Bhat YJ, Bashir Y, Latif I
… +7 more, Daing A, Devi R, Shah IH, Akhtar S, Rather S, Nabi N, Saqib NU
J Cutan Aesthet Surg
· 2022 · PMID 37035592
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BACKGROUND: Systemic sclerosis is a multisystem auto-inflammatory disease-causing fibrosis in the skin and internal organs. A frequent complication of systemic sclerosis is the limited mouth opening (LMO), a difficult-to...BACKGROUND: Systemic sclerosis is a multisystem auto-inflammatory disease-causing fibrosis in the skin and internal organs. A frequent complication of systemic sclerosis is the limited mouth opening (LMO), a difficult-to-treat condition with only a few treatment options available. AIMS AND OBJECTIVES: The aim of this study was to evaluate the response of fractional carbon dioxide (CO) laser resurfacing in LMO associated with systemic sclerosis. MATERIALS AND METHODS: This was a hospital-based prospective study in which diagnosed cases of systemic sclerosis were taken. Patients who had significant LMO and who gave informed consent were included in the study. Fractional CO laser treatment was performed in the perioral area. Patients were assessed at baseline, after three and six sessions, and 3 months after the last session. Assessment was done by measurement of the interincisor distance (IID) using a ruler and calculation of the mouth handicap in systemic sclerosis (MHISS) scale. RESULTS: Improvement in IID occurred 3 months after the first session with a mean gain of +5 mm (range 2-7). At 6 months, a mean gain of +8.5 mm (range 7-10) in IID was observed ( < 0.001). The MHISS score decreased by a mean of 14 (range 11-17) ( < 0.001). All patients showed improvement of mouth opening, which allowed the patients to have better phonation and the patients were able to have proper dental care posttreatment in the form of brushing of teeth and other dental procedures. The adverse effects noted in these patients included erythema that resolved spontaneously or after icing posttreatment. Other adverse effects noted were stinging and burning sensations that were mild and transient. CONCLUSION: Fractional CO laser forms a safe, effective, and well-tolerated treatment modality for improvement of LMO in systemic sclerosis. LIMITATIONS: The limitations of this study were less number of patients and no long-term follow-up.
J Cutan Aesthet Surg
· 2022 · PMID 37035591
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BACKGROUND: Due to its unique cosmetic appearance and functioning, scrotal skin offers a major clinical challenge in terms of reconstruction. Thus, successful reconstruction of scrotal skin should include both provision...BACKGROUND: Due to its unique cosmetic appearance and functioning, scrotal skin offers a major clinical challenge in terms of reconstruction. Thus, successful reconstruction of scrotal skin should include both provision of pliable texture and protection of testicular functions. Skin grafts and flaps are important options for such reconstruction; however, they both have unique features that bring about specific limitations and specific problems. AIMS AND OBJECTIVES: In the light of the negativities related to the widely used skin grafts and flaps, this study aims to discuss the use of bilobed pudendal flap-a simple, uniform, and pliable tissue-for the first time in the related literature for the reconstruction of scrotal skin defects caused by Fournier's gangrene. MATERIALS AND METHODS: This study was performed using the single-step method of scrotal skin reconstruction on eight patients who had developed scrotal skin defects and underwent reconstruction by using three-dimensional bilobed pudendal flaps (defect and reconstructive tissues planned on different planes) from December 2016 to August 2019. RESULTS: No complication such as infection, bleeding, hematoma, partial or complete flap loss, scar contraction, urinary problem, erectile dysfunction or discomfort, or sensation loss was observed in seven out of eight study patients. The only complication to have developed in one patient was minimal dehiscence, which was then corrected by restoration. CONCLUSION: Repair of scrotal skin defect using a three-dimensional bilobed pudendal flap enabled an elastic scrotal repair acceptable in sensorial and visual terms.
