Railroading technique of dermal grafting for linear atrophic scarring.

Dermal grafting is a valuable technique in the field of dermatosurgery for the treatment of atrophic scars where the source of filler material is the patient's own dermis. However, it is underused for the reasons being difficulties in placing the graft in the tunnel, keratin cysts and complications due to biofilms. Railroading technique used in urology for rupture urethra has been described for dermal grafts to overcome the technical difficulties of graft placement.

Misnomers in dermatology: an update.

The name of a condition in dermatology, gives a clue regarding the clinical feature, etiology, or histopathology of the disease. A disease might have been termed wrongly due to its resemblance to another known condition. Misnomers often mislead a physician regarding the etiology or histopathology of the condition. Here is a list of misnomers, with explanation, and the appropriate name in parentheses.

Evaluation of Perifollicular Inflammation of Donor Area during Hair Transplantation in Androgenetic Alopecia and its Comparison with Controls.

BACKGROUND: Mild perifollicular inflammation is seen in both androgenetic alopecia (AGA) cases and normal controls, whereas moderate or dense inflammation with concentric layers of collagen, is seen in AGA cases but only in very few normal controls, and may lessen the response to topical minoxidil. Moderate or dense lymphocytic inflammation and perifollicular fibrosis have poor hair growth following transplantation. AIM: The purpose of the study is to evaluate the perifollicular lymphocytic inflammation and fibrosis in AGA patients during follicular unit hair transplantation (FUT) and its comparison in normal controls. MATERIALS AND METHODS: A total of 21 male patients with AGA and 7 matched controls participated in the study. Histopathological analysis of biopsy specimens from donor strip of patients during the hair transplantation and two 4 mm punch biopsies on controls were performed. Morphometric analysis was performed and perifollicular fibrosis was scored based on the width of the condensed collagen at the lower infundibulum and isthmus from 0 to 3. Perifollicular infiltrate was also scored 0-3 and a total score of 3 or more out of 6 was considered significant. RESULTS: Nearly 76% of AGA patients had perifollicular fibrosis more than 50 µm at ×200 magnification. Almost 33.33% patients had moderate/dense perifollicular lymphocytic infiltrate whereas none of the controls had it. Total score in AGA cases was significantly higher than controls (P = 0.012) using Chi-square test. Out of 21 patients, 13 had a score of 3 or more and were followed-up with monthly treatment with intralesional steroids using a dermaroller. CONCLUSION: Histopathological evaluation of the donor area is a must during hair transplantation to evaluate the extent of perifollicular inflammation and achieve better results by following it up with treatment directed to decrease the inflammation.

A study of donor area in follicular unit hair transplantation.

BACKGROUND: The advent of follicular unit transplantation (FUT) has given a natural appearance in the recipient area in the past two decades, but has left behind an unsightly scar in the donor area. A study of donor area and techniques to make it cosmetically acceptable is lacking. AIM: The aim of this study was to evaluate the donor area after follicular unit hair transplantation and to show a few techniques to make the donor scar aesthetically pleasing. MATERIALS AND METHODS: The donor area was examined for scar width and patient satisfaction scores of donor area in 30 consecutive patients from March 2012 to February 2013 retrospectively after a minimum of 3 months after the procedure. Complications such as effluvium along suture line, wound infection, dehiscence, necrosis, folliculitis, keloids and wide scars were also noted. RESULTS: Scar width increased with increase in width of the donor strip. Patient satisfaction scores declined with larger strip widths. The most common complication seen was folliculitis-like lesions. Double trichophytic closure yielded the most aesthetically acceptable scar. CONCLUSION: FUT produces a linear scar in the donor area, which can be a significant concern in patients wishing to cut their hair short. Restricting the width of the donor strip and trichophytic closure has greatly improved the appearance of the scar.

Safe practice of cosmetic dermatology: avoiding legal tangles.

The present day dermatologists, in addition to conventional skin physicians, are also dermatologic-surgeons and cosmetologists in their practice. The cosmetic procedures have the inherent risk of malpractice litigations leaving an unsatisfied patient and a troublesome lawsuit against the doctor. A MEDLINE search was conducted for article with words such as legal issues and dermatology, malpractice in dermatology, safe practice of cosmetology etc. The selected articles are scrutinized and compiled so as to help the young dermatologists to have a comprehensive overview of safe cosmetology practice. This article aims at sensitizing the young dermatologists for the possible complications and provides an overview of safe practice. It also provides a list of simple routine precautions which helps the dermatologist to avoid unnecessary trips to the courthouse.

Transcutaneous blepharoplasty in blepharochalasis.

Blepharochalasis is a rare degenerative disease of skin of lids. We report 3 cases of blepharochalasis, out of which two involved upper eyelids and one involved lower eyelids. All the three cases were treated with transcutaneous blepharoplasty with acceptable cosmetic results.