Icy Intrigue: A Case Report of an Unusual Encounter With an Ice Pick Injury.

An ice pick is rarely observed as a weapon of offense in homicide or suicide. The severity of injuries produced by an ice pick ranges from circular contused abrasions to punctured wounds with clean-cut margins. We present a case of a self-inflicted ice pick injury to the chest autopsied at the AIIMS Rishikesh morgue. During this study, we noticed and analyzed the unusual presentation of injury by an ice pick, contrary to the injuries generally observed in ice pick cases. We highlight a peculiar case of a homicidal ice pick injury observed during the autopsy. The presentation deviated from typical patterns, with the weapon penetrating the victim's body in an unconventional manner. The findings challenge traditional assumptions regarding ice pick injuries and underscore the importance of comprehensive forensic analysis. Understanding and documenting atypical presentations of such injuries can aid forensic experts in accurately determining the cause and manner of death, facilitating the pursuit of justice in criminal investigations.

Acne Scars: An Update on Management

Acne vulgaris is a troubling skin disease known to have both physiologic and psychological effects on patients. Acne scars, a frequent complication, can further impact patients' quality of life. Scars result from an impairment in the healing process. Acne scars can be categorized as follows: atrophic scars (including ice pick, rolling, boxcar subtypes) and trophic (including hypertrophic and keloid scars), the latter being less common. Though various treatment approaches have been suggested, there is a lack of high-quality evidence on effective, type-specific acne scar approaches. Herein, we aim to review the current evidence for treating various acne scars.

Acne scarring-pathophysiology, diagnosis, prevention and education - Part 1.

Acne scarring is common and can occur despite effective acne management. Acne scarring patients suffer from significant psychosocial morbidity including depression and suicidality. Despite availability and advancement of therapeutic modalities, treatment for acne scarring is uncommon and often overlooked in the acne patient encounter. The utilization of acne scarring assessment tools and identification of specific acne scar subtypes allow for a tailored therapeutic approach. Part I of this continuing medical education series covers the pathophysiology and morphology of textural and pigmented acne scars, scarring assessment tools and medical treatment options. The principles reviewed will aid in the approach and initiation of acne scar treatment in the outpatient setting.

Secondary Stabbing Headache Associated with COVID-19: a Case Report.

Although COVID-19 is mainly an acute viral illness, persistent symptoms are common. However, headache is not a frequent sequela of this disease. Furthermore, stabbing/ice-pick cephalalgia has been reported in < 10% of cases of COVID-19, and recurrent forms occurring after vaccination against the disease have not been published yet. We present here an unusual short-lasting unilateral stabbing/ice-pick headache with recurrent periodicity over 10 months, which may represent a sequela of COVID-19. The cephalalgia presented in a 55-year-old male with no significant medical problems approximately 4 months after the acute onset of COVID-19, and recurred twice 12 days after the second dose of COVID-19 vaccination with BNT162b2 (Pfizer). This report represents a contribution to the semiological pattern of COVID-19-related cephalea.

Efficacy and safety of topical timolol 0.5% plus saline 0.9% versus each one alone in acne scar trichloroacetic acid-CROSS therapy: A blinded randomized controlled trial.

Trichloroacetic acid-CROSS (TCA-CROSS) or chemical reconstruction of scars is an approved method in the treatment of ICE-PICK scars. Timolol is a blocker of beta-adrenergic receptors that speeds up the healing of skin wounds. In this study, for the first time, the TCA-CROSS technique was combined with the use of saline injection and topical timolol to increase the effectiveness of treatment, and reduce the number of treatment sessions and complications, and thus improve the aesthetic result. In this parallel-group split-face randomized controlled assessor and analyst-blinded study, 45 patients with atrophic acne scars were randomly divided into 3 equal groups. TCA-CROSS treatment was performed on all facial scars of patients. In group 1, before TCA-CROSS, saline was injected under the scars on one side of the face, in group 2, after TCA-CROSS, 0.5% timolol eye drops were applied on the scars on one side, and in group 3, saline was injected before TCA-CROSS. After that, timolol eye drops were applied on the scars of the same side. In all groups, the choice of control side was random. The number of scars and patient and physician satisfaction were the main variables evaluating the effectiveness of the treatment. TCA-CROSS improved scars in both control and treatment sides of all 3 groups. Although the number of scars decreased on the treatment side of groups 2 and 3, the decrease was not statistically significant. In the saline + TCA group, the number of scars on the treatment side was slightly more than on the control side. In the group of patients who used timolol, the severity and duration of scar hyperpigmentation were significantly lower (group 2 p = 0.016, group 3 p = 0.002). No permanent complication was observed in the patients. Patients' satisfaction in groups 2 and 3 was higher in the treatment side than the control side. The combination of saline injection followed by TCA-CROSS is not recommended. Application of 0.5% timolol after TCA-CROSS caused a slight decrease in scar severity and a significant reduction of post-inflammatory hyperpigmentation (PIH) duration. So, the topical timolol makes a better result of TCA-CROSS for acne scar treatment.

