FROM THE LITERATURE
Year : 2010 | Volume
: 3 | Issue : 2 | Page : 129--131
From the literature
Venkat Charmalaya Centre for Advanced Dermatology, Bangalore, Karnataka, India
B S Anitha
Venkat Charmalaya Centre for Advanced Dermatology, Bangalore, Karnataka
|How to cite this article:|
Anitha B S. From the literature.J Cutan Aesthet Surg 2010;3:129-131
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Anitha B S. From the literature. J Cutan Aesthet Surg [serial online] 2010 [cited 2022 Jun 30 ];3:129-131
Available from: https://www.jcasonline.com/text.asp?2010/3/2/129/69032
Combination Excision and Liposuction in a Single-stage Treatment of Various Skin Disorders
Hua Lie, Gui-e Ma, Jian Chen, Zhen-Jun Liu
Int J Dermatol 2010;49:311-6.
Several skin lesions such as nevus, haemangioma, scar and keloids cannot be treated effectively by non-surgical methods and surgical excision becomes the optimal treatment. Large lesions pose a challenge to the surgeons, as the skin defect resulting from excision cannot often be closed by direct closure. The disadvantages of surgical methods in such cases include wide incision scar, skin necrosis or sensory deficit due to damaged blood and nerve supply as a result of extensive undermining of the flap.
In this study, the authors have attempted to overcome these disadvantages by combining surgical excision with liposuction, to treat skin disorders located at sites rich in subcutaneous fat. Liposuction of the underlying fat would result in increased laxity of skin and allow easier primary closure without any of the aforementioned complications.
Thirty-five patients were selected in the age group of 16-50 years. A total of 40 skin disorders including post-surgical incision scars, melanin pigmented nevus, capillary haemangiomas, keloids and burn scars were treated by this method. The lesions were located at different subcutaneous fat-rich sites like abdomen, lumbar region, buttocks, upper arm and thigh. A trochanter scar resulting from infection was also treated similarly. The size of lesions treated varied from 3.5 ΄ 2 cm to 40 ΄ 9.5 cm. Liposuction was first done in regions where they were located followed by complete excision of the overlying lesion. The resulting defect borders were gently undermined and the wrinkled skin created by liposuction served as sliding flaps on both sides of the defect, which were pulled together to cover the defect. The repair of skin defects could be done without any complications such as wound dehiscence, infection, incision edge necrosis, sensory deficit or severe scar recurrence. The liposuction regions showed satisfactory cosmetic result without asymmetry and irregularities, with well-balanced body contour.
In conclusion, some large skin disorders located at sites rich in subcutaneous fat can be treated in one stage with excision and liposuction. However, the indications for this technique are limited, as it can be done only in fat-rich areas.
Prospective Controlled Clinical and Histopathologic Study of Hidradenitis Suppurativa Treated with the Long-pulsed Neodymium: Yttrium-aluminium-garnet Laser
Mahmoud BH, Tierney E, Hexsel CL
J Am Acad Dermatol 2010;62:637-45.
Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory and suppurative disease involving skin flexures such as axilla, inframammary and inguinal areas. It is a painful and disfiguring skin condition with follicular hyperkeratosis and obstruction as the primary event and apocrine involvement as a secondary phenomenon, clinically characterized by deep-seated nodules, abscesses, sinus tract formation and scarring. This is a prospective, randomized, right-left within-patient controlled trial conducted for the evaluation of clinical and histopathologic efficacy of long-pulsed Nd:YAG laser treatment for HS. The authors have used this laser based on recent studies, which showed that this disorder originates from follicular occlusion and the suggested mechanism of action of the laser is release of obstruction of the hair follicle caused by photothermolysis mediated destruction of hair.
