All posts in dr. chabra

Natural beauty… with a little help from our friends

Take a look at the photo above. Does one photo automatically make you think that person is happier, friendlier and even more beautiful? Did you have a check list you went through to determine which photo one was more attractive than the other? Our minds subconsciously recognize aspects of people’s faces and bodies that allow us to make the decision that something is considered beautiful. It is the eyes, mouth, cheekbones- all in the right proportions and balanced….natural.

With time we start to develop changes on our faces and bodies that stand out or distort our original proportions. We have creases between our eyebrows, lines above our lips, sunken skin on our cheeks, brown spots on the chest and hands, and little rolls above our waistband. All of these changes are part of the aging process yet lend us to feel less attractive and takes away from our confidence when we look in the mirror. Our minds subconsciously recognize the imperfections. We notice them on ourselves and everyone we meet.

Can using lasers, Botox or fillers actually give us back our natural beauty? Every day cosmetic dermatologists hear, “I don’t want the procedure done because I don’t want to look fake.” However, when done correctly, cosmetic procedures can restore or slightly enhance our face and bodies but still appear natural.

We have all seen examples of overdone or poorly done procedures. Even though when just looking at the lips or the forehead alone they may look “perfect.” However, a frozen forehead or huge lips that are out of proportion make us stop and think…what is wrong with this picture? No longer do we think beautiful but unnatural.

Subtle procedures that appear natural is the goal at Midlands Cosmetic, Dermatology & Skincare. We strive to make people look better without others realizing anything was done.



FDA approved injection can melt away chin fat

This article was featured on KMEG14 Siouxland News.

CORRECTION: The video states that the KYBELLA™ procedure costs “around $5,000.” The correct price is $1200.

There’s a new treatment to melt away “double-chin fat,” and you don’t have to go under the knife for it.

The Kybella procedure is an FDA approved non- surgical injection, which eliminates fat below the chin.

Midlands Clinic Dermatologist Dr. Indy Chabra is one of the first dermatologists in Siouxland to offer the fat removing treatment.

“The product works by dissolving fat cells and releasing the fat, so it works in a permanent manner. So the number of injections really depends on the degree of submental fullness, how much fat there is underneath the chin. So it varies person to person. In this patient, it was 20 injections.”

The procedure costs $1200. Chabra says his patients experience visible results around their chin and areas around the neck.


Common care products cause skin irritations

Common care products cause skin irritations

This article originally appeared in the Sioux City Journal, and was also published in the May 2014 issue of Siouxland Life Magazine.

April 11, 2014 11:28 am • DOLLY A. BUTZ
(Photograph by Dawn J. Sagert)

Indy Chabra’s patients often think the red, itchy rashes on their skin are related to something they ate. They don’t usually suspect that the things they wear, touch or clean themselves with could be causing the problem.

“They waste so much money going to the allergist and getting prick testing,” the Dakota Dunes dermatologist said.

Nickel is the most common cause of allergic contact dermatitis in the United States. But everything from sofas made in China to volleyballs and formaldehyde-based products, Chabra said, can cause rashes which are often treated with a strong topical steroid.

“If you look at the back of shampoo bottle or any product, it’ll say DMDM hydantoin or a bunch of other allergens,” he said. “When you’re allergic to any of this stuff you often have cross allergies.”

Annually, the American Contact Dermatitis Society selects a contact allergen of the year. The 2013 allergen of the year is Methylisothiazolinone (MI), a powerful preservative increasingly found in cosmetics and toiletries, including wet wipes.

Infants and young children present at Midlands Clinic, 705 Sioux Point Road, with rashes after parents have tried numerous over-the-counter treatments. Chabra asks them if they’ve been using wet wipes. They stop. The rash clears up.

“Every time they use it, that’s when the rash comes. You stop it, the rash goes away,” he said.

Chabra asks patients suffering from allergic contact dermatitis if they’ve recently changed skin or hair care products. The answer is often, “No.”

