Journal of Cutaneous and Aesthetic Surgery
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   Table of Contents - Current issue
January-March 2016
Volume 9 | Issue 1
Page Nos. 1-55

Online since Friday, March 11, 2016

Accessed 7,132 times.

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Innovations and simulations in dermatosurgery p. 1
Niti Khunger
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Classifications of patterned hair loss: a review p. 3
Mrinal Gupta, Venkataram Mysore
Patterned hair loss is the most common cause of hair loss seen in both the sexes after puberty. Numerous classification systems have been proposed by various researchers for grading purposes. These systems vary from the simpler systems based on recession of the hairline to the more advanced multifactorial systems based on the morphological and dynamic parameters that affect the scalp and the hair itself. Most of these preexisting systems have certain limitations. Currently, the Hamilton-Norwood classification system for males and the Ludwig system for females are most commonly used to describe patterns of hair loss. In this article, we review the various classification systems for patterned hair loss in both the sexes. Relevant articles were identified through searches of MEDLINE and EMBASE. Search terms included but were not limited to androgenic alopecia classification, patterned hair loss classification, male pattern baldness classification, and female pattern hair loss classification. Further publications were identified from the reference lists of the reviewed articles.
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Is lesional stability in vitiligo more important than disease stability for performing surgical interventions? results from a multicentric study p. 13
Imran Majid, Venkataram Mysore, Thurakkal Salim, Koushik Lahiri, Manas Chatterji, Niti Khunger, Suresh Talwar, S Sachhidanand, Shyamanta Barua
Background: Ensuring stability of the disease process is essential for undertaking surgical intervention in vitiligo. However, there is no consensus regarding the minimum duration of stability or the relative importance of disease and lesional stability in selecting patients for vitiligo grafting. Aim: This multicentric study aims to assess the relative importance of lesional and disease stability on selecting patients for vitiligo grafting. Materials and Methods: One hundred seventy patients were recruited into the study and divided into two groups: Group A with lesional stability of >1 year but overall disease stability of only 6-11 months and Group B with overall disease stability of >1 year. Patients underwent either tissue or cellular vitiligo grafting on the selected lesions and the repigmentation achieved was scored from 0 (no repigmentation) to 6 (100% repigmentation). Repigmentation achieved on different sites of the body was compared between the two groups. Adverse effects at both the donor and the recipient sites were also compared. Results: Of the 170 patients who were enrolled, 82 patients were placed in Group A and 88 patients in Group B. Average repigmentation achieved (on scale of 0 to 6) was 3.8 and 4.04 in Group A and Group B, respectively. In Group A, ≥90% repigmentation was achieved in 36.6% (30/82) patients, while 37.5% (33/88) achieved similar results in Group B. Additionally, 47.6% (39/82) and 53.4% (47/88) of cases achieved partial repigmentation in Group A and Group B, respectively. Perigraft halo was the commonest adverse effect observed in both groups. Statistical analysis revealed no significant differences between the two groups with respect to the repigmentation achieved or adverse effects observed. Repigmentation achieved was the best on the face and neck area, while acral areas responded the least. Conclusions: Lesional stability seems to be as relevant as the overall disease stability in selecting patients for surgical intervention in vitiligo.
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A study of the outcome of primary excision and closure technique in the management of lip Leukoderma in 30 patients p. 20
Shilpa Kanathur, S Sacchidanand, Somaiah Savitha, Ramamurthy Ranjitha, DV Lakshmi, Gorur Divya
Context: Lips being one of the graceful cosmetic units of the face, any disfigurement, including depigmentation, can be embarrassing, psychologically distressing, and socially stigmatizing. Even with the evolution of various surgical modalities, none of the techniques ensure 100% pigmentation with a good cosmetic appearance. With this background, this study was undertaken to study the efficacy of the technique-primary excision and closure in treatment of lip leukoderma (LL). Aims: To study the efficacy, cosmetic outcome, and recurrence following primary excision and closure technique in the management of LL. Settings and Design: A prospective single-center open-label uncontrolled study. Materials and Methods: Thirty patients with LL involving inner margin of the lower lip and those who fulfilled inclusion and exclusion criteria were included in the study. After obtaining consent and physician fitness, patients were posted for primary excision and closure of the vitiliginous area of the lip. Patients were followed up at the immediate postoperative period and 6 months later. Patient satisfaction scale was done by asking the patient to grade the response between one and ten. Statistical Analysis Used: Mean and percentiles. Results: Out of 30 patients, 29 patients achieved complete clearance that was cosmetically acceptable. Only one patient showed recurrence at the end of 6 months. Average patient satisfaction scale showed an average of 9.66. Conclusions: Primary excision and closure technique is one of the safe, inexpensive modality in the management of LL involving the inner margin of the lip with immediate result.