Twenty-two patients of HS were treated monthly with laser for 4 months and followed up for 2 months, for a total study period of 6 months. Disease activity was measured at baseline, and treatment response was assessed before each laser session and monthly for 2 months after completion of laser treatment using a modified scoring system based on Lesion Area and Severity Index described by Sartorius et al. Histopathologic study was done at baseline, immediately after laser treatment, and at 1 and 4 weeks after treatment. Patients' level of satisfaction was assessed by a questionnaire. Significant and progressive improvement was seen during the 4 month treatment period, which was maintained over the 2 month follow-up period. On an average, the percentage of improvement was 72.7% on laser-treated side and 22.9% on control side. Histopathologic examination showed an initial acute neutrophilic infiltrate and granulomatous inflammation in follow-up biopsy specimen 4 weeks later. An inflammatory infiltrate surrounding the hair shaft remnants denoted destruction of hair follicles. This supports the suggested mechanism of action of laser as photothermolysis mediated destruction of hair and subsequent relief from obstruction of the hair follicle.
In conclusion, long-pulsed Nd:YAG laser, together with topical benzoyl peroxide and clindamycin is more effective treatment in both clearing pre-existing lesions and preventing new eruptions, with high patient satisfaction. However, larger controlled studies with long-term follow-up period are required to establish the results.
Effective Treatment of Facial Redness in Patients of Atopic Dermatitis using Intense Pulsed Light System
Sang Ho OH, Byung Kee Bae, Tae Gyun Kim
Dermatol Surg 2010;36:475-82.
Facial erythema can be caused by several causes such as steroid dermatitis, rosacea, seborrheic dermatitis and atopic dermatitis. Facial atopic dermatitis leads to psychological and social distress in patients. Facial skin being thinner than skin in other areas, is more susceptible to steroid-induced side effects like atrophy, telangiectasia, perioral dermatitis and rosacea. Topical tacrolimus and pimecrolimus have minimal effect on distended vasculature. Hence, facial redness in atopic dermatitis is difficult to treat. Intense pulsed light (IPL) can ablate abnormal vessels and decrease dermal inflammatory infiltrate, which is useful in the treatment of vascular and pigmented lesions. This study was conducted to evaluate safety and efficacy of IPL treatment in patients with facial atopic dermatitis using objective and quantitative means.
Eleven patients, with mild to moderate refractory facial atopic dermatitis were included in the study. Patients were instructed to stop topical treatment including corticosteroids and calcineurin inhibitors, one week before treatment and to use only a moisturizer on the face during the study period, so as to promote wound healing and prevent dryness. The whole face, except for periorbital, perinasal and perioral areas was twice exposed to an IPL device using a 590 nm cut-off filter (590-1,200 nm) at a fluence of 12 to 13 J/cm 2 . The pulse duration was 30 milliseconds with a 20 ms intervening delay. A total of 3 sessions at 2-weeks interval was given to each patient. Objective clinical response was examined using the Eczema Severity Score (ESS), a polarization colour imaging system, and evaluation was done by two dermatologists. Data on Quality of life were evaluated using the Dermatology Life Quality Index (DLQI). These evaluations were done at each treatment sessions and follow-up took place at 4 weeks after the third treatment. The ESS was significantly low (P = 0.005), erythema scale also decreased significantly (P = 0.04) and mean DLQI score also improved significantly (P = 0.005). None of the patients showed any noticeable side effects. Hence, the authors conclude that IPL treatment can be used as an adjunct modality for the treatment of erythema in refractory facial atopic dermatitis patients, with minimal side effects.
Dermabrasion for Acne Scars During Treatment with Oral Isotretinoin
Bagatin E, Guadanhim LR, Yarak S
Dermatol Surg 2010;36:483-9.
Acne is a multifactorial inflammatory disease of the pilosebaceous follicles. Acne treatment involves topical medications like retinoids, benzoyl peroxide, antibiotics in early phases and oral medications like antibiotics and isotretinoin in cases of moderate to severe inflammatory forms with tendency of scarring. Atypical or exaggerated cicatrisation and occurrence of keloids or hypertrophic scars associated with oral isotretinoin have been reported in 1980s and 1990s. Stimulation of angiogenesis and production of collagenase inhibitor by isotretinoin, resulting in collagen accumulation was considered to be the underlying mechanism. In spite of being controversial, depressed acne scar revision by any aggressive procedures has not been recommended until 6-12 months after drug use terminates. There has been debate whether such a recommendation is based on sufficient evidence. This study, an interventional, prospective study of an ambulatory surgical procedure, was conducted to evaluate wound healing after localized dermabrasion in patients receiving oral isotretinoin.
