Journal of Cutaneous and Aesthetic Surgery
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   2008| July-December  | Volume 1 | Issue 2  
    Online since November 22, 2008

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Pharmacological sphincterotomy for chronic anal fissures by botulinum toxin A
Uwe Wollina
July-December 2008, 1(2):58-63
DOI:10.4103/0974-2077.44160  PMID:20300345
Chronic anal fissure is a common proctologic disease. Botulinum toxin (BTX) can be used for temporary chemical denervation to treat this painful disorder. Its application is by intramuscular injections into either the external or internal anal sphincter muscle. The mode of action, application techniques, and possible complications or adverse effects of BTX therapy are discussed in this report. The healing rate is dependent on the BTX dosage. The short-term healing rate (≤ 6 months) is 60-90%, whereas about 50% of the patients show a complete response in long-term follow-up studies (> 1 year). Adverse effects are generally mild, but relapses occur more often than with surgery. Conservative therapy is currently considered as a first-line treatment. With increasing evidence for its efficacy, BTX can now be considered among the first-line nonsurgical treatements. Although, surgical management by lateral sphincterotomy is the most effective treatment, it shows a higher incidence of incontinence and greater general morbidity rate than BTX. BTX is a useful alternative to surgery and in many cases, surgery can be avoided with the use of BTX.
  10,049 659 3
Dermal fillers: Tips to achieve successful outcomes
Maya Vedamurthy, Amar Vedamurthy
July-December 2008, 1(2):64-67
DOI:10.4103/0974-2077.44161  PMID:20300346
Fillers have become a common aesthetic treatment for several cosmetic problems. Several types of fillers are available from different sources and of different longevities. It is important that the treating physician be aware of the different techniques of administration and their possible side effects. This article reviews the available literature on the subject.
  7,602 1,018 2
Evaluation of long-pulsed 1064 nm Nd:YAG laser-assisted hair removal vs multiple treatment sessions and different hair types in Indian patients
Rachna Mittal, Snehal Sriram, Kamaldeep Sandhu
July-December 2008, 1(2):75-79
DOI:10.4103/0974-2077.44163  PMID:20300348
Background: Longer wavelength lasers such as Nd: Yag0 are considered to be the best for darker skin phototypes. Objectives : The aim of this study was to investigate the safety and efficacy of long-pulsed, 1064 nm Nd:YAG laser-assisted hair removal in relation to multiple treatment sessions and different hair types in Indian patients. Method: Fifty-nine adult women with skin phototypes IV and V were treated with a long-pulsed Nd: Yag0 laser (1064 nm, 10 mm spot size, fluence of 30-50 J/cm 2 , pulse duration 15-30 ms). Six consecutive treatment sessions were given at 4-6 week intervals. The modified Ferriman Gallway system of scoring was used to grade the hairs before each treatment session and six weeks after the last therapy. Based on this grading, three main hair types were recognised: thin vellus (Grade 1), intermediate (Grade 2), and terminal hair (Grades 3 and 4). Patients were divided into three groups: achievers who converted to thin vellus hair (Grade I), responders who shifted to a lower grade but were short of reaching grade 1, and failures who did not show any change throughout the six laser sessions. Results: Six weeks after six laser treatment sessions, the achievers totaled 56%, responders 23%, and failures 20% of the patient population. At the end of the 3 rd , 4 th , 5 th , and 6 th sessions, achievers were 5, 15, 25, and 56% respectively of all the patients ( P < 0.001, which was statistically significant). Achievers for terminal hair were 57.5% while it was 53.8% for intermediate hair ( P = 0.9, nonsignificant). There were no permanent side effects. There were no failures in the terminal group while nearly 50% of the patients were failures in the intermediate group. Conclusion: Six multiple laser treatment sessions with a long-pulsed, 1064 nm Nd: Yag0 laser with contact cooling were found to be safe and effective for hair reduction in Indian patients with both terminal and intermediate hair. The success rate was found to improve with successive sessions. However, terminal hairs responded better than intermediate hairs.
  7,014 678 1
Tumescent liposuction: A review
Jayashree Venkataram
July-December 2008, 1(2):49-57
DOI:10.4103/0974-2077.44159  PMID:20300344
Liposuction is a cosmetic procedure to remove fat. Liposuction may be performed either under general anaesthesia or under local anaesthesia. The procedure has been reported to be associated with significant morbidity and risk of mortality under general anaesthesia. Since the first description by Jeffrey Klein, dermatologic surgeons have made significant contributions in this field, and tumescent liposuction using microcannuale under local anaesthesia, is regarded as safe and effective. The author has performed over 200 liposuctions in the last four years in India and this article describes the procedure of microcannular tumescent liposuction in the light of her experience.