J Cutan Aesthet Surg
· 2022 · PMID 37035589
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BACKGROUND: Multiple studies have proposed the effectiveness of Platelet rich plasma (PRP) in treatment of atrophic acne scars. But an unanswered question is - whether it is the presence of growth factors in PRP or the m...BACKGROUND: Multiple studies have proposed the effectiveness of Platelet rich plasma (PRP) in treatment of atrophic acne scars. But an unanswered question is - whether it is the presence of growth factors in PRP or the mechanical factors during the injection that are responsible for its effectiveness? Also, no study compares PRP as a monotherapy against inert solution like normal saline (NS), that too, in a split face pattern using a non-invasive objective evaluation method. AIMS: Primary - To compare the efficacy of intralesional PRP and NS injections, in the treatment of atrophic acne scars. Secondary - To assess the side effect profile of the PRP injections. STUDY DESIGN: Prospective Interventional Comparative Split Face study. MATERIALS AND METHODS: 30 out of 33 patients completed the study and 20 of them were subjected to Ultrabiomicroscopic (UBM) analysis. Each patient received intralesional injections of NS and PRP in a split face pattern at two weekly intervals for five sittings. Treatment response was assessed using Goodman And Baron qualitative grading system, photographic evaluation by two blinded dermatologist and UBM analysis (scar depth & length). RESULTS: All the three methods showed a statistically significant treatment response. However, there was no significant inter group difference and PRP and NS had similar efficacy in treating acne scars. CONCLUSION: We conclude that subscision like mechanical effect of injecting solution is more important than the nature of the solution in treatment of atrophic acne scars and UBM sonography can be proposed as an objective assessment tool for such studies.
Alegre A, Pino A, Jiménez N
… +2 more, Jaén P, Anitua E
J Cutan Aesthet Surg
· 2022 · PMID 37035588
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BACKGROUND: Acne vulgaris is a common condition that often results in secondary cutaneous damage in the form of scarring. Scars require shape-specific scaffolds. Recently, a new 3D gel derived from plasma rich in growth...BACKGROUND: Acne vulgaris is a common condition that often results in secondary cutaneous damage in the form of scarring. Scars require shape-specific scaffolds. Recently, a new 3D gel derived from plasma rich in growth factors technology (PRGF) has been developed with the aim of overcoming these limitations. OBJECTIVE: The aim of this study was to preliminarily assess the clinical performance of the combination therapy with PRGF-gel (PG) and fractional ablative laser for post-acne scar amelioration. MATERIALS AND METHODS: Nine patients suffering from post-acne scars received a combination of PG and fractional ablative laser therapy. Macrophotographs were taken and patients completed a satisfaction survey. Images were also analyzed following the ECCA score. Clinicians were also asked to fulfill a clinical improvement score and any undesired side effects were recorded. RESULTS: Patients were referred to be highly satisfied as an 8.7 ± 0.9 satisfaction score was achieved. Healthcare specialists objectivated that the scar reduction and overall skin quality at the end of the study had noticeably improved. The ECCA score showed a significant 55% of improvement compared with baseline. No major side effects were recorded, and the tolerance of the treatment was excellent. CONCLUSION: The combined therapy with PG and fractional ablative laser might help in the management of post-acne scars and overall skin rejuvenation.
J Cutan Aesthet Surg
· 2022 · PMID 37035587
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Glomus tumor is a rare and benign vascular hamartoma originating from the neuro-myo-arterial apparatus of the glomus body in the reticular dermis. Most commonly, it presents as a solitary subungual lesion which is often...Glomus tumor is a rare and benign vascular hamartoma originating from the neuro-myo-arterial apparatus of the glomus body in the reticular dermis. Most commonly, it presents as a solitary subungual lesion which is often painful and triggered by changes in temperature and pressure on the affected digit. However, multiple glomus tumors both digitally and elsewhere on the body which may or may not be painful are also known to occur. Due to its cryptic location and varied presentation, there is an invariable delay in the diagnosis and management of this condition. We report a case of glomus tumor in a 28-year-old woman presenting with paroxysmal painful lesion over her right thumb for 5 years.
J Cutan Aesthet Surg
· 2022 · PMID 37035585
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BACKGROUND: Inverted nipple is a relatively common symptom to encounter, and numerous surgical techniques have been developed for correction. AIM: The aim of this study is to provide a simple and effective procedure with...BACKGROUND: Inverted nipple is a relatively common symptom to encounter, and numerous surgical techniques have been developed for correction. AIM: The aim of this study is to provide a simple and effective procedure with long-term results. MATERIALS AND METHODS: A total of 209 nipples of 108 patients received inverted nipple correction via double triangle suture technique. RESULTS: Of the 108 patients, 7 patients had unilateral inverted nipple and 101 patients had bilateral. Of the 209 nipples operated, 28 were grade 1, 117 were grade 2, and 64 were grade 3. The mean follow-up period was 13.16 ± 6.77 months. There were minimal complications. CONCLUSION: Double triangle suture technique is a safe and reliable inverted nipple correction method. It requires two small incisions, few sutures, and minimal operation time. We especially recommend this procedure for young women with potential breastfeeding in the future and who concern for minimal scars.