“Companies change the specific ingredients of products without telling people,” he said. “Second, our immune system changes. Third, the skin changes. If the skin is broken down, the chances of it developing an allergic contact dermatitis is higher.”

Chabra performs a T.R.U.E. test or epicutaneous patch test, to help him diagnose allergic contact dermatitis. The test’s sticky panel, which is applied to the patient’s upper back, contains tiny amounts of 35 allergens. Substances a person isn’t allergic to, won’t cause a skin reaction.

Gold, Chabra said, is the most common cause of eyelid dermatitis in women.

“Because the gold rings — and a lot of the facial products they use have sunscreen in them — have zinc and titanium. Titanium is a metal that upgrades little particles of gold. You’re putting this on your face every day, and eyelid skin is some of the thinnest skin in the body. That’s why you get eyelid dermatitis.”

A women visited her ophthalmologist multiple times to rid herself of an eyelid rash, before coming to Midlands Clinic. Chabra performed a patch test, which he said “lit up for gold.”

“Then we realized that the glasses have 14-carat gold,” he said. “She changed them and she was fine.”

Chabra also patch-tested a high school volleyball player suffering from a facial rash. It turns out that the teen is allergic to rubber accelerants used in the manufacturing process.

“To make rubber you take the sap and vulcanize it. Otherwise rubber is very gooey, and so you use all these accelerants in it,” Chabra explained. “She was allergic to all of those.”

Chabra contends that the teen is in a tough situation. He instructed her to wash her hands immediately after playing volleyball, and not to touch her face before she does.

“Allergic contact dermatitis is one of the more rewarding areas,” he said. “You can figure it out and fix it.”


Evaluation and Management of Multiple Osteoma Cutis

Evaluation and Management of Multiple Osteoma Cutis

Osteoma cutis is the formation of bone in the dermis or subcutis. Depending on the context, these de novo ectopic bone lesions may be classified as primary or secondary osteoma cutis. Primary osteoma cutis is the idiopathic formation of bone. In contrast, secondary osteoma cutis, which is much more common, is bone formation as a potential complication of several acquired disorders, such as severe acne; connective tissue disease; or inherited disorders such as Albright’s hereditary osteodystrophy.

Read the rest of this article featuring Dr. Chabra here.


Gouty Tophi on the Ear: A Review

Gouty Tophi on the Ear: A Review

Although the classic location of gouty tophi is the great toe (podagra), gouty tophi of the ear also is common and is worth including in the differential diagnosis in patients presenting with ear lesions. Other entities presenting as papules or nodules on the ear include chondrodermatitis nodularis helicis (CNH), actinic keratosis, basal cell carcinoma, squamous cell carcinoma, verruca vulgaris, amyloids, rheumatoid nodules, and elastotic nodules. If tophaceous gout is suspected, alcohol fixation of the biopsy specimen is preferable, as it enables visualization of characteristic needle-shaped urate crystals.

Read the rest of this article featuring Dr. Chabra here.


Driving without sunscreen can cause cancer

Driving without sunscreen can cause cancer

Do you ever think about wearing sunscreen while you are driving? A local Siouxland dermatologist says its time to because two out of three skin cancer cases are related to driving.

Skin cancer, the most common cancer diagnosis, is responsible for three and a half million cases each year.

A Siouxland dermatologist at the Midlands Clinic decided to dive into the numbers and found something that caught his eye.

Read the rest of this article featuring Dr. Chabra here.


The sun is finally here. What about sunscreen?

The sun is finally here. What about sunscreen?

How does sunscreen prevent skin cancer?

By protecting the skin from sunlight, sunscreen prevents the development of skin cancer. Skin cancers will require surgeries to treat, and may even kill you.

Sunlight contains ultraviolet (UV) light, which can be divided into 3 sub-types – UV-C (100-290 nm), UV-B (290-320 nm), and UV-A (320-400). Almost all of the deadly UV-C, and most of UV-B light are blocked by the Earth’s ozone layer. However, some UV-B and most of the UV-A penetrate the atmosphere and reach us.

