Standard guidelines of care for acne surgery.

Acne 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. PHYSICIANS' QUALIFICATIONS: 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 "hands-on" training in appropriate training centers. FACILITY: 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. ACTIVE ACNE: 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. CRYOTHERAPY: 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.

Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing.

Resurfacing is a treatment to remove acne and chicken pox scars, and changes in the skin due to ageing. MACHINES: Both ablative and nonablative lasers are available for use. CO 2 laser is the gold standard in ablative lasers. Detailed knowledge of the machines is essential. INDICATIONS FOR CO 2 LASER: 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 2 laser is not recommended for the removal of tattoos. AESTHETIC INDICATIONS: Resurfacing for acne, chicken pox and surgical scars, periorbital and perioral wrinkles, photo ageing changes, facial resurfacing. PHYSICIANS' QUALIFICATIONS: Any qualified dermatologist (DVD or MD) may practice CO 2 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 2 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. FACILITY: CO 2 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. PREOPERATIVE COUNSELING AND INFORMED CONSENT: 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. Choice of the machine and the parameters depends on the site, type of lesion, result needed, and the physician's experience. ANESTHESIA: 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 postoperative care is important to avoid complications.

Tratamiento combinado de cicatrices de larga evolución: Resultado estético y reparador en una adolescente / Combined treatment of old scars: Aesthetic and reparative results in an adolescent

Las cicatrices extensas son lesiones que condicionan la vida de los pacientes que las padecen, produciendo retracción social o como en este caso condicionando la vestimenta de una joven adolescente de 15 años. Se realiza el tratamiento de cicatrices postquemadura que padece desde los 2 meses de edad, combinando diversos métodos como peeling, mesoterapia, dermoabrasión y ultrasonido, obteniendo como resultado la mejoría clínica, estética y psicológica, brindándole una calidad de vida superior.

Extensive scars modify the patient's life. Significant scarring causes functional and cosmetic deformities, discomfort and psychological stress. We report a teenager, who suffered from burning when she was two months old. She has been under scar treatment combining several methods such as peeling, mesotherapy, manual dermoabrasion and ultrasound. Up to now, we improved the patient's life quality, obtaining a clinical improvement, such as aesthetic and psychological one.

Tatuajes y "piercing" / Tattoos and piercing

A pesar de estar en el siglo XXI se ha retomado el lenguaje con códigos de comunicación arcaicos. Los jóvenes forman su identidad mediante la interacción con sus pares y los tatuajes y "piercing" tienen sus propios códigos, que son interpretados por el grupo que los lleva. Actualmente los tatuajes y los "piercing" encuentran su lugar predominante en la población adolescente, donde se han reinstalado por ser "moda" y generalmente se aceptan por estar generalizados. Asimismo los observamos en poblaciones marginales: de drogadictos y carcelarias. Realizarse un tatuaje y/o "piercing" implica ciertos riesgos, entre los que podemos mencionar la transmisión de infecciones que pueden ser localizadas en las zonas del tatuaje y/o "piercing"; y/o generalizadas como las virósicas algunas de las cuales conllevan riesgos de salud como el virus del HIV, de las hepatitis A,B,C. Pueden observarse también reacciones alérgicas, de hipersensibilidad, liquenoides, granulomatosas y varias como cicatrices hipertróficas y queloides; asimismo desencadenar un primer episodio de psoriasis, lupus, etc. Dentro de las recomendaciones para informar a la población deberíamos incluir: que las regiones del cuerpo más riesgosas para la realización de los mismos (que debieran evitarse) son aquellas que asientan en cabeza (incluyendo boca, nariz), cuello y órganos genitales. También es importante tener la vacunación antitetánica actualizada, considerar las condiciones de higiene del local donde se va a asistir y el tipo de material a utilizar, debiendo ser en lo posible material descartable. Los cuidados durante los primeros días post práctica son: mantener la zona limpia y seca, baños cortos, secarse sin frotado y no exponerse al sol por tres o cuatro meses. Asimismo es aconsejable ante cualquier reacción concurrir a la consulta profesional.

In spite of being in the XXI century, several archaic codes of communication language have been restablished. Young people form their identity by peer interaction, and tattoos and piercing have their own codes interpreted by the group by whom are exhibited. Nowadays tattoos and piercing have taken their place among adolescents where they have been reinstalled as "fashion" and widely accepted. Also, there are used in marginal populations such as drug users and prison inmates. Having a tattoo and/or piercing implies certain risks among which we are the transition of infectious diseases that could be localized at the site of the tattoo/piercing, or generalized as viral infections such HIV, and hepatitis A, B, or C. Other possible complications are the appearance of allergic, hypersensitivity, lichenoid, and granulomatous reactions, or the triggering of a first episode of psoriasis, lupus, etc. In the recommendations to inform the population we should include that the body regions more unsafe for these practices are: the head (including mouth and nose), neck, and genitalia. Is also very important to have tetanus vaccines updated, considering the hygiene conditions of the tattoo parlor and the quality of the material that is going to be used which should be disposable if possible. The local care in the first days post-practice are: keeping the region clean and dry, short showers, dry without rubbing, and avoid the sun for three or four months. Also is advisable in the case of any reaction seek for professional advice.