J Cutan Aesthet Surg
· 2022 · PMID 36561419
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Retronychia is an uncommon type of ingrown nail characterized by ingrowing of the proximal nail plate into the proximal nail fold (PNF), inciting cycles of inflammation. The condition can be symptomatic due to swelling a...Retronychia is an uncommon type of ingrown nail characterized by ingrowing of the proximal nail plate into the proximal nail fold (PNF), inciting cycles of inflammation. The condition can be symptomatic due to swelling and inflammation of the PNF, but most often it is noticed because of a proximal thickening of the nail plate and the failure of nail to grow distally. It usually affects the great toenails of young females, commonly due to recurrent trauma and footwear-related issues. This condition is difficult to recognize in the initial stages and often requires surgical management when the nail plate becomes significantly impacted. We present a case of retronychia in a 24-year-old lady, who was treated surgically. The report serves to highlight the diagnostic and therapeutic approach in such cases.
J Cutan Aesthet Surg
· 2022 · PMID 36561418
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Targeted cryotherapy of lesions in difficult to access location is a challenging scenario. We propose the use of add-on tips fashioned from disposable micropipettes, needle caps, and syringe barrels as a solution.Targeted cryotherapy of lesions in difficult to access location is a challenging scenario. We propose the use of add-on tips fashioned from disposable micropipettes, needle caps, and syringe barrels as a solution.
J Cutan Aesthet Surg
· 2022 · PMID 36561417
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BACKGROUND: Posttraumatic facial scars are not only unaesthetic but also have a negative sociopsychological impact. Surgeons constantly try to achieve the most aesthetic scar by various suturing methods. The tensile forc...BACKGROUND: Posttraumatic facial scars are not only unaesthetic but also have a negative sociopsychological impact. Surgeons constantly try to achieve the most aesthetic scar by various suturing methods. The tensile forces acting on the edges of the wound during healing are a major factor in determining the final appearance of a scar. AIM: Injecting botulinum toxin type A (BTX-A) locally to produce temporary muscular paralysis to relieve the tensile forces acting on suture line, thus improving the appearance of the scar. MATERIALS AND METHODS: In this study, patients with posttraumatic facial lacerations were locally injected with BTX-A before suturing (with vicryl 4-0 and ethilon 5-0 in layers). BTX-A reformulated with local anesthetic with vasoconstrictive was used in this study for immediate action. Patients were followed for a duration of 6 months with standardized photographs of the scar for evaluation. RESULT: A total of 50 patients with traumatic facial lacerations were included in the study. This study demonstrated significantly less increase in scar width ( = 0.000) and irregularities ( = 0.017), and improved discoloration of the scar ( = 0.000) in patients who received BTX-A injection. The overall results showed significant ( < 0.05) improvement over the period of 6 months. Both visual analog scale scoring and patient self-assessment scale were favorable in the BTX-A group, showing statistically significant improvement ( < 0.05). CONCLUSION: Botulinum toxin-induced immobilization of the wound enhances healing and improves the eventual appearance of the scar.
J Cutan Aesthet Surg
· 2022 · PMID 36561416
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A simple technique of using a dental burr to sharpen a follicular unit extraction (FUE) punch for hair transplant surgery is used. During the process of extraction in FUE, the sharpness of a punch plays a vital role in r...A simple technique of using a dental burr to sharpen a follicular unit extraction (FUE) punch for hair transplant surgery is used. During the process of extraction in FUE, the sharpness of a punch plays a vital role in reducing transection rates and thus increasing the yield of harvested grafts. Every time a sharp punch loses its sharpness, its expensive to replace it, hence we have described an ingenious technique to reuse a punch innumerable times, thus reducing the financial burden for the surgeon and the patient.
