Journal of Cutaneous and Aesthetic Surgery
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   Table of Contents - Current issue
Coverpage
January-March 2015
Volume 8 | Issue 1
Page Nos. 1-75

Online since Tuesday, April 14, 2015

Accessed 2,695 times.

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EDITORIAL  

Bridging the generation gap-dilemmas of a cosmetic surgeon p. 1
Niti Khunger
DOI:10.4103/0974-2077.155059  
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GUEST EDITORIAL Top

Shifting paradigm in laser tattoo removal p. 3
Sanjeev J Aurangabadkar
DOI:10.4103/0974-2077.155061  
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JCAS SYMPOSIUM Top

Laser-tissue interaction in tattoo removal by Q-switched lasers p. 5
Shyamanta Barua
DOI:10.4103/0974-2077.155063  
Q-switched (QS) lasers are widely considered the gold standard for tattoo removal, with excellent clinical results, impressive predictability, and a good safety profile. The generation of giant pulses by the method of Q-switching is responsible for the unique laser-tissue interaction that is seen in tattoo removal by QS lasers. The QS lasers work by impaction and dissolution of the tattoo pigments. Mechanical fragmentation of the tattoo pigments encased in intracellular lamellated organelles followed by their phagocytosis by macrophages is thought to be the major event in the clearance of pigments by QS lasers. A few novel techniques have been tried in recent times to hasten the clearance of tattoo pigments.
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Laser tattoo removal: A clinical update p. 9
Stephanie GY Ho, Chee Leok Goh
DOI:10.4103/0974-2077.155066  
Techniques for tattoo removal have evolved significantly over the years. The commonly used Quality-switched (QS) ruby, alexandrite, and Nd:YAG lasers are the traditional workhorses for tattoo removal. Newer strategies using combination laser treatments, multi-pass treatments, and picosecond lasers offer promising results. The tattoo color and skin type of the patient are important considerations when choosing the appropriate laser. Standard protocols can be developed for the effective and safe treatment of tattoos.
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Optimising laser tattoo removal p. 16
Kabir Sardana, Rashmi Ranjan, Sneha Ghunawat
DOI:10.4103/0974-2077.155068  
Lasers are the standard modality for tattoo removal. Though there are various factors that determine the results, we have divided them into three logical headings, laser dependant factors such as type of laser and beam modifications, tattoo dependent factors like size and depth, colour of pigment and lastly host dependent factors, which includes primarily the presence of a robust immune response. Modifications in the existing techniques may help in better clinical outcome with minimal risk of complications. This article provides an insight into some of these techniques along with a detailed account of the factors involved in tattoo removal.
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Newer trends in laser tattoo removal p. 25
Swapnil D Shah, Sanjeev J Aurangabadkar
DOI:10.4103/0974-2077.155070  
Q switched lasers are the current gold standard for laser tattoo removal. Though these systems are generally quite effective in clearing tattoos & have an established safety record, certain limitations exist while following the standard protocol. To overcome these limitation newer techniques such as multipass method, combination treatments with chemical agent and other laser have been introduced. These methods help in faster, less painful and complication free tattoo removal.
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Complications of tattoos and tattoo removal: Stop and think before you ink p. 30
Niti Khunger, Anupama Molpariya, Arjun Khunger
DOI:10.4103/0974-2077.155072  
Tattooing is a process of implantation of permanent pigment granules in the skin. Tattoos can be decorative, medical or accidental. There has been a exponential increase in decorative tattooing as a body art in teenagers and young adults. Unfortunately there are no legislations to promote safe tattooing, hence complications are quite common. Superficial and deep local infections, systemic infections, allergic reactions, photodermatitis, granulomatous reactions and lichenoid reactions may occur. Skin diseases localised on the tattooed area, such as eczema, psoriasis, lichen planus, and morphea can be occasionally seen. When used as a camouflage technique, colour mismatch and patient dissatisfaction are common complications. On the other hand, regrets after a tattoo are also seen and requests for tattoo removal are rising. Laser tattoo removal using Q-switched lasers are the safest; however, complications can occur. Acute complications include pain, blistering, crusting and pinpoint hemorrhage. Among the delayed complications pigmentary changes, hypopigmentation and hyperpigmentation, paradoxical darkening of cosmetic tattoos and allergic reactions can be seen. Another common complication is the presence of residual pigmentation or ghost images. Scarring and textural changes are potential irreversible complications. In addition, tattoo removal can be a prolonged tedious procedure, particularly with professional tattoos, which are difficult to erase as compared to amateur tattoos. Hence the adage, stop and think before you ink holds very much true in the present scenario.
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ORIGINAL ARTICLES Top

