Vol. 6 No. 1 (2021)

Open Access

Editorials

Article ID: 172

Chemical peeling as a treatment of melasma

by Shahin Aghaei

Journal of Surgical Dermatology, Vol.6, No.1, 2021; 2216 Views

Melasma, which is derived from the Greek word “Melas” (black) is an acquired, symmetrical and macular pigmentation of exposed areas of skin including cheeks, upper lip, chin, nose and forehead. Although it is much more common in skin of color, any race could be affected. Most of cases are women during their reproductive years.

Open Access

Research Highlights

Article ID: 132

Rare manifestation of neoplastica alopecia in metastatic cancer

by Editorial Office

Journal of Surgical Dermatology, Vol.6, No.1, 2021; 1289 Views

Dermatologists recently reported the case of a former breast cancer patient who presented a fast-progressing disease condition called alopecia neoplastica, a rare form of skin metastasis in the scalp, underscoring the importance of prompt and accurate skin evaluations of patients with past and present history of visceral carcinomas.

Open Access

Original Research Articles

Article ID: 50

Clinical and dermoscopic features of nevi in patients with psoriasis

by Natalia Glebovna Ilina, Yulia Mihailovna Krinitsuna, Aleksey Viktorovich Taganov, Andrey Aleksandrovich Tulupov, Irina Stanislavovna Kolesnikova, Dmitry Vladimirovich Yudkin, Irina Gennadievna Sergeeva

Journal of Surgical Dermatology, Vol.6, No.1, 2021; 2455 Views

The aim of the present study is to display the clinical and dermoscopic features of melanocytic nevi of more than 5 mm in diameter in psoriasis patients. A total of 32 patients with psoriasis (21 male, 11 female; average age 37.4) formed the first study group. In 22 patients (68.8%), melanocytic nevi of 5 mm in diameter and bigger (total of 68 nevi) were clinically found. For a randomized trial, 100 people (21 male, 79 female; average age 27.8) without psoriasis were invited to form the second study group. Only 37 of them had nevi ≥5 mm in diameter (total of 60 nevi). Complete questionnaire, full body photometric skin examination, dermoscopy examination on the dermatoscope HEINE MINI 10X with 70% ethyl alcohol immersion, skin type identification according to the Fitzpatrick classification, and nevi assessment according to ABCD and ABC rules were obtained for all recruited people. Our study showed that patients with psoriasis are more susceptible to melanocytic nevi of >5 mm in diameter (68.8%), while the result for the second group was 37%. As for nevi of dysplastic criteria, we found 32% in psoriasis patients vs. 42% in the monitoring group. Moreover, we should bear in mind the influencing factors of skin phototype II and artificial insolation (e.g., tanning, PUVA (Psoralen and ultraviolet A), and narrowband phototherapy 311 nm) obtained by the patients from the first group.

Open Access

Original Research Articles

Article ID: 136

Subungual glomus tumour excision: The nail plate flap technique

by Sandeep Mehrotra, Vikas Singh, Uday Singh Dadwal

Journal of Surgical Dermatology, Vol.6, No.1, 2021; 3144 Views

Subungual glomus tumours, though rare, cause distressing symptoms and merit surgical treatment with minimal morbidity. Approaches to the nail bed over the years have varied from earlier nail excisions to trans/sub/periungal techniques. Nail plate preservation has beneficial effects on pain, and cosmesis and surgical modifications to ensure the same are desirable. We employed a simple nail preservation technique on six patients over the last seven years. After an accurate localization of the lesion based on pin test and MRI, a proximally-based nail plate flap was marked and elevated beyond the glomus. The tumour was removed through a linear nail-bed incision, following which the nail plate flap was reposited without suturing. All cases had gratifying relief of symptoms. Within a few weeks of the excision, no nail distortion was noticeable. No recurrences were noted on follow-up for one year. The nail flap transungal approach relies on accurate preoperative tumour localization. It ensures a protective post-operative cover with reduced pain. A minimalistic approach with no skin incisions ensures less morbidity and improved cosmesis with no nail deformity. The nail plate flap technique can be employed in selected cases for improved outcomes.