J Cutan Aesthet Surg
· 2022 · PMID 36561415
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BACKGROUND: In the recent years, there has been a significant rise in the number of men seeking rejuvenating procedures. The development of minimally invasive, non-surgical, office-based procedures without minimal downti...BACKGROUND: In the recent years, there has been a significant rise in the number of men seeking rejuvenating procedures. The development of minimally invasive, non-surgical, office-based procedures without minimal downtime has stimulated a fresh interest among men who may seek cosmetic treatment to increase competitiveness and appear youthful in the workplace. It is important to understanding the differences in facial features in men and women to achieve more natural results and to reduce the risk of feminizing the male's face. AIM: The purpose of this study was to present our experience of midface rejuvenation using hyaluronic acid (HA) fillers in men. MATERIALS AND METHODS: The authors discuss the anatomical considerations, pathophysiology of aging, gender considerations, and their injection technique for midface rejuvenation in male patients. RESULTS: Midface rejuvenation was successful in male patients using HA dermal fillers while maintaining the masculine features. The treatment was well tolerated and resulted in high level of satisfaction. CONCLUSION: Use of injectable HA dermal fillers is a safe, effective, and well-tolerated non-surgical treatment modality for midface rejuvenation in men. A thorough knowledge of the midface anatomy, injection techniques, and properties of individual fillers along with an understanding of the considerations in facial features of men can make injectable dermal fillers a rewarding treatment even in male patients.
Ankad BS, Koti VR, Nagathan V
… +2 more, Janagond AB, Nikam BP
J Cutan Aesthet Surg
· 2022 · PMID 36561414
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Subcutaneous phycomycosis is a rare saprophytic fungal infection. We herein report a case of subcutaneous phycomycosis with stony hard swelling on the chest wall as an unusual site of infection. Diagnosis was made based...Subcutaneous phycomycosis is a rare saprophytic fungal infection. We herein report a case of subcutaneous phycomycosis with stony hard swelling on the chest wall as an unusual site of infection. Diagnosis was made based on the clinical, histopathological, and culture studies. Oral treatment with itraconazole resulted in rapid resolution of lesion.
J Cutan Aesthet Surg
· 2022 · PMID 36561413
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The psychology behind an aesthetic procedure needs to be understood and assessed by the attending cosmetologist for the satisfactory outcome of the procedure. Being alert about certain psychiatric conditions can help in...The psychology behind an aesthetic procedure needs to be understood and assessed by the attending cosmetologist for the satisfactory outcome of the procedure. Being alert about certain psychiatric conditions can help in deferring certain procedures, which prevent us from correcting something that is actually not required and will protect us from future trouble. The incorporation of the user-friendly body dysmorphic disorder (BDD) screening questionnaire in preaesthetic procedure workup as a routine can help in excluding psychologically unstable patients, who can be a contraindication for conducting the procedure per se.
J Cutan Aesthet Surg
· 2022 · PMID 36561412
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BACKGROUND: Molluscum contagiosum (MC) is a common self-limiting viral infection of the skin. Many therapeutic agents have been used for it with varying success rates. OBJECTIVE: To evaluate and compare the efficacy and...BACKGROUND: Molluscum contagiosum (MC) is a common self-limiting viral infection of the skin. Many therapeutic agents have been used for it with varying success rates. OBJECTIVE: To evaluate and compare the efficacy and safety profile of topical 20% glycolic acid and 30% salicylic acid in the treatment of MC in pediatric patients. MATERIALS AND METHODS: All patients of MC between 1 and 15 years of age attending the outpatient department of dermatology were randomized into two treatment groups A and B. Group A was treated with 20% glycolic acid solution, and group B was treated with 30% salicylic acid solution daily for 4 weeks. Parents of patients were instructed to apply the medication once daily at night for 1 h on the lesions only. The assessment of response and side effects were analyzed in all the patients weekly for 4 weeks during the daily treatment protocol. Follow-up was done monthly for 3 months after the completion of therapy. RESULTS: At the end of 4 weeks, group A patients (60 patients) were treated with 20% glycolic acid out of which 34 (56.66%) patients had a complete clearance of lesions. Group B patients were treated with 30% salicylic acid out of which 38 (63.33%) had a complete clearance of lesions. Secondary bacterial infection was the most common side effect followed by postinflammatory hyperpigmentation in both groups. CONCLUSION: 30% salicylic acid was found to be more effective and has less side-effect profile in the treatment of MC than 20% glycolic acid.