Read the rest of this article featuring Dr. Chabra here.


New Faces at Midlands Clinic

Midlands Clinic, a multispecialty clinic in Dakota Dunes, has recently undergone an expansion and remodel to accommodate the addition of two physicians and a nurse practitioner to its staff.

“Midlands Clinic has been growing steadily every year, and to meet the demand of our expanding patient base, new providers have been added to the clinic,” said Clinic Administrator Stacy Harmelink, MBA. “Consequently, we had to add multiple exam and procedure rooms as well as expand our patient waiting area.”

The newest additions to the Midlands Clinic staff are Drs. Indy Chabra, dermatologist; Craig Nemechek, general surgeon; and Allie Nettleton, a nurse practitioner in endocrinology.

Dr. Indy Chabra, M.D., Ph.D., is an addition to the Dermatology department. He specializes in medical, surgical and cosmetic dermatology.

“It was not uncommon for a new patient to wait months for an appointment with Dr. Michelle Daffer, our current dermatologist. With the addition of Dr. Chabra, our patient demand can be handled in a more timely manner,” said Harmelink.

Chabra, a native of India who moved to Long Island, N.Y. with his family when he was 12, received his undergraduate degree at Stanford University in California. He completed his medical degree and Ph.D. in Molecular Microbiology and Genetics at the State University of New York. He performed his internship and residency in dermatology at the University of Pittsburgh Medical Center, the second largest training program in the United States.

Board eligible in dermatology, Chabra is also a member of the American Academy of Dermatology and a member of the American Society for Dermatologic Surgery.

“My goal is to make sure people in this community know they can get the best diagnosis and treatment of any skin, hair or nail problem – medical or cosmetic – here at Midlands Clinic. They don’t have to go to Omaha or Sioux Falls, or Mayo Clinic in Rochester. Between Michelle and I we are highly trained and up to date. We also use the latest technology,” Chabra said.
Chabra said patients who have had dermatological conditions for months or years and have been treating it on their own or going from doctor to doctor and not getting the right treatment don’t need to continue that way.

“We’re the specialists in the area, and patients should be aware of that. With three providers, including a physician’s assistant, we can easily accommodate new patients,” he said. “One of the challenges is patients not being able to see a dermatologist when they actually have the problem. Our goal is when someone has a problem, we will try to accommodate them. We want to diagnose and treat it while it’s happening.”

One such condition is actinic keratosis, which is a small, rough, raised area found on skin that has been in the sun for a long period of time.

Some actinic keratoses may develop into a type of skin cancer. He attributes actinic keratosis to our climate and the lack of sunlight during certain months of the year.

“During the winter time, we’re inside all of the time. In the summer time we get hit with sun. The climate changes dramatically. The average skin doesn’t get melanin and can quickly get sunburns.

“We’re experts here,” said Chabra. “Use us. We have a a lot of experience with that. Patients are very pleased with the results.”
Chabra said Midlands Clinic is also the go-to place for cosmetic procedures, such as chemical peels, neurotoxins, fillers, lasers and electrodessication.

“There are a lot of different modalities and there is ultrasound technology. None do everything. You should go somewhere you can get the right treatments for the right problems. We’re seeing that family doctors or aestheticians are associated with those types of procedures. Patients are associating us with medical dermatology. We’re not associated with cosmetic dermatology. It’s something I want to change.”

Midlands Clinic performs a lot of skin cancer surgery, and has recently added a new modality, photodynamic therapy, for patients who have many difficult to treat skin cancer lesions.

“We’re one of the only places in this area that offers this to patients,” he said. “It allows for treatment of multiple lesions in one setting. It has been used in Europe for years. It is covered by all insurances including Medicare.”

Harmelink said the addition of photodynamic therapy has increased patient volume because the therapy is faster and more convenient than other therapies available.