Efficacy of 15% trichloroacetic acid and 50% glycolic acid peel in the treatment of frictional melanosis: A comparative study p. 37
S Sacchidanand, Ashvith B Shetty, B Leelavathy
DOI:10.4103/0974-2077.155078  
Background: Frictional dermal melanosis is aesthetically displeasing. Various modalities ranging from depigmenting agents to lasers have been tried but it continues to be a difficult problem to treat. Objective: To study and compare the efficacy of 15% trichloroacetic acid (TCA) and 50% glycolic acid in the treatment of frictional melanosis of the forearm. Materials and Methods: 40 patients of frictional melanosis of the forearm were included in the study. Patients were randomly divided into two equal groups A and B. Pre-peel priming was carried out with 12% glycolic acid and sunscreen for 2 weeks. Group A was treated with trichloroacetic acid (TCA-15%) peel and Group B with glycolic acid (GA-50%) peel. Four peels were done one every 15 days. Clinical photographs were taken to assess the response. Response to therapy was evaluated by both objective and subjective methods. The patients were followed up for 3 months after the last peel to note any relapse. Results: Both TCA and glycolic acid peels were effective in frictional melanosis. TCA showed better response compared to glycolic acid at the end of the treatment, both by subjective and objective methods. However, this difference was not statistically significant (P > 0.05). No permanent side effects were seen in any of the treated patients and the improvement was sustained without any relapse at 3 months. Conclusion: Chemical peeling with both tricholoroacetic acid (15%) and glycolic acid (50%) is safe and effective for the treatment of frictional dermal melanosis. Tricholoroacetic acid was found to be marginally superior to glycolic acid.
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Efficacy of modified Jessner's peel and 20% TCA versus 20% TCA peel alone for the treatment of acne scars p. 42
Neerja Puri
DOI:10.4103/0974-2077.155082  
Introduction: There is a paucity of studies on the use of chemical peels for acne scars among the Asian population. A trichloroacetic acid (TCA) and Jessner's combination chemical peel, originally described by Monheit, is said to be better than a TCA peel alone. Aims: The aim of the study was to compare the efficacy of 20% TCA and Jessner's solution versus 20% TCA alone for the treatment of acne scars. Materials and Methods : The patients were divided into two groups of 25 patients each. Chemical peeling was done in both the groups. In Group I, chemical peeling with Jessner's peel followed by 20% TCA was done and in Group II patients chemical peeling with 20% TCA peel alone was done. Results: In Group I (Jessner's peel and 20% TCA), mild improvement of acne scars was seen in 8% cases, moderate improvement in 32% cases and marked improvement of acne scars was seen in 60% patients. In Group II (20% TCA), mild improvement of acne scars was seen in 32% cases, moderate improvement in 40% cases and marked improvement of acne scars was seen in 28% patients. But, the difference in improvement of acne scars was not statistically significant in both the groups (P value > 0.05).
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Ultrapulse carbon dioxide laser ablation of xanthelasma palpebrarum: A case series p. 46
Vikas Pathania, Manas Chatterjee
DOI:10.4103/0974-2077.155084  
Context: Xanthelasma palpebrarum is the most common form of xanthomas. Albeit a benign entity, it is cosmetically disturbing and a frequently recurring dermatologic referral. Although the classical treatment option remains surgical excision, alternatively, chemical cauterization, cryosurgery and electrofulguration have all been tried in the past with mixed results. The use of laser systems such as carbon dioxide laser, Erb:YAG laser, Q-switched Nd:YAG laser, diode laser, pulsed dye laser and KTP laser have become popular in the treatment of these lesions. Recent literature suggests minimal pigmentary changes and scarring with the use of ultrapulse carbon dioxide laser treatment of these lesions. Aim: To study and evaluate the effectiveness of ultrapulse carbon dioxide laser ablation for treatment of xanthelasma palpebrarum. Materials and Methods: 10 patients presenting with bilateral xanthelasma palpebrarum, new and with recurrence were studied for results after a single treatment with ultrapulse carbon dioxide laser (10,600 nm; 100-200 Hz; 200-400 μsec). The follow-up time was 9 months. Results: All lesions were treatable with a single-laser treatment session. Two patients (20%) developed recurrence during the follow-up period. Side effects included post inflammatory hyperpigmentation in two patients (20%), but no visible scarring was observed. Conclusions: The ultrapulse carbon dioxide laser is an effective and safe therapeutic alternative in treatment of xanthelasma palpebrarum.
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External tissue expansion for difficult wounds using a simple cost effective technique p. 50
Vijayaraghavan Nandhagopal, Ravi Kumar Chittoria, Devi Prasad Mohapatra, Friji Meethale Thiruvoth, Dinesh Kumar Sivakumar, Arjun Ashokan
DOI:10.4103/0974-2077.155087  
Objective: To study and discuss role of external tissue expansion and wound closure (ETEWC) technique using hooks and rubber bands. Materials and Methods: The present study is a retrospective analysis of nine cases of wounds of different aetiology where ETEWC technique was applied using hooks and rubber bands. Results: All the wounds in the study healed completely without split thickness skin graft (SSG) or flap. Conclusion: ETEWC technique using hooks and rubber bands is a cost-effective technique which can be used for wound closure without SSG or flap.
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INNOVATION Top

