A histologic evaluation of the effects of skin refrigerants in an animal model

Cryoanalgesia with dichlorotetrafluoroethane lessens the pain of botulinum toxin injections for the treatment of palmar hyperhidrosis

BACKGROUND

Hyperhidrosis is a troublesome problem that can be embarrassing in both social and professional situations. Botulinum toxin injections have proven efficacious in the treatment of hyperhidrosis. However, when treating palmar hyperhidrosis, pain at the injection site limits this therapy. We describe a method of cryoanalgesia using dichlorotetrafluoroethane to lessen the pain of botulinum toxin injections during the treatment of palmar hyperhidrosis.

OBJECTIVE

To show the successful use of dichlorotetrafluoroethane or Frigiderm in the treatment of palmar hyperhidrosis.

METHODS

This is a case report of a patient with a 20-year history of palmar hyperhidrosis who had previously tried several unsuccessful techniques to control pain during botulinum toxin injections to his palms. The left hand of the patient was pretreated with a spray of Frigiderm for 5 seconds before each of the botulinum injections. Two to 3 seconds of dichlorotetrafluoroethane at a distance of 2 to 4 inches were sprayed before each palmar injection. There was 1 to 2 seconds of frosting on the skin before the botulinum toxin was administered. After the botulinum toxin injection was administered, the patient was subjectively asked about pain during injection.

RESULTS

The patient subjectively reported a 75% decrease in the intensity of pain with the Frigiderm application, which he said made the injections much more tolerable. No epidermal changes were noted at the time of treatment or at the telephone follow-up visit. The patient presented for follow-up 3 months later. He stated that the sweating had minimally returned but that he had not yet returned to baseline.

CONCLUSION

The use of botulinum toxin for the treatment of palmar hyperhidrosis is often limited because of the pain of multiple injections. In this case report, we describe the successful use of cryoanalgesia with dichlorotetrafluoroethane or Frigiderm to lessen the pain of botulinum toxin injections during the treatment of palmar hyperhidrosis.

Dermabrasion

This article provides an overview of the resurfacing technique of dermabrasion. Preoperative consultation, perioperative medications, postoperative management, common complications, and reasonable outcome expectations are all described in detail. A description of proper technique, intraoperative equipment, and an approach to full-face procedures is also described.

Treatment of upper lip wrinkles: a comparison of the 950 microsec dwell time carbon dioxide laser to manual tumescent dermabrasion

BACKGROUND

High-energy pulsed or computer-scanned continuous-wave carbon dioxide (CO2) laser resurfacing has gained popularity as a wrinkle treatment because of its minimal thermal injury and precise control of tissue vaporization depth. Manual tumescent dermabrasion has also been effective for treating facial wrinkles. This is, to our knowledge, the first study comparing the use of CO2 laser to manual tumescent dermabrasion for the treatment of wrinkles on the upper lip.

OBJECTIVE

To compare prospectively the clinical efficacy of the 950 microsec dwell time CO2 laser to that of manual tumescent dermabrasion in the treatment of upper lip wrinkles.

METHODS

Twenty female subjects with moderate to severe upper lip wrinkles were randomly treated with the 950 microsec dwell time CO2 laser on one side of the upper lip and manual tumescent dermabrasion on the other.

RESULTS

The average upper lip laser-treated wrinkle score (0 = none to 5 = severe) decreased from 4.3 +/- 0.2 before treatment to 1.8 +/- 0.3 at 6 months after treatment. The average upper lip dermabrasion-treated wrinkle score decreased from 4.4 +/- 0.2 to 1.5 +/- 0.3. The degree to which the wrinkle score improved after laser treatment compared with that after dermabrasion was not statistically significant (P =.216).

CONCLUSION

Manual tumescent dermabrasion and 950 microsec dwell time CO2 laser resurfacing are equally effective for the treatment of upper lip wrinkles.

Laser skin resurfacing with the SilkTouch flashscanner for facial rhytides

BACKGROUND

Effective treatment of facial rhytides has been reported using carbon dioxide (CO2) lasers with high peak power and short exposure time which creates char-free ablation. Char-free ablation can also be created using a Silktouch flashscanner attached to a conventional CO2 laser.

OBJECTIVE

The purpose of this study is to evaluate the effectiveness of the SilkTouch flashscanner in skin resurfacing.

METHODS

The SilkTouch flashscanner attached to one of two continuous wave CO2 lasers was used to treat facial rhytides on 40 patients. Histopathology to evaluate the depth of penetration of the scanner on both CO2 lasers was performed on preauricular skin prior to excision during facelift surgery. Silicone surface replicas were obtained pre- and 2 months post-laser treatment on two patients and evaluated by optical micrometry. Clinical evaluation of all patients pre- and post-laser treatment was performed.

RESULTS

Clinical evaluation showed significant improvement of facial rhytides. Optical micrometry revealed a decrease in rhytide volume, indicating rhytide improvement.

CONCLUSION

The Silktouch flashscanner is effective for the treatment of facial rhytides.

Effects of a skin refrigerant/anesthetic and age on the pain responses of infants receiving immunizations

Although pain management is an important nursing responsibility, few interventions for minimizing distress of infants during painful procedures have been studied. Sixty infants, 2 through 6 months of age, were studied during a routine DPT immunization in order to examine (a) the effectiveness of cooling the skin in reducing distress behaviors and (b) the relationship between age and distress behavior. Infants were randomly assigned to experimental or control groups. Prior to the injection, the sites were sprayed for 2 to 3 s with either a skin refrigerant/anesthetic or compressed air. Behaviors were video- and audio-taped during and 60 s post injection, and coded for (a) facial expression, (b) cry, and (c) body movements. MANOVA revealed fewer distress behaviors following refrigerant spray and more complex, varied behavioral responses for older infants. The findings provide further evidence that infants perceive pain and that nursing interventions for pain reduction should be tested and extended to the very young.

Dermatologic cosmetic surgery

Many cosmetic surgery procedures performed today were either developed or refined by dermatologic surgeons. The role played by dermatologic surgeons in the development of dermabrasion, hair transplantation, liposuction, blepharoplasty, face-lift, cutaneous implants, fat transplantation, chemical peel, and sclerotherapy is described.