Open Access

Original Research Articles

Article ID: 80

The efficacy and safety of a 70% glycolic acid peel with vitamin C for the treatment of photoaging

by Shiyao Sam Yang, MeiQi May Liau, Jun Khee Heng, Han Sim Matthias Toh, Chen Wee Derrick Aw, Sue-Ann Ho

Journal of Surgical Dermatology, Vol.6, No.1, 2021; 3986 Views

Glycolic acid peels have been shown in many studies to improve the appearance of photoaged skin. Vitamin C is known to be a potent natural antioxidant and plays an important role in the collagen biosynthetic pathway. In this study, we report our clinical experience with 70% glycolic acid peel added with vitamin C. We found that all parameters of photoaging, in particular the composite wrinkling score, discolouration score and the global photoaged score, showed statistically significant improvement. Patient satisfaction also revealed improvement in keeping with the physician assessment. It is also associated with an excellent safety profile. In conclusion, a combination of 70% glycolic acid with vitamin C chemical peel is a well-tolerated effective treatment of photoaging in Asian skin.

Open Access

Reviews

Article ID: 21

Evidence of incompatibility for topical anionic agents used in conjunction with chlorhexidine gluconate: A systematic review

by Gary Tran, Thy N Huynh, Finola M Bruins, Najeah Ahmad, William A Budris, Alba Posligua, Josh A Hammel, Beatrice Nardone, Dennis P West

Journal of Surgical Dermatology, Vol.6, No.1, 2021; 5884 Views

Chlorhexidine gluconate (CHG) is a widely used antiseptic agent for skin and wound disinfection. The cationic properties of CHG may allow its inactivation and precipitation by anionic agents in commonly used topical agents. We conducted a systematic review by searching through PubMed, Cochrane Library, and Web of Science databases and selected original research articles reporting on CHG incompatibility, defined as inactivation or precipitation. The search yielded 22 publications that demonstrated CHG incompatibility via: 1) reduced antibacterial activity (carbomer, acrylates/C10-C30 alkyl acrylate crosspolymer, dentin, bovine serum albumin, copolymer M239144, sodium lauryl sulfate, heat-killed microbes, triethanolamine, and bark cork); and 2) visible precipitate formation (sodium hypochlorite, EDTA, saline, ethanol, andnystatin). Only three publications reported on CHG incompatibility in dermatology, specifically for carbomer, triethanolamine, and acrylates/C10-C30 alkyl acrylate crosspolymer. Although limited evidence linking CHG incompatibility and anionic agents exists, clinicians should carefully consider the nature of topical agents used if CHG is concurrently applied. Increased awareness of CHG incompatibility may result in better antibacterial activity thus ensuring optimal patient management.

Open Access

Case Reports

Article ID: 77

Alopecia neoplastica: An uncommon presentation of metastatic breast carcinoma

by Felipe Ladeira de Oliveira, Luisa Kelmer Cortês de Barros Silveira, Thais Schiavo Moraes, Fernanda Helena Craide, Maria Cristina Mejia Briceño, Bernard Kawa Kac

Journal of Surgical Dermatology, Vol.6, No.1, 2021; 2673 Views

Cutaneous metastasis may correspond to the initial clinical presentation of hidden internal malignancies. In patients presenting said neoplasia, clinical manifestations of breast cancer reaches 23.9%. Considering that neoplastic alopecia appears as an unusual pattern of the said metastasis, this report describes a case of such uncommon neoplastic alopecia which presents itself as a cutaneous metastasis of rapid progression in a patient with prior breast cancer history. We present a 47-year-old female patient reporting lesions at the scalp, and who was asymptomatic with a 1-year evolution. The patient reported prior breast cancer history and presence of lung metastasis, and was undergoing chemotherapy at the time of consultation. A dermatological evaluation showed only a nodular lesion with erythematous surface and a diameter measuring about 4 cm, firm in consistency, and immovable. She was routed to the Department of Dermatological Surgery, and the results from histopathology were consistent with a diagnosis of metastatic breast adenocarcinoma. Neoplastic alopecia appears as an unusual form of cutaneous metastasis which is predominantly described in association with breast cancer. The lesion’s clinical features play a crucial role at the differential diagnosis, as the presence of erythema could distinguish neoplastic alopecia from alopecia areata. The existence of cutaneous metastasis leads to unfavorable outcomes. As a conclusion, cutaneous evaluation of patients is essential for treating visceral metastases, since the forms of cutaneous metastasis are diverse and can also affect the scalp.