Repair of minor true hare lip using V-Y plasty: How i do it p. 54
Abdelrahman EM Ezzat
DOI:10.4103/0974-2077.155089  
Background: Minor true hare lip is rare central midline deficiency of the upper lip. There are multiple techniques but little consensus on the preferred surgical technique. Materials And Methods: A transoral approach for repair using mucosal V-Y plasty is described by employing a vertical inverted V incision. Result: The contour of the free labial border immediately improves with avoidance of skin scar. Conclusions: The midline cleft lip notch or minor true (hare lip) midline clefts can be effectively treated by mucosal lengthening using a V-Y plasty. Moreover, the ability to augment the tubercle with mucosa through a VY plasty is simple and easy.
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ETHICS Top

Cosmetic surgery in teenagers: To do or not to do p. 57
Kuldeep Singh
DOI:10.4103/0974-2077.155091  
The media makes it out to be a big story that teens are getting cosmetic surgery in larger numbers than ever. However, this is far from the truth. Yearly data, is increasingly showing a reduction in the percentage, as well as absolute numbers of these surgeries. Only, very essential surgery should be done for teenagers. The consult should be done in the presence of a parent, and even if the teen is above legal consenting age, parental supervision is still needed. A cooling off period, informed consent under parental supervision, and a time to rethink is essential. If a problem is severe enough to cause psychological problems, a psychologist can help in arriving at a decision.
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CASE REPORT Top

An unusual case of desmoplastic malignant melanoma p. 60
Pandiaraja Javabal, Viswanathan Subramanian
DOI:10.4103/0974-2077.155093  
Desmoplastic malignant melanoma is a rare variant of spindle cell melanoma, commonly seen in older adults, on sun-exposed areas. It accounts for 1-4% of all cases of cutaneous melanoma. The common location of the desmoplastic melanoma is the head and neck region, whereas, other sites are less common. Regional lymph node involvement is reported in 0 to 13.7% of the cases, which is less frequent than other cutaneous melanomas. A 75-year-old male presented with an ulceroproliferative growth on the left foot that was diagnosed as desmoplastic melanoma with regional lymph node metastasis and in transit metastasis, with extensive pulmonary metastasis.
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CORRESPONDENCE Top

Aesthetic management of gum hyperpigmentation by a simple technique p. 64
Anshul Singhal, Dhruvakumar Deepa
DOI:10.4103/0974-2077.155095  
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Giant scrotal lymphoedema p. 67
Hassan Ravari, Hamed Ghoddusi Johari, Ata'ollah Rajabnejad, Alireza khooei
DOI:10.4103/0974-2077.155096  
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Persistence of hyaluronic acid filler for subcutaneous atrophy in a case of circumscribed scleroderma p. 69
Shehnaz Z Arsiwala
DOI:10.4103/0974-2077.155099  
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Elective tongue piercing: Fad with fallout p. 71
Mundoor Manjunath Dayakar, Anitha Dayakar, Seeham Mohammed Akbar
DOI:10.4103/0974-2077.155101  
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Second degree skin burn with garlic and table salt p. 72
Yakup Cil
DOI:10.4103/0974-2077.155102  
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ERRATUM Top

Primary bilateral extramammary paget's disease of the axillae: Another case of this strange disease: Erratum p. 74

DOI:10.4103/0974-2077.155103  
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Split face comparative study of microneedling with prp versus microneedling with vitamin c in treating atrophic post acne scars: Erratum p. 75

DOI:10.4103/0974-2077.155104  
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