A Morphological Study of Acne Scarring and Its Relationship between Severity and Treatment of Active Acne.

BACKGROUND: Scarring is one of the most dreadful complications of acne for which patients seek surgical treatment. OBJECTIVE: The aim of this research was to study the morphological features of acne scarring and the relationship between severity of acne and its treatment with type and severity of acne scars. MATERIALS AND METHODS: This was a hospital-based, noninterventional, cross-sectional study carried out over a period of 1 month on 100 patients with post-acne scarring. A morphological evaluation of the types, sites, and severity of acne scars was done, and details of the severity and treatment of acne were recorded. RESULTS: Of 100 patients included in the study, 61 were male and 39 were females. Females had an earlier onset of acne (15.8 years) as compared to males (16.5 years). The mean duration of active acne was longer in males (99.3 months) than that in females (74.4 months). Male patients had more severe acne vulgaris as compared to females (P = 0.0001). Of 100 patients, 52 started treatment 1 year after the onset of acne, and 18 patients had never taken any anti-acne medication. Morphologically, majority of post-acne scars were ice pick scars in 94% patients, followed by rolling scars in 86%, boxcar scars in 54%, and keloidal scars in 10% patients. Male patients had more severe acne scarring than females (P < 0.05). Of 54 patients with severe acne, 22 progressed to moderate grade and 32 patients progressed to severe grade of acne scarring. Significant reduction in the severity of acne scarring was observed in patients who received isotretinoin as compared to that in patients who received oral antibiotics. CONCLUSION: Majority of patients with active acne delay treatment, which leads to increased acne scarring. Ice pick scars are the most common type of acne scars, and keloidal scars are more common in males. Males have a longer duration of acne, they delay treatment, and have more severe acne scarring. Early introduction of oral isotretinoin may help to reduce the severity of acne scarring. Public education is essential to urge patients to seek early and appropriate treatment of acne that can reduce the incidence and severity of acne scarring and its psychosocial consequences.

Primary Stabbing Headache.

PURPOSE OF REVIEW: To provide a comprehensive and updated review of the literature on primary stabbing headache. RECENT FINDINGS: Changes to the ICHD-3 criteria have resulted in increased sensitivity to capture primary stabbing headache (PSH). According to the ICHD-3, the sharp stabbing pain is no longer restricted to the first division of the trigeminal nerve. Age, gender, and co-morbidities such as migraine seem to influence the prevalence of PSH. Subclassification into monophasic, intermittent, and chronic forms have been proposed in a recent prospective study and may be helpful from a prognostication perspective; however, further studies are required. Secondary etiologies for stabbing headaches are part of the differential diagnosis of primary stabbing headache; therefore, it is reasonable to perform neuroimaging. For severe frequent attacks, indomethacin continues to be considered first line. Other treatment options include COX2 inhibitors and melatonin.

Prophylaxis with melatonin for primary stabbing headache in pediatrics: a case report.

