Complications of expanded polytetrafluoroethylene (e-PTFE) facial implant

Implantation of the expanded polytetrafluoroethylene (e-PTFE) implant to achieve correction of nasolabial folds or thinning lip has been fraught with complications in spite of patient acceptance since its introduction in 1997. The four most frequent postoperative complications are extrusion, movement, infection, and swelling. In examination of 86 insertions of the 3.2 mm tubular implants, these sequelae are generally manageable for the physician and patient. If the patient understands possible courses of healing, both physician and patient satisfaction may be achieved.

Complications of chemical resurfacing

Complications of chemical resurfacing may occur even though a controlled chemical wound has been induced. The surgeon must be totally familiar with the types of peels and the management of postoperative wound care based on the skin type of the patient. A thorough understanding of the concepts involved will enable early treatment and avoidance of permanent sequelae, such as pigmentary dyschromias, infection, or scarring.

Treatment of melasma with Jessner's solution versus glycolic acid: a comparison of clinical efficacy and evaluation of the predictive ability of Wood's light examination

BACKGROUND

Melasma can be resistant to topical therapy.

OBJECTIVE

Our purpose was to evaluate the efficacy of superficial peels in conjunction with topical tretinoin and hydroquinone in patients with melasma and to evaluate the ability of Wood's light examination to predict response to treatment.

METHODS

We measured increased light reflectance in melasma areas with a colorimeter. Clinical observations were scored through an index designed to weigh numerically homogeneity, intensity of color, and area of melasma.

RESULTS

Colorimetric analysis showed an average lightening of 3.14 +/- 3.1 on the glycolic acid-treated side and 2.96 +/- 4.84 on the Jessner's solution-treated side. There was no statistically significant difference between the right and left. There was an overall decrease in melasma area and severity of 63%.

CONCLUSION

Superficial peels hasten the effects of topical therapy in melasma. Wood's light examination did not help predict response to treatment.

Advances in chemical peeling

Chemical peeling is traditionally discussed in terms of the depth of injury: superficial, medium, or deep. There have been a number of important advances in both superficial and medium-depth chemical peeling over the last several years. This article reviews the state of the art of these techniques and the increasing understanding of their effects on skin.

Deep chemical peeling

Facial skin wrinkling and sagging are concerns that often compel patients to seek counsel on rejuvenative procedures. Facial plasty procedures will alleviate many of these concerns. However, deep chemical peels, in conjunction with surgery or alone, can often significantly improve both the ravages of excess sun exposure and the stigmata of aging.

Treatment of facial telangiectasia with sclerotherapy, laser surgery, and/or electrodesiccation: a review

BACKGROUND

Facial telangiectasia is extremely common in patients with fair complexion. Electrosurgery has been the primary form of treatment in the past.

OBJECTIVES

The authors retrospectively evaluated over 300 patients treated with sclerotherapy for facial telangiectasias.

METHODS

Retrospective analysis of over 300 patients with facial telangiectasia treated with sclerotherapy and 55 facial spider telangiectasias treated with laser.

RESULTS

Sclerotherapy utilizing hypertonic saline, Sclerodex, polidocanol, and sodium tetradecyl sulfate resulted in-between 50 and 100% resolution of facial telangiectasia with minimal complications.

CONCLUSION

The treatment of facial telangiectasia should include sclerotherapy and laser treatment modalities, which effect a higher rate of clearance with less adverse sequela.

Variations and comparisons in medium-depth chemical peeling

Two effective methods in chemical peeling, solid carbon dioxide plus trichloroacetic acid and Jessner's solution plus trichloroacetic acid, were compared clinically with photographs and histologically with serial biopsies. Carbon dioxide produced a deeper wound than Jessner's solution, and CO2 + TCA was slightly deeper than Jessner's + TCA but was probably not significantly deeper from a clinical standpoint except in correcting scarring. Triple consecutive applications of TCA can substantially increase wound depth with both combination peels.

Complications of chemical peeling

In spite of controlled wounding with chemical peeling agents, complications may occur, resulting in patient and physician dissatisfaction. Precautions and factors causing these complications are examined, and relative contraindications to chemical peeling are discussed.

Medium-depth chemical peeling of the skin: a variation of superficial chemosurgery

Medium-depth chemical peeling of the skin is an intermediate procedure between superficial trichloroacetic acid application and deep phenolic cauterant application. Combining solid carbon dioxide with trichloroacetic acid promotes both epidermal and dermal regeneration. The technique for treatment of actinic degeneration, acne scarring, rhytids, and pigmentary aberrations is presented.

Black tongue secondary to methyldopa therapy

A case of black tongue associated with methyldopa administration is reported. The symptoms disappeared when the medication was discontinued. The possible mechanism is discussed.

Spindle cell lipoma. An unusual dermatologic presentation

A 30-year-old woman had nontender subcutaneous mass over the left temple that histologically demonstrated a mixed pattern of mature lipocytes and spindle cells, many in a palisading and fascicular pattern, separated by fibrous trabeculations. No cellular atypia or increased mitotic activity was seen, and a predominance of mast cells was noted. This case illustrates the spindle cell lipoma, a benign variant of lipoma that has been confused in the past with both malignant spindle cell and lipocytic tumors. Our case, although atypical in sex, age, and location, serves to identify this entity in the dermatologic literature.

Carcinoid in an umbilical nodule

An umbilical nodule may be an early or late sign of metastasis from an internal location. To our knowledge, we are reporting the first case of carcinoid occuring as an umbilical mass. The occurrence in our patient of idiopathic hyperparathyroidism, diabetes mellitus, and carcinoid suggests the diagnosis of multiple endocrine adenomatosis, type I, which may result from a developmental defect in the amine and amine precursor uptake and decarboxylation cell system.

Photolocalized tinea facialis

The case of a 34-year-old white woman with tinea facialis that persisted for nine months prior to diagnosis is presented. The confluent plaquelike erythematous eruption of the face with eyelid lichenification that flared outdoors was thought to represent polymorphic light eruption and was refractory to antibiotics, corticosteroids (topical and systemic), and antimalarials. A KOH preparation was positive when the dermatosis spilled onto the mandibular region, and restaining of the initial skin biopsy revealed fungal hyphae. Complete resolution was accomplished with griseofulvin and MicTin. Tinea cab be added to the list of infectious agents that have a photosensitivity component. The fungus possibly "photolocalizes" to sun-damaged areas, ie, areas of increased capillary permeability. This case illustrates the importance of including tinea in considering diagnoses of sun-exposed lesions of the face.