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| Year : 2011 | Volume
: 4
| Issue : 1 | Page : 72-73 |
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| From the literature |
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Swathi Bhat
Venkat Charmalaya- Centre for Advanced Dermatology, Bangalore, Karnataka, India
Click here for correspondence address and email
| Date of Web Publication | 9-Apr-2011 |
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How to cite this article:
Bhat S. From the literature. J Cutan Aesthet Surg 2011;4:72-3 |
Bilateral Forearm Intravenous Regional Anaesthesia with Prilocaine for Botulinum Toxin Treatment of Palmar Hyperhidrosis
Enroth SB, Rystedt A, Covaciu L
J Am Acad Dermatol 2010;63:466-474
Intracutaneous injection of botulinum toxin (BTX) is a safe, effective and well-established treatment for palmar hyperhidrosis. The treatment involves 10-20 intracutaneous injections in each palm, which are painful. The treatment needs to be repeated every 6-12 months. Therefore, the anaesthetic method used should have minimal side effects, especially regarding long-term consequences such as damage to peripheral nerves.
The aim of this study was to investigate the efficacy and side effects of bilateral forearm intravenous regional anaesthesia (IVRA) using prilocaine, for BTX administration in hyperhidrosis. This study was performed over a period of 1 year among 166 consecutive patients aged 15 to 57 years. All patients were treated bilaterally with BTX type A injections using forearm IVRA with prilocaine (5 mg/ml). In a subgroup of patients, forearm nerves were studied with neurophysiological methods and blood concentrations of prilocaine were measured. Pain evaluation with a visual analog scale was accompanied with a questionnaire about treatment.
In all, 95% of the patients answering the questionnaire were satisfied with the anaesthetic effect. There was a fast recovery of motor and sensory function. No subclinical signs of sensory nerve damage were found. Recall and reporting bias were the potential sources of limitations of this study.
In conclusion, bilateral forearm intravenous regional anaesthesia provides an effective and well-tolerated anaesthesia during BTX treatment of palmar hyperhidrosis.
Surgical Treatment of Epidermodysplasia Verruciformis
Hofner MV, Camacho FM
Dermatol surg 2010;36:363-367
Epidermodysplasia verruciformis (EV) is a rare genodermatosis caused by human papilloma virus, clinically characterized by widespread erythematous or brown scaling papules, similar to pityriasis versicolor or ; and flat, wart-like papules, similar to seborrheic keratoses. Squamous cell carcinoma can develop on the sun-exposed areas later in life in approximately half of patients.
This study was done during a 5-year period by curettage and application of 35% trichloroacetic acid (TCA) on the non-malignant wart-like lesions. Ten patients aged 33 to 67 years were treated with curettage of wart-like lesions using curette. Curettage was performed after applying topical anaesthetic cream in majority of the patients, removing the epidermis and reaching upper bleeding dermis, followed by application of 35% TCA with a cotton bud, rubbing lightly for a few seconds. Because many lesions were removed in every patient (30 to 50 per session), only those that were harder or more infiltrated were submitted for histopathological examination, which revealed no signs of malignancy.
This treatment showed good cosmetic results with light scarring and no reappearance of lesions on the sites treated, during a mean follow-up of 3.5 years.
In conclusion, curettage and application of 35% TCA has been shown to be an effective and low-cost alternative, compared to oral, topical or other physical ablative therapies, with satisfactory cosmetic results and no recurrence during follow-up.
Hidradenitis Suppurativa: Successful Treatment using Carbon Dioxide Laser Excision and Marsupialization
Hazen PG, Hazen BP
De rmatol Surg 2010;36:208-213
Hidradenitis suppurativa (HS) is a disease characterized by the presence of chronic furuncular masses in the intertrigenous areas which may intermittently heal and flare, over months or years, and can also result in the formation of sinus tracts. This study was done in patients with longstanding lesions of HS, by using carbon dioxide laser excision and marsupialization of the inflammatory and draining sinuses.
Sixty-one patients with longstanding HS were studied. The sharplan CO 2 laser was used at a spot size 0.22 mm with energies ranging from 8 to 30 W to excise the masses in 185 areas of 61 patients, up to a level immediately beneath the identified sinus tracts. At completion of all excisions, the laser was used in a defocused mode to vaporise the base and margins of the field. A uniform smooth pocket-like (marsupial) defect was created, which was allowed to heal through secondary intention. This laser was chosen because the vascular-control effects of laser would allow better visualisation of cutaneous sinus tracts. The procedure was performed in an outpatient setting, using local anaesthesia; in previous patients treated for other conditions. There had been outstanding patient comfort after management, and qualities of wound healing were good to excellent.
In follow-up from 1 to 19 years, acceptable to excellent qualities of healing were seen. Recurrence within the treated areas occurred in 2 of 185 sites treated.
To conclude, carbon dioxide laser excision and marsupialization appears to be an effective therapy for management of longstanding HS lesions. There was good patient comfort, lower costs, good healing and minimal risk of recurrence within the treated areas.
Evaluation of 60 Patients with Pilonidal Sinus Treated with Laser Epilation after Surgery
Oram Y, Kahreman F, Koyuncu E
Dermatol Surg 2010;36:88-91
Pilonidal sinus is a debilitating, painful, chronic disease of the natal cleft that involves mainly the sacrococcygeal region. The clinical presentation varies from asymptomatic pits to painful draining abscesses. The most common manifestation of pilonidal disease is a painful fluctuant mass in the sacrococcygeal region.
This article is a prospective study dealing with the efficacy of alexandrite laser epilation after surgical intervention in patients with pilonidal sinus. Sixty patients who underwent surgical treatment of pilonidal sinus were treated with 755 nm alexandrite laser after surgery. The number of epilation treatments ranged from 2 to 5 performed at 6- to 8-week intervals. The laser treatment was performed after healing from surgery was completed.
The overall recurrence rate was 13.3%, after a mean follow-up period of 4.8 years. Seventy-five percent of the recurrences were detected after a follow-up period of 5 to 9 years. To conclude, the results strongly suggested that laser hair removal after surgical intervention in the pilonidal sinus disease decreases the recurrence over long term. Laser epilation is simple, quick, without any complications and serves as an adjunctive treatment after the surgical intervention, to prevent further surgery.
Correspondence Address:
Swathi Bhat
Venkat Charmalaya- Centre for Advanced Dermatology, Bangalore, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-2077.79205
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