Peeling y dermabrasión / Peeling and dermabrasion

En el último tiempo, los peelings químicos y mecánicos como la microdermabrasión se han convertido en importantes armas terapéuticas para los dermatólogos, permitiendo mejorar el aspecto de la piel, disminuir los efectos del fotoenvejecimiento y utilizarlos en diferentes patologías cutáneas de consulta frecuente. Es responsabilidad del dermatólogo conocer y controlar los diferentes productos y métodos utilizados en estas técnicas, asegurándose su confiabilidad mediante estudios científicos serios que permitan comprender su verdadera efectividad. En este artículo se revisarán aspectos clínicos e histológicos del envejecimiento intrínseco y del fotoenvejecimiento, así como las principales características de los peelings químicos, sus indicaciones, manejo y complicaciones. También se abordarán los elementos más importantes de los peelings mecánicos.

Therapeutic regional dermabrasion in papular lichen amyloidosis of shins

Therapeutic regional dermabrasion of shins is a useful surgical method for planing away the persistent pruritic lichenified hyperkeratotic eruptions of papular lichen amyloidosis. Seventeen patients [12 females and 5 males] of 35 to 52 years age having papular lichen amyloido sis on shins, refractory to various medical lines of treatment for 5-12 years duration were subjected to regional dermabrasion. Extensor surfaces [shins] of both lower extremities [34 sites] in all 17 cases were treated by multiple sittings of spot dermabrasion. All 34 sites healed with superficial scarring and complete response [100%] with total clearance of lesions was observed in all 34 sites. Pruritus stopped in all the dermabraded sites immediately. No local recurrence has been observed in any sites over a minimum follow up period of 2 years. Apart from superficial scarring occurring at all 34 sites, the other side effect observed was varying degree of hypopigmentation in 20 out of the 34 sites dermabraded. Complication in the form of parchment like deep atrophic scarring with persistent hypopigmentation, erythema and at places depigmentation were observed, at 4 sites which were dermabraded deeply. Similar complications with delayed wound healing were observed at the 5th site as sequel to secondary bacterial infection following spot dermabrasion

Tratamento da hipomelanose gotada idiopática por dermabrasäo localizada / Treatment of the idiopathic guttate hypomelanosis by localized dermabrasion

FUNDAMENTOS - A hipomelanose gotada idiopática é dermatose freqüente, inestética, de causa desconhecida e de poucas opçöes terapêuticas. OBJETIVOS - Propor um tratamento eficaz para a hipomelanose gotada idiopática por dermabrasäo localizada. PACIENTES e MÉTODOS - No periódo de fevereiro de 1995 a março de 1996, vinte pacientes do sexo feminimo com idade entre 19 e 66 anos e diagnóstico clínico de hipomelanose gotada idiopática foram tratadas por dermabrasäo localizadas e acompanhadas. Utilizou-se aparelho portátil de baixa rotaçäo e lixas adamantinas apropriadas para o procedimento, permitindo a abrasäo seletiva das lesöes. A abrasäo foi epidérmica e realizada na faixa de 10.000 a 15.000 rpn, sem anestesia local. CONCLUSÄO - O método mostrou-se rápido, simples, efetivo, seguro, reproduzível e de baixo custo e risco.

Verrucous epidermal nevus: a therapeutic trial

Fifty six patients with verrucous epidermal nevus were chosen for this study to evaluate different therapeutic modalities in its treatment. The patients were divided into 4 groups. Group I included 20 patients treated by dermabrasion. The results were satisfactory, the follow up photographs after 3 and 6 months showed no recurrence or scar formation in 18 patients but partial recurrence was recorded after 6 months in 2 cases. Group 2 included 8 patients treated by CO[2] laser, 3 cases showed partial disappearance of the lesion leaving small protruding remnants, 3 cases showed recurrence of the lesion after 6 months. Two cases developed hypertrophic scar with keloid formation. Group 3 included 20 patients treated by electrodessication and the results were satisfactory, follow up for 3 to 6 months showed no recurrence. Scar formation was noticed in 5 patients. Group 4 included 8 patients treated by podophyllin ointment under occlusion for 4 to 6 months. The results were satisfactory and convincing. Follow up for 3 months showed no recurrence with smooth surface