  6,160 845 4
QYAG5 Q-switched Nd:YAG laser treatment of nevus of ota: An Indian study of 50 patients
Sanjeev Aurangabadkar
July-December 2008, 1(2):80-84
DOI:10.4103/0974-2077.44164  PMID:20300349
Background: Nevus of Ota is very common in Asian patients. The condition is more common in females, with a male-female ratio of 1:4.8. Most patients seek treatment early in life due to the psychological trauma and cosmetic disfigurement. The Q-switched lasers have changed the way we approach the condition and have become the mainstay of therapy. Aims and Objectives: To evaluate long-term safety and efficacy of pigmented lesion laser Palomar QYAG5 Q-switched Nd:YAG in 50 Indian patients. Materials and Methods: Fifty patients of nevus of Ota underwent multiple treatments (average 6 sessions) carried out over a period of 1year with a Q-switched Nd:YAG laser (QYAG5, Palomar, USA). Of the 50 patients, 2 were males; and the rest, females. Five patients had a bilateral involvement. Skin types treated included phototypes 4 and 5. The response after subsequent treatments was documented through serial photographs that were taken before and after the completion of treatments. Patients were followed up for a period of 1 year after the last session. Response to treatment was graded based on physician's global assessment. Results: Excellent improvement was noted in a majority of the patients at the end of the treatments. Greater-than-60% improvement was seen in 66% of the patients. The remaining patients had moderate clearing of pigmentation (30%-60% improvement). No significant adverse effects were seen immediately after the treatments and on long-term follow-up. Transient post-inflammatory hyperpigmentation was observed in 5 (10%) patients, which cleared with use of sunscreens and bleaching agents within 2 months. No textural change or scarring was seen. Hypopigmentation (guttate type) was observed in 1 (2%) patient, which resolved within 3 months. No recurrence was observed after 1 year of follow-up. Conclusion: This study validates the superior efficacy of Q-switched Nd:YAG laser when compared to conventional methods for treatment of nevus of Ota.
  5,927 584 3
Use of lasers for Becker's nevus and Keratosis pilaris

July-December 2008, 1(2):112-112
  5,608 472 -
Techniques of skin biopsy and practical considerations
Urmila Nischal, KC Nischal, Uday Khopkar
July-December 2008, 1(2):107-111
DOI:10.4103/0974-2077.44174  PMID:20300359
Skin biopsy is a safe, easy and out-patient procedure of diagnostic and academic relevance. There are various methods of performing skin biopsy depending on the size of lesion, suspected clinical diagnosis and site of lesion. Although biopsy is usually a safe procedure, complications such as bleeding, infection and scarring may occasionally be encountered while performing biopsy in an out-patient with basic infrastructure. This article details the various techniques of skin biopsy, their indications and practical steps to curtail complications arising from the procedure.
  4,961 812 2
Lymphangioma circumscriptum (microcystic lymphatic malformation): Palliative coagulation using radiofrequency current
HM Omprakash, SC Rajendran
July-December 2008, 1(2):85-88
DOI:10.4103/0974-2077.44165  PMID:20300350
Lymphangioma circumscriptum (LC, microcystic lymphatic malformation), a hamartomatous lymphatic malformation, is a difficult condition to treat. Different treatments such as surgical excision, lasers, sclerotherapy etc have all been tried with varying success. We report here the efficacy of a radiofrequency current in two patients with lymphangioma circumscriptum. The radiofrequency technique is a safe, economical, and commonly available technique for the treatment of LC; the surgical safety and outcome were satisfactory in our patients.
  3,251 359 1
Teledermatology: Its role in dermatosurgery
Garehatty Rudrappa Kanthraj
July-December 2008, 1(2):68-74
DOI:10.4103/0974-2077.44162  PMID:20300347
Dermatologic surgery and aesthetic dermatology are rapidly emerging and expanding specialties in India. However, dermatologists practicing surgeries and aesthetics in India represent a highly selected group and are mostly confined to metros. Dermatologists in the peripheral and remote regions need to reach these specialists for the benefit of their patients and teledermatology is an invaluable tool for this purpose. Video-conference, store and forward, Satellite communication, Hybrid teledermatology, mobile teledermatology, Integration model, nurse-led teledermatology, teledermatology focusing difficult-to-manage cases, screening and triage services are the various teledermatology services developed to suit the needs of dermatology care from a distance. Types of teledermatology service, pattern of net work connectivity and purpose of dermatology service are the three cardinal parameters for management of the dermatoses from a distance. This article reviews the literature, and analyzes the possible options available for a teledermatosurgery practice.