Dr. Craig Nemechek recently became board-certified in general surgery. His emphasis is in laparoscopic surgery.

Nemechek, a McCook, Neb. native, came to Midlands Clinic from Altoona, Iowa. He completed his general surgery residency at Iowa Methodist Medical Center in Des Moines in June. He earned his undergraduate degree in natural science from Midland Lutheran College in Fremont, Neb., in 2001 and his medical degree from the University of Nebraska Medical Center in Omaha in 2006.

He developed an interest in complex hernia repair during his residency at Iowa Methodist Medical Center, where he focused on performing open or laparoscopic hernia repair procedures.

Nemechek said he joined Midlands Clinic because it is a good fit.

“Dr. (William) Rizk and Dr. (Robert) Anderson came from the same training program. Midlands Clinic offers a unique opportunity in a unique place. I have great partners. It’s a unique job in a nice Siouxland town. I can take on larger, more complex cases and Midlands Clinic has the facilities to take care of them,” he said.

For the past year, Nemechek has been using his experience and expertise at Midlands Clinic to treat hernias. Another condition that is a prominent part of his practice is Gastroesophageal Acid Reflux surgery. People who have certain types of hernias can be more prone to acid reflux.

“Many people suffer from acid reflux,” said Nemechek. “The vast majority do well with medications. Some people don’t get relief. They have other symptoms not relieved by medications or don’t want to take medications. In those cases we recreate and correct the one way valve. Patients with acid reflux usually have leaking of gastric acid into the swallowing tube or esophagus. Surgery helps prevent leaking of acid into the esophagus.”

To obtain objective information regarding the nature and severity of the reflux, esophageal motility and complications of GERD, Nemechek peforms studies that include a 24 hour monitoring of the pH (acidity) in the esophagus. A small Bravo probe is placed into the esophagus with a scope at very specific points, and the number of acid exposures as well as the quantity of acid exposure is recorded.

If the patient is a good candidate for surgery, the procedure can be done laparoscopically.

“Most people who have had the surgery have a very high satisfaction score,” he said.

Allie Nettleton, B.S.N., NP-C, started at Midlands Clinic in August. She is assisting Dr. Tareq Khairalla with his caseload in the Endocrinology department. Nettleton graduated from Briar Cliff University’s nurse practitioner program in May and received her certification in July. She brings 17 years of nursing experience to Midlands Clinic.

“Dr. Khairalla has a very busy practice,” said Nettleton, a 1990 graduate of Woodbury Central High School in Moville. “Some patients waited 3-4 months to get into see him. I hope to lighten his load and allow patients to be seen quickly. We can diagnose, treat and manage endocrine diseases, such as diabetes and osteoporosis. We also help with thyroid management.”

Nettleton said she decided to become an advanced practical nurse because she sought new challenges.

“I had the desire to be an advanced practical nurse for the past 10 years. In 2009 I made the decision to pursue my goals in life. I feel fortunate to have been chosen for this position. I have a great mentor and teacher in Dr. Khairalla,” said Nettleton, who had worked at the Mercy Weight Loss Center clinic for six months in 2008.

The most common condition she and Dr. Khairalla have been seeing in the clinic is diabetes.

“I didn’t realize there was so much diabetes in Siouxland. There are also a lot of thyroid disorders including hypothyroidism and hyperthyroidism, and thyroid cancer, which is easily treatable. Osteoporosis, or bone disease, is affecting younger generations,” she said.

Midlands Clinic also diagnoses and treats adrenal and pituitary disorders.

“We are delighted to welcome these three new providers to our group,” said Harmelink. “The current physicians in our group are confident that these new providers bring skills and increased access to care in the communities we serve.

“These are well-trained providers and they will add to the quality of care Midlands Clinic is known for,” she added.
All three providers are accepting new patients.

Midlands Clinic is located at 705 Sioux Point Road, Suite 100, in Dakota Dunes. For more information or to make an appointment, please call (605) 217-5500.