Posted on July 31, 2008
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M-IPL is an safely and effectively treats various skin problems such as unwanted body hair, wrinkles, sun damage, freckles, age spots, hyper-pigmentation, melasma, rosacea, vascular lesions, telangiectasia, and acne
Posted on July 31, 2008
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Krupashankar DSIndian Journal of Dermatology, Venereology and Leprology 2008 74(7):61-67Resurfacing is a treatment to remove acne and chicken pox scars, and changes in the skin due to ageing. <b> Machines</b> : Both ablative and nonablative lasers are available for use. CO<sub> 2</sub> laser is the gold standard in ablative lasers. Detailed knowledge of the machines is essential. <b> Indications for CO<sub> 2</sub> laser:</b> Therapeutic indications: Actinic and seborrheic keratosis, warts, moles, skin tags, epidermal and dermal nevi, vitiligo blister and punch grafting, rhinophyma, sebaceous hyperplasia, xanthelasma, syringomas, actinic cheilitis angiofibroma, scar treatment, keloid, skin cancer, neurofibroma and diffuse actinic keratoses. CO<sub> 2</sub> laser is not recommended for the removal of tattoos. <b> Aesthetic indications:</b> Resurfacing for acne, chicken pox and surgical scars, periorbital and perioral wrinkles, photo ageing changes, facial resurfacing. <b> Physicians' qualifications:</b> Any qualified dermatologist (DVD or MD) may practice CO<sub> 2</sub> laser. The dermatologist should possess postgraduate qualification in dermatology and should have had specific hands-on training in lasers either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist/plastic surgeon, who has experience and training in using lasers. For the use of CO<sub> 2</sub> lasers for benign growths, a full day workshop is adequate. As parameters may vary in different machines, specific training with the available machine at either the manufacturer's facility or at another centre using the machine is recommended. <b> Facility:</b> CO<sub> 2</sub> lasers can be used in the dermatologist's minor procedure room for the above indications. However, when used for full-face resurfacing, the hospital operation theatre or day care facility with immediate access to emergency medical care is essential. Smoke evacuator is mandatory. <b> Preoperative counseling and Informed consent </b> Detailed counseling with respect to the treatment, desired effects, possible postoperative complications, should be discussed with the patient. The patient should be provided brochures to study and also given adequate opportunity to seek information. Detailed consent forms need to be completed by the patients. Consent forms should include information on the machine used; possible postoperative course expected and postoperative complications. Preoperative photography should be carried out in all cases of resurfacing. <b>Choice of the machine and the parameters</b> depends on the site, type of lesion, result needed, and the physician's experience. <b> Anesthesia:</b> Localized lesions can be treated under eutectic mixture of local anesthesia (EMLA) cream anesthesia or local infiltration anesthesia. Full-face resurfacing can be performed under general anesthesia. Proper <b> postoperative care</b> is important to avoid complications. (Source: Indian Journal of Dermatology, Venereology and Leprology)
Posted on July 31, 2008
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Khunger NitiIndian Journal of Dermatology, Venereology and Leprology 2008 74(7):28-36Acne surgery is the use of various surgical procedures for the treatment of postacne scarring and also, as adjuvant treatment for active acne. Surgery is indicated both in active acne and post-acne scars. <b> Physicians' qualifications:</b> Any Dermatologist can perform most acne surgery techniques as these are usually taught during postgraduation. However, certain techniques such as dermabrasion, laser resurfacing, scar revisions need specific &quot;hands-on&quot; training in appropriate training centers. <b> Facility:</b> Most acne surgery procedures can be performed in a physician's minor procedure room. However, full-face dermabrasion and laser resurfacing need an operation theatre in a hospital setting. <b> Active acne:</b> Surgical treatment is only an adjunct to medical therapy, which remains the mainstay of treatment. Comedone extraction is a process of applying simple mechanical pressure with a comedone extractor, to extract the contents of the blocked pilosebaceous follicle. Superficial chemical peel is a process of applying a chemical agent to the skin, so as to cause controlled destruction of the epidermis leading to exfoliation. Glycolic acid, salicylic acid and trichloroacetic acid are commonly used peeling agents for the treatment of active acne and superficial acne scars. <b> Cryotherapy:</b> Cryoslush and cryopeel are used for the treatment of nodulocystic acne. Intralesional corticosteroids are indicated for the treatment of nodules, cysts and keloidal acne scars. Nonablative lasers and light therapy using Blue light, non ablative radiofrequency, Nd:YAG laser, IPL (Intense Pulsed Light), PDT (Photodynamic Therapy), pulse dye laser and light and heat energy machines have been used in recent years for the treatment of active inflammatory acne and superficial acne scars. Proper counseling is very important in the treatment of acne scars. Treatment depends on the type of acne scars; a patient may need more than one type of treatment. Subcision is a treatment to break the fibrotic strands that tether the scar to the underlying subcutaneous tissue, and is useful for rolling scars. Punch excision techniques such as punch excision, elevation and replacement are useful for depressed scars such as ice pick and boxcar scars. TCA chemical reconstruction of skin scars (CROSS) (Level C) is useful for ice pick scars. Resurfacing techniques include ablative methods (such as dermabrasion and laser resurfacing), and nonablative methods such as microdermabrasion and nonablative lasers. Ablative methods cause significant postoperative changes in the skin, are associated with significant healing time and should be performed by dermatosurgeons trained and experienced in the procedure. Fillers are useful for depressed scars. Proper case selection is very important in ensuring satisfactory results. (Source: Indian Journal of Dermatology, Venereology and Leprology)
Posted on July 31, 2008
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Khunger NitiIndian Journal of Dermatology, Venereology and Leprology 2008 74(7):5-12Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. <b> Indications </b> for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. <b> Contraindications</b> include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations. <b> Physicians' qualifications</b> : The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. <b> Facility</b> : Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility. <b> Preoperative counseling and Informed consent</b> : A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. <b> Superficial peels</b> are considered safe in Indian patients. <b> Medium depth peels</b> should be performed with great caution, especially in dark skinned patients. <b> Deep peels</b> are not recommended for Indian skin. It is essential to do<b> prepeel priming</b> of the patient's skin with sunscreens, hydroquinone and tretinoin for 2-4 weeks. <b> Endpoints in peels: </b> For glycolic acid peels: The peel is neutralized after a predetermined duration of time (usually three minutes). However, if erythema or epidermolysis occurs, seen as grayish white appearance of the epidermis or as small blisters, the peel must be immediately neutralized with 10-15% sodium bicarbonate solution, regardless of the duration of application of the peel. The end-point is frosting for TCA peels, which are neutralized either with a neutralizing agent or cold water, starting from the eyelids and then the entire face. For salicylic acid peels, the end point is the pseudofrost formed when the salicylic acid crystallizes. Generally, 1-3 coats are applied to get an even frost; it is then washed with water after 3-5 minutes, after the burning has subsided. Jessner's solution is applied in 1-3 coats until even frosting is achieved or erythema is seen. Postoperative care includes sunscreens and moisturizers Peels may be repeated weekly, fortnightly or monthly, depending on the type and depth of the peel. (Source: Indian Journal of Dermatology, Venereology and Leprology)
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Posted on July 31, 2008
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