  3,161 371 -
Botulinum toxin deaths: What is the fact?
HM Omprakash, SC Rajendran
July-December 2008, 1(2):95-97
DOI:10.4103/0974-2077.44169  PMID:20300354
  3,020 414 1
Radiofrequency ablation of adenoma sebaceum
MR Swaroop, KC Nischal, CM Rajesh Gowda, NU Umashankar, HB Basavaraj, BD Sathyanarayana
July-December 2008, 1(2):89-91
DOI:10.4103/0974-2077.44166  PMID:20300351
Adenoma sebaceum is one of the diagnostic features of tuberous sclerosis. Histologically, they are angiofibromas that occur over the central part of the face and hence, cause a major cosmetic disfigurement. Different forms of ablative treatments including laser ablation have been used for the treatment of this condition. Laser treatment is expensive and any form of treatment for adenoma sebaceum is not a one-time procedure but is a recurring process as the condition is genetic in aetiology. It is therefore appropriate to use a cheap and easily available modality, particularly in the Indian scenario. We hereby report a case of tuberous sclerosis in whom we ablated the lesions by radiofrequency technique with acceptable results.
  3,087 313 2
Hailey-Hailey disease: A novel method of management by radiofrequency surgery
AS Nandini, Venkataram Mysore
July-December 2008, 1(2):92-93
DOI:10.4103/0974-2077.44167  PMID:20300352
Hailey-Hailey disease is a chronic, recurrent disease that causes considerable morbidity to the patient. While the medical line of treatment is only palliative, different surgical modalities have been reported to offer longer lasting remission. We report a case of Hailey-Hailey disease successfully treated with radiofrequency surgery.
  2,859 314 -
Modified subcuticular stitch
George Alex
July-December 2008, 1(2):106-106
DOI:10.4103/0974-2077.44173  PMID:20300358
  2,464 359 -
Evaluation of speakers at CME: Cosmecon 2006, an international conference on ageing and anti-ageing
MR Vijayashankar
July-December 2008, 1(2):98-102
DOI:10.4103/0974-2077.44170  PMID:20300355
Aim: To determine what constitutes effective or ineffective lecturing in dermatological conferences and also the utility of a scientific programme for the dermatologists. Methods and Materials: Evaluation forms were circulated to delegates attending the Cosmecon conference on ageing and anti-ageing, held in July 2006 at Bangalore. Feedback from the delegates in the form of completed evaluation forms of individual speakers and each session of the 3-day conference Cosmecon (including the live workshop on aesthetic and surgical procedures) were studied. Comments were analysed with the help of a biostatistician to determine the positive and negative responses. Results: On day 1 of the conference, workshop included 14 procedures by different specialists and on the second and third days of the conference, there were a total of 10 sessions, with five on each day. Evaluation forms were handed out to 440 delegates on day 1 and 600 delegates on days 2 and 3. Fifty-five speakers were evaluated by an average 56 delegates out of 440 delegates on day 1 and 600 delegates on the second and third days. The delegate response to completing the evaluation form was poor. Only about 25% of the delegates completed the feedback forms. However, the feedback did give some insight to the scientific programme, on both positive and negative aspects. Most delegates stated that they benefited from the presentations. The main negative response was lack of opportunity to ask questions after a lecture. The main positive comment was that the time keeping in the conference was very good. Conclusion: The response of the delegates in providing feedback was poor. Efforts have to be made to educate and encourage delegates to complete the feedback forms. Systematic review of the speakers would provide information to design future CME programmes effectively and to incorporate improvements for effective lecturing and to avoid ineffective lectures. The CME evaluation can also help the organizers to provide training to presenters and to monitor performance.
  2,183 352 -
Radiofrequency in dermatosurgery
Sharad Mutalik
July-December 2008, 1(2):94-94
DOI:10.4103/0974-2077.44168  PMID:20300353
  1,863 400 -
Lawrence M Field's article on "An evolution of the 'Golden Age' of dermatological surgery (1958-2008)" and my views
Suresh P Joshipura
July-December 2008, 1(2):103-103
DOI:10.4103/0974-2077.44171  PMID:20300356
  1,668 217 -
(Great) grandfatherly advice for young(er) dermatologic surgeons
Lawrence M Field
July-December 2008, 1(2):104-105
DOI:10.4103/0974-2077.44172  PMID:20300357
  1,541 224 1
From the literature
AS Nandini
July-December 2008, 1(2):113-114
  1,369 211 -
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