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Mastering surgical skills through simulation-based learning: Practice makes one perfect p. 27
Niti Khunger, Sushruta Kathuria
Simulation-based learning in surgery is a learning model where an environment similar to real life surgical situation is created for the trainee to learn various surgical skills. It can be used to train a new operator as well to assess his skills. This methodology helps in repetitive practice of surgical skills on nonliving things so that the operator can be near-perfect when operating on a live patient. Various models are available for learning different dermatosurgery skills.
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A simple user-made iontophoresis device for palmoplantar hyperhidrosis Highly accessed article p. 32
Rahul Nagar, Suneel Singh Sengar
Iontophoresis is defined as passing of an ionized substance through intact skin by application of direct electric current. Tap water iontophoresis is reliable and effective method for treatment of palmar and plantar hyperhydrosis when practiced with appropriate technique and timing.One of the major setback for using iontophoresis is that the apparatus is expensive and is not readily available.A simple user-made Iontophoresis device have been described here, which could be easily constructed and used at home.
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Elastofibroma: An uncommon tumor revisited p. 34
Rashmi Patnayak, Amitabh Jena, Sarla Settipalli, N Nagesh
Elastofibromas are rare benign, soft-tissue slow-growing tumors seen predominantly in elderly females. The most common location is the infrascapular region. These benign tumors require resection only in symptomatic cases. We present a case of elastofibroma in a 46-year-old female. She presented with gradually increasing soft-tissue swelling of 8 cm Χ 6 cm in the right inferior subscapular region for the last 2 years. She underwent excisional biopsy and the histopathology was reported as elastofibroma. Microscopically, the mass showed numerous characteristic eosinophilic, beaded elastic fibers. These fibers were highlighted by the Verhoeff's elastic stain. We present this uncommon case to emphasize the important role of histopathology in diagnosis. A definitive diagnosis helps to avoid unnecessary wide and radical resection.
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Comedones induced by vascular laser therapy p. 38
Gulsen Tukenmez Demirci, Ayse Tulin Mansur, Ayse Tulin Gulec
A 21-year-old female presented with acne-like blackheads on brownish areas located on the cheek. She had been treated with neodymium-doped yttrium aluminium garnet (Nd-YAG) laser (1071 nm), 160 j/cm 2 , three months ago for erythema and telangiectasia of her face. Afterwards, she developed atrophic, slightly depressed, hyperpigmented, 3-4 mm scars with superimposed tiny comedones within the treated areas. Topical treatment with tretinoin 0.05% cream on alternate days, and Sun Protection Factor (SPF) 50 sunscreen daily were commenced. After 2 months, comedones and hyperpigmentation mostly resolved but mild superficial atrophy persisted. According to our knowledge, this is the first case of atrophic scars studded with open comedones, developing shortly after laser therapy used for facial telangiectasia.
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A severe case of levamisole-induced vasculitis requiring extensive surgery and skin grafts p. 41
Kirill Alekseyev, Ida Micaily, Nirupama Parikh
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An unusual presentation of piloleiomyoma p. 43
Aditya Kumar Bubna, Mahalakshmi Veeraraghavan, Sankarasubramanian Anandan, Leena Dennis Joseph
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Double hatchet flap for scalp defect reconstruction p. 45
Roberto Cecchi, Laura Bartoli, Luigi Brunetti, Giovanni Troiano
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Iatrogenic deep dermal wound due to chemical do-it-yourself tattoo removal p. 47
Sinan Ozturk, Cihan Sahin, Ceyhun Cesur, Fikret Eren, Huseyin Karagoz
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Glove puncture during liposuction: A report of two cases p. 48
Shidlingappa Shirol, Priyadarshini Cooduvalli, Mahesh Prabhu
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Successful hair transplant outcome in cicatricial lichen planus of the scalp by combining scalp and beard hair along with platelet rich plasma p. 51
Kuldeep Saxena, Deepali K Saxena, Sandeep S Savant
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