INTRODUCTION: Primary stabbing headache (or "ice pick headache") is an alteration characterized by brief jabs (short stabs of pain, lasting ~3 seconds), which appear spontaneously, irregularly, and affecting unilaterally or bilaterally. Indomethacin has traditionally been used as the main therapeutic option. However, this drug is ineffective in a considerable percentage of patients and can generate multiple adverse effects that occur at therapeutic doses. CLINICAL CASE: A 7-year-old male patient with primary stabbing headache of mild to moderate intensity, lasting 3 to 4 seconds, without relevant history, with normal neurodevelopment, neurological examination and neuroimaging; no triggers were identified. It was started therapeutic trial with Coenzyme Q10; however, no improvement in the symptoms was identified. TREATMENT AND OUTCOMES: A therapeutic management was carried out with Melatonin, which led to complete remission of the symptoms; without adverse effects in the posterior follow-up months. CLINICAL AND SCIENTIFIC RELEVANCE: There is little information regarding effective and safe treatments for primary stabbing headache in children. The present case identifies Melatonin as an innovative, effective and safe therapeutic alternative in the treatment of primary stabbing headache in children. This is a significant advance in the understanding of primary stabbing headache in the pediatric population. CONCLUSION: Melatonin may be an effective and safe therapeutic option for the treatment of primary stabbing headache in pediatric patients. It is necessary to deepen its research, in order to establish its use in a clinical practice guide.

INTRODUCCIÓN: La cefalea punzante primaria, es una alteración que se caracteriza por punzadas breves (∼3 segundos), que aparecen espontáneamente, de forma irregular y afectación unilateral o bilateral. Tradicionalmente se ha utilizado Indometacina como opción terapéutica principal. Sin embargo, este medicamento es inefectivo en un porcentaje considerable de pacientes y puede generar múltiples efectos adversos que se presentan a dosis terapéuticas. CASO CLÍNICO: Paciente masculino de 7 años de edad con cefalea punzante primaria de intensidad leve a moderada con una duración entre 3 y 4 segundos sin antecedentes relevantes, con neurodesarrollo, examen neurológico y de neuroimagen normales; no se identificaron desencadenantes. Se inició prueba terapéutica con Coenzima Q10, sin embargo no se identificó mejoría en los síntomas. TRATAMIENTO Y RESULTADOS: Se realizó un manejo terapéutico con Melatonina que conllevó a remisión completa de la sintomatología y sin efectos adversos en los meses posteriores de seguimiento. RELEVANCIA CLÍNICA Y CIENTÍFICA: Existe poca información respecto a tratamientos efectivos y seguros para cefalea punzante primaria en niños. El presente caso identifica la Melatonina como una alternativa terapéutica innovadora, efectiva y segura en el tratamiento de la cefalea punzante primaria en niños. Lo anterior constituye un avance significativo en la comprensión de la cefalea punzante primaria en la población pediátrica. CONCLUSIÓN: La melatonina puede ser una opción terapéutica efectiva y segura para el tratamiento de la cefalea punzante primaria en pacientes pediátricos. Se requiere ahondar en su investigación para establecer su uso en una guía de práctica clínica.

Prophylaxis with melatonin for primary stabbing headache in pediatrics: a case report / Profilaxis con melatonina para cefalea punzante primaria en pediatría: reporte de caso

Abstract Introduction: Primary stabbing headache (or "ice pick headache") is an alteration characterized by brief jabs (short stabs of pain, lasting ~3 seconds), which appear spontaneously, irregularly, and affecting unilaterally or bilaterally. Indomethacin has traditionally been used as the main therapeutic option. However, this drug is ineffective in a considerable percentage of patients and can generate multiple adverse effects that occur at therapeutic doses. Clinical case: A 7-year-old male patient with primary stabbing headache of mild to moderate intensity, lasting 3 to 4 seconds, without relevant history, with normal neurodevelopment, neurological examination and neuroimaging; no triggers were identified. It was started therapeutic trial with Coenzyme Q10; however, no improvement in the symptoms was identified. Treatment and outcomes: A therapeutic management was carried out with Melatonin, which led to complete remission of the symptoms; without adverse effects in the posterior follow-up months. Clinical and scientific relevance: There is little information regarding effective and safe treatments for primary stabbing headache in children. The present case identifies Melatonin as an innovative, effective and safe therapeutic alternative in the treatment of primary stabbing headache in children. This is a significant advance in the understanding of primary stabbing headache in the pediatric population. Conclusion: Melatonin may be an effective and safe therapeutic option for the treatment of primary stabbing headache in pediatric patients. It is necessary to deepen its research, in order to establish its use in a clinical practice guide.