Seven patients taking oral isotretinoin for 1-6 months with daily doses ranging from 10 to 40 mg were included in the study. An area of 1 cm 2 with depressed scars on face was selected and subjected to manual dermabrasion using a diamond fraise, not connected to a rotation engine but with strong and controlled pressure. A 6-month re-epithelization follow-up by clinical evaluation was conducted. All the patients showed excellent results of atrophic acne scar revision with normal cicatrisation evolution. Hypertrophy scar or keloid as a result of localized abrasion was not seen in any patient. The authors recommend further studies with more number of patients and full-face dermabrasion to re-evaluate the validity of the current recommendation for waiting 6-12 months after treatment with oral isotretinoin to revise atrophic acne scars.
Glycolic Acid Peels Versus Amino Fruit Acid Peels in the Treatment of Melasma
Ilknur T, Bicak MU, Demirtasoglu M, Ozkan S
Dermatol Surg 2010;36:490-5.
Melasma is a common pigmentary disorder characterized by symmetric, hypermelanotic, irregular light to gray brown macules on the sun exposed parts of the face. Conventional treatment for melasma includes sunscreens, hydroquinone or tretinoin. But chemical peels are now becoming more popular. Glycolic acid is an α-hydroxyl acid is a peeling agent, which inhibits melanin synthesis in melanocytes and promotes epidermal remodelling and accelerated desquamation. Amino fruit acids are carboxylated acidic amino acid created by dissolution and acidification of natural acidic amino acid. These are potent anti-oxidants and effective anti-ageing cosmeceuticals, and also have potent effect against photopigmentation. This is a single-blind, randomized right-left comparison study conducted to compare the therapeutic effects of glycolic peels and amino fruit acid peels in patients with melasma.
Thirty-one patients with epidermal type of melasma were selected and subjected to 12 serial peels on the 2 halves of the face at 2-week intervals for 6 months. Clinical evaluation based on the modified Melasma Area and Severity Index (MASI) scores was performed at baseline and at 3 and 6 months. Statistically significant decrease in modified MASI score was found with both peeling methods (P < 0.05) but there was no statistically significant difference between the 2 methods (P > 0.05) in terms of regression of melasma. It was also observed that the side effects were minimal with amino fruit acid peels. Hence, it was concluded that although both glycolic acid peel and amino fruit acid peel are almost equally efficacious in the treatment of melasma, amino fruit acid peels are less irritating and better tolerated.
Long-term Results of Split-skin Grafting in Combination with Excimer Laser for Stable Vitiligo
Al-Mutairi N, Manchanda Y, Al-Doukhi A, Al-Haddad A
Dermatol Surg 2010;36:499-505.
Vitiligo is an idiopathic pigmentary disorder characterized by depigmented macules, distributed in localized or segmental or generalized pattern. Medical therapies are considered as the first line of treatment. In refractory patients, surgical therapies can be used alone or in conjuction with medical therapy to achieve repigmentation. This study was conducted to determine the long-term results of combination therapy with split skin thickness grafting and 308-nm excimer laser for the management of stable focal or segmental Vitiligo.
Seventeen patients with focal or segmental Vitiligo clinically stable for atleast 1 year and not responding to medical modalities were treated with split-skin-thickness grafting. After 2 weeks, the grafted area was treated with 308-nm excimer laser twice a week with a fluence starting from 100 J/cm 2 . A total of 32 sessions were completed over a period of 16 weeks. The response was evaluated at the end of treatment and again 1 year after surgery. Thereafter, the patients were followed atleast once a year. At the end of laser therapy, though all the 17 patients showed repigmentation, the results in 12 patients were graded as excellent and in 15 patients as good. Final evaluation done at the end of 1 year revealed excellent results in all 17 patients. Two patients developed new Vitiligo lesions on the other part of body during follow-up. None of the patients developed depigmentation of the transplanted skin. In conclusion, the use of excimer laser after grafting minimizes the chance of developing perigraft halo or achromic fissures, and routine use of post-grafting excimer laser may lead to fast, uniform, complete repigmentation of the recipient areas, which is long lasting and cosmetically good.