Open Access

Case Reports

Article ID: 151

Acantholytic squamous cell carcinoma: Pathological study of three cases in Ecuador

by Eduardo Garzón Aldas, Gabriela Torres

Journal of Surgical Dermatology, Vol.6, No.1, 2021; 4106 Views

Adenoid squamous cell carcinoma is an uncommon histopathological variant of squamous cell carcinoma characterized by acantholysis of tumor cells creating pseudolumina and the appearance of glandular differentiation. It is also known as pseudoglandular, pseudoangiosarcomatous, adenoid, epithelioma dyskeratoticum, or adenoacanthoma. In this article, we describe and analyze three cases of acantholytic cell carcinoma. The purpose is to verify if the data of our cases can be validated with scientific information. All our cases presented lesions in the face, and in one of them the developed tumor on the skin showed actinic keratosis. The other two tumors were located in the right side of the face, and both were big: the bigger tumor was approximately 8 × 4 cm and the other one with a size of 6 × 2.5 cm. Due to the size and location, they were both send to the oncologist for treatment. One of our cases showed metatypical carcinomas accompanied by acantholytic variant of squamous cell carcinoma. None of our cases presented metastasis. The histopathological finding were keratinized squamous tumor cell type, adenoid structures with round spaces with a defined wall of at least one-cell width, and spaces with isolated or group of dyskeratotic cells.

Open Access

Case Reports

Article ID: 160

Tuberculosis verrucosa cutis

by Krishnabharath S

Journal of Surgical Dermatology, Vol.6, No.1, 2021; 2057 Views

We report a case of 23-year-old male patient with tuberculosis verrucous cutis on the foot for a duration of six months without responding to routine treatment. Tuberculosis is a common disease worldwide. Extrapulmonary tuberculosis contributes to 10% of cases. Cutaneous tuberculosis occupies a small spectrum of extrapulmonary tuberculosis. Tuberculosis verrucosa cutis is an exogenous infection occurring in a previously sensitized patient by direct inoculation of the organism. It occurs in sensitized patients with a moderate to high immune response. The diagnosis in our patient was confirmed by history, clinical examination, histopathological examination and the patient’s response to anti-tuberculous therapy.

Open Access

Perspectives

Article ID: 14

Refinement in Asian blepharoplasty for the aging

by Apirag Chuangsuwanich

Journal of Surgical Dermatology, Vol.6, No.1, 2021; 1632 Views

Signs of an aging face beginning at the periorbital region are easily noticeable and may require surgical correction. The hanging of upper eyelids, tired look, and sunken upper eyelids are common symptoms and signs. Most of the described techniques of blepharoplasty for the aging emphasize on the excision of the hanging eyelid skin which will leave patients with long scar. However, eyebrow and eyelid ptosis are common among aging people. Therefore, undertaking only an upper blepharoplasty does not necessarily yield good aesthetic results. This paper describes a modified blepharoplasty technique with limited incision. The operation also includes eyebrow reposition and/or correction of eyelid ptosis that further improve results. An asymmetry of the frontalis muscle could cause asymmetry in the eyelid folds post-operatively. However, botulinum toxin injection may correct this problem.

Open Access

Short Communications

Article ID: 157

IC plasty for reconstruction of axillary defect

by Samir El Mazouz, Abdelmoughit Echchaoui, Jaouad Hafidi, Nour-eddine Gharib, Abdellah Abbassi

Journal of Surgical Dermatology, Vol.6, No.1, 2021; 2479 Views

Reconstruction of axillary defects following surgery or trauma has always been a significant challenge for plastic surgeons. A variety of reconstruction options are available, including directed cicatrization, skin grafts and local flaps, but all of these procedures may allow skin contracture and leave unsightly scars.

Open Access

Correspondences

Article ID: 135

Value of exposure: External postings of plastic surgery trainees in India

by Rahul Bamal, Amrita Mandal

Journal of Surgical Dermatology, Vol.6, No.1, 2021; 2266 Views

The medical education system in India is not perfect and recent developments have again raised questions about the working and conduct of the Medical Council of India. There are loud calls for standardization and, in the midst of this chaos, there are always people who strive for excellence, who try to absorb knowledge at every opportunity and who can burst onto the mega screen anytime. Our aim should be to provide them with the congenial environment in which they can flourish.