Resumen Introducción: La cefalea punzante primaria, es una alteración que se caracteriza por punzadas breves (∼3 segundos), que aparecen espontáneamente, de forma irregular y afectación unilateral o bilateral. Tradicionalmente se ha utilizado Indometacina como opción terapéutica principal. Sin embargo, este medicamento es inefectivo en un porcentaje considerable de pacientes y puede generar múltiples efectos adversos que se presentan a dosis terapéuticas. Caso clínico: Paciente masculino de 7 años de edad con cefalea punzante primaria de intensidad leve a moderada con una duración entre 3 y 4 segundos sin antecedentes relevantes, con neurodesarrollo, examen neurológico y de neuroimagen normales; no se identificaron desencadenantes. Se inició prueba terapéutica con Coenzima Q10, sin embargo no se identificó mejoría en los síntomas. Tratamiento y resultados: Se realizó un manejo terapéutico con Melatonina que conllevó a remisión completa de la sintomatología y sin efectos adversos en los meses posteriores de seguimiento. Relevancia clínica y científica: Existe poca información respecto a tratamientos efectivos y seguros para cefalea punzante primaria en niños. El presente caso identifica la Melatonina como una alternativa terapéutica innovadora, efectiva y segura en el tratamiento de la cefalea punzante primaria en niños. Lo anterior constituye un avance significativo en la comprensión de la cefalea punzante primaria en la población pediátrica. Conclusión: La melatonina puede ser una opción terapéutica efectiva y segura para el tratamiento de la cefalea punzante primaria en pacientes pediátricos. Se requiere ahondar en su investigación para establecer su uso en una guía de práctica clínica.

New Onset Focal Stabbing Headache Associated With Peripheral Vertigo: A Case Report.

We present a novel case of a focal stabbing headache sharing features of primary stabbing headache that started and resolved with the onset and resolution of a course of self-limiting peripheral vertigo. The association of onset and improvement of the stabbing headaches support the trigeminal and vestibular reciprocal relationships. Vestibular input may be the driving force and a potential target for treatment.

Ice Pick Headache.

Ice pick headache, also called idiopathic or primary stabbing headache, is a unique headache type associated with ultra-brief stabs of pain, most commonly in the frontal or temporal area. It occurs predominantly in women and is estimated to affect 2-35% of the population. Unlike other headache types of short duration, such as short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), ice pick headache is not associated with any cranial autonomic symptoms but has been known to occur with nausea, vomiting, photophobia, and dizziness. It exists in two forms: primary and secondary, with examples of secondary causes being herpes zoster meningoencephalitis, meningiomas, stroke, and multiple sclerosis. Ice pick headache is one of the "indomethacin responsive headaches," but up to 35% of patients fail to show significant benefit with that treatment. Other treatment options include gabapentin, cyclooxygenase-2 inhibitors, melatonin, and external hand warming.

Evaluation of Acne Scars: How to Assess Them and What to Tell the Patient.

The prevalence and emotional impact of acne scarring are underestimated by the medical community. Dermatology providers should be able to evaluate the acne scar patient and discuss treatment options. Important aspects of the patient history include current treatments, prior acne scar procedures, and the patient's goals for treatment. During the physical examination, the scars are assessed and classified by scar morphology and overall severity of scarring. Finally, a treatment plan is developed in which the most appropriate procedures are matched with the scars that will work the best. Helping the patient understand likely expectations for improvement will increase overall satisfaction.

Primary and secondary stabbing headache.

Eight out of the 33 cases of primary stabbing headache seen in a general neurology clinic (40% have headache as their chief complaint) in the last 3.5 years are presented. The epidemiology, association with other primary headache disorders, secondary associations, testing, and treatment of primary stabbing headache are reviewed.

