Cy,
The vagina has a natural, mild, musky smell. This smell changes with hormonal changes during the menstrual cycle, pregnancy, use of hormonal medication and menopause. Strong smelling foods such as onions, garlic, caffeine and some fruits may also affect the vaginal smell. Sweat and hygiene concerns in and around the vagina and surrounding areas may contribute to the odour. During and after intercourse, the vaginal smell may change due to use of lubricants and due to interactions between semen and vaginal fluids.
If there is a foul odour, it is may be due to vaginal infections like candidiasis, trichomoniasis, gonorrhoea, bacterial vaginosis (BV) among others. This may be due to overgrowth of some bacteria or fungi naturally found in the vagina or in the nearby areas, due to changes in the internal environment of the vagina or due to an infection from somewhere else. It may also cause itching or a burning sensation, abnormal discharge and pain during intercourse.
It would be advisable for your girlfriend to see a doctor and have a vaginal swab for analysis and culture tests, and possibly a urine test, even as you are also screened. You should also avoid intercourse until treatment is complete or use a condom. She should also avoid wearing tight clothing, and avoid douches and perfumed products in and around the vagina. After intercourse, she should urinate immediately afterwards and rinse the vulva and vagina with plain water. She should also avoid sugary foods, wipe front to back, shower and change underwear after sweating or exercise and wear cotton underwear. Adequate water intake is also important.

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