Ankad BS, Smitha SV, Nikam BP
… +1 more, Rangappa M
J Cutan Aesthet Surg
· 2022 · PMID 36561411
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CONTEXT: Confluent reticulated papillomatosis (CRP), terra-firme-forme-dermatitis (TFFD), and dermatitis neglecta (DN) are the benign, acquired conditions that present with dirty-looking hyperpigmented and hyperkeratosis...CONTEXT: Confluent reticulated papillomatosis (CRP), terra-firme-forme-dermatitis (TFFD), and dermatitis neglecta (DN) are the benign, acquired conditions that present with dirty-looking hyperpigmented and hyperkeratosis lesions on neck, back, and truncal areas. They pose difficulty in diagnosis because of their clinical similarities and thereby in treatment approaches. Bedside test and histopathology is helpful in the diagnosis. Dermoscopy is utilized as an evidence-based diagnostic method. AIMS: To evaluate and to compare the dermoscopic patterns among CRP, TFFD, and DN and to correlate them in terms of histopathological features. MATERIALS AND METHODS: It was a cross-sectional observational study with a total of 62 patients, among whom 30 were CRP, 20 had TFFD, and 12 were diagnosed as DN. Clinical and dermoscopic evaluation was done in all patients, and histopathology was carried out in selective cases to confirm the diagnosis. RESULTS: Global view of dermoscopy in CRP revealed a cerebriform pattern. The arrangement of pigment globules was characteristic in CRP, TFFD, and DN, giving a "cobblestone," "mosaic," and "cornflake-like" appearance, respectively. The color of the pigment globules was strikingly significant. Yellow globules were predominant in CRP and TFFD, having p values of 0.001 and 0.004, respectively. Scales were conspicuously present in CRP, with a statistically significant p value of 0.003. Focal white areas and hair changes were observed in CRP alone, whereas black dots were found only in TFFD. CONCLUSION: Dermoscopy acts as an and a noninvasive, rapid technique in the diagnosis of clinically look-alike conditions. It demonstrates characteristic features in CRP, TFFD, and DN. Thus, it is an evidence-based diagnostic method that assists the treating physician in daily clinical practice.
Thakurani S, Gupta S, Mohammad A
… +1 more, Escandón JM
J Cutan Aesthet Surg
· 2022 · PMID 36561410
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BACKGROUND: Basal cell carcinoma (BCC) can be categorized as one of the commonly occurring skin malignancies in the world, with several variations in treatment protocols. Sun exposure has been attributed to its causality...BACKGROUND: Basal cell carcinoma (BCC) can be categorized as one of the commonly occurring skin malignancies in the world, with several variations in treatment protocols. Sun exposure has been attributed to its causality; however, other factors such as gender, age, and occupation also affect its incidence. We aimed to characterize the patient population who underwent surgical management for facial BCC at a tertiary referral hospital. Further, we have described an algorithm that may aid in surgical decision-making based on the location of the lesions on the face. MATERIALS AND METHODS: We performed a retrospective chart review of all patients who presented with a facial BCC to our institution between 2018 and 2019. Data regarding patients' demographic characteristics, skin phototype, average sun exposure, occupation, residence place (rural or urban), and surgical outcomes were recorded. RESULTS: Sixty-eight patients underwent reconstructive procedures after oncologic resection of facial BCC: 41.2% were males and 58.8% were females. Forty-eight (70.6%) patients were from rural areas, and 20 patients (29.4%) from urban areas ( < 0.001). Twenty-six patients reported >2 h of sunlight exposure, 16 reported <2 h of continuous sun exposure, and 26 reported intermittent sun exposure. A significantly higher proportion of patients with facial BCC presented with a Fitzpatrick skin type 4 in comparison to types 3 and 5 ( < 0.001). The most common reconstructive technique was the V-Y advancement flap (=22, 32.4%), followed by the forehead flap (=12, 17.6%) and the Limberg flap (=12, 17.6%). All the flaps were healthy post-operatively and none of them suffered from flap failure, infection, or suture line dehiscence. There was no recurrence at 1-year follow-up. CONCLUSION: This study gives a correlation between incidence of BCC and age, gender, and sun exposure in Indian population. In our experience, local flaps yield outstanding results and are the first choice for reconstruction of the face when composite defects are not present. Our algorithm aids in surgical decision-making.
Khade S, Rao M, Vishnoi JR
… +2 more, Soudamini AB, Nalwa A
J Cutan Aesthet Surg
· 2022 · PMID 36561409
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Retiform hemangioendothelioma (RH) is a rare vascular neoplasm with intermediate malignant potential mostly occurring in extremities. It is important to differentiate this neoplasm from malignant conditions as RH has a g...Retiform hemangioendothelioma (RH) is a rare vascular neoplasm with intermediate malignant potential mostly occurring in extremities. It is important to differentiate this neoplasm from malignant conditions as RH has a good prognosis. As it has a tendency to recur locally, it may be misdiagnosed as a malignant tumor. Herein, we report a rare case of RH occurring in the medial canthus.