Técnica CROSS en cicatrices de acné / CROSS technique in acne scars

La cicatrización patológica es una complicación frecuente del acné que resulta del daño en la piel que se produce durante la curación de dicho proceso inflamatorio. Muchos pacientes desarrollarán cicatrices a pesar de un tratamiento oportuno y adecuado. A grandes rasgos se consideran dos tipos de cicatrización patológica: excesiva (cicatrices hipertróficas y queloides) e insuficiente (cicatrices atróficas). Estas últimas se ven en el 80-90% delos casos y se subclasifican en pica hielo, ondulada y en caja. Múltiples tratamientos se usan para eliminar las cicatrices del acné. A menudo, una combinación de varias técnicases necesaria para un tratamiento efectivo. La técnica CROSS es una modalidad terapéutica segura, eficaz y rentable en el tratamiento de las cicatrices pica hielo sin complicaciones significativas.

Pathological scarringis a common complication of acne that results from the skin damagethat occurs during the healing of this inflammatory process. Many patients develop scarringdespite a timely and appropriate treatment. Roughly two types of scarring are considered:excessive (hypertrophic scars and keloids) and insufficient (atrophic scars). The latter are seen in 80-90% of cases and are subclassified into ice pick, rolling and box car. Multiple treatments are used to remove acne scars. Often a combination of several techniquesis necessary for an effective treatment. The CROSS technique is a safe, effective andprofitable therapeutic modality for the treatment of ice pick scars without significant complications.

Ice pick death: a case report and discussion of the injury pattern.

Death due to ice pick injury rarely reported in forensic literature. We report death of a 16-year old male, who was allegedly assaulted on chest, back and thigh by his school-mate, with an ice pick. The accused had got the ice pick from his father's ice shop to attack the victim. The multiple stabs to the chest region had perforated the lung and penetrated the heart chambers. The victim succumbed to death on the way to hospital and medico-legal autopsy was conducted. The injuries inflicted by the ice pick are highlighted and its pattern is discussed in this article, owing to the peculiar nature of the wounds produced by the ice-pick.

Minimally invasive aesthetic procedures in young adults.

Age is a significant factor in modifying specific needs when it comes to medical aesthetic procedures. In this review we will focus on young adults in their third decade of life and review minimally invasive aesthetic procedures other than cosmetics and cosmeceuticals. Correction of asymmetries, correction after body modifying procedures, and facial sculpturing are important issues for young adults. The implication of aesthetic medicine as part of preventive medicine is a major ethical challenge that differentiates aesthetic medicine from fashion.

An Assessment of the Efficacy and Safety of CROSS Technique with 100% TCA in the Management of Ice Pick Acne Scars.

BACKGROUND: Chemical reconstruction of skin scars (CROSS) is a technique using high concentrations of trichloroacetic acid (TCA) focally on atrophic acne scars to induce inflammation followed by collagenisation. This can lead to reduction in the appearance of scars and cosmetic improvement. AIMS: The aim of this pilot study is to investigate the safety of the CROSS technique, using 100% TCA, for atrophic ice pick acne scars. SETTINGS AND DESIGN: Open prospective study. MATERIAL AND METHODS: Twelve patients with predominant atrophic ice pick post acne scars were treated with the CROSS technique, using 100% TCA, applied with a wooden toothpick, at two weekly intervals for four sittings. Efficacy was assessed on the basis of the physician's clinical assessment, photographic evaluation at each sitting and patient's feedback after the fourth treatment, and at the three-month and six-month follow-up period, after the last treatment. RESULTS: More than 70% improvement was seen in eight out of ten patients evaluated and good results (50 - 70% improvement) were observed in the remaining two patients. No significant side effects were noted. Transient hypopigmentation and hyperpigmentation was observed in one patient each. Physician's findings were in conformity with the patient's assessment. Three months after the last treatment, one patient noted a decrease in improvement with no further improvement even at the six-month follow-up period. CONCLUSION: The CROSS technique with 100% TCA is a safe, efficacious, cost-effective and minimally invasive technique for the management of ice pick acne scars that are otherwise generally difficult to treat. In few patients the improvement may not be sustained, probably due to inadequate or delayed collagenisation.