Vol. 1 No. 2 (2016)

  • Open Access

    Original Research Articles

    Article ID: 29

    Treatment of periorbital dark circles: Comparative study of chemical peeling with a combination of trichloroacetic acid and lactic acid versus carboxytherapy

    by Arwa Mohammad Hassan, Ghada Fawzy Hassan, Hedaya Yousef Aldalies, Gamal Mohammad El Maghraby

    Journal of Surgical Dermatology, Vol.1, No.2, 2016; 4359 Views

    DOI: https://doi.org/10.18282/jsd.v1.i2.29

    Periorbital dark circles (PODC) are a common worldwide cosmetic problem. It is difficult to treat due to complications in its pathogenesis and aetiology. Available lines of treatment for PODC include whitening creams, topical retinoid acid, chemical peeling, laser therapy, carboxytherapy, autologous fat transplantation, injectable fillers and surgery (blepharoplasty).The aim of this study isto evaluate and compare the efficacy of chemical peels using trichloroacetic acid (3.75%) and lactic acid (15%) in a gel formula with that of carboxytherapy, in the treatment of periorbital hyperpigmentation.Two groups of patients with PODC were included in the study, named Group A and B in which each group consisted of 15 patients. Group A was assigned for patients who received treatment with chemical peeling with a combination of trichloroacetic acid (3.75%) and lactic acid (15%) in a gel formula, once a week for four weeks. Group B was assigned for patients who received carboxytherapy that was performed by subcutaneous and intradermal injection of CO2 once a week for four weeks. All patients were assessed by digital photographs, before and after treatment, by observing the improvement in the grade of PODC. Reports of patient satisfaction and global tolerance were evaluated by three medical observers. There was a significant improvement in the grade of PODC in both groups. The degree of improvement of PODC in group A was excellent, with good grade in 93.4% of the treated patients while fair grade in 6.6% of them. There was a statistically significant improvement in the pigmented type. The degree of improvement of PODC in group B was excellent, with good grade in 86.7% of the treated patients while fair grade in 13.3% of them. However, no statistically significant difference between the two groups was observed. Minimal and transient side effects were noticed; however, it did not require further treatment. In conclusion, the two methods of treatment were effective in the treatment of PODC, with the improvement of PODC observed from the first treatment session with both chemical peeling and carboxytherapy.

  • Open Access

    Original Research Articles

    Article ID: 45

    Tear trough – Anatomy and treatment by autologous fat grafting

    by Chang Yung Chia

    Journal of Surgical Dermatology, Vol.1, No.2, 2016; 3410 Views

    DOI: https://doi.org/10.18282/jsd.v1.i2.45

    Tear trough is the main irregularity at midface, of which treatment is difficult. There is no agreement in literature about its anatomy and best treatment. The author presented an anatomical study and personal autologous fat grafting technique for tear trough treatment. Anatomical dissections were done on two fresh cadavers to examine the skin, subcutaneous, muscle and bone layers, spaces, and attachments. Safety and efficacy were evaluated via retrospective analysis of the last 200 consecutive procedures performed by the author. Tear trough is caused by the abrupt transition of the palpebral orbicular oculi muscle (OOM) (i.e., thin skin without subcutaneous fat compartment) to the orbital OOM (i.e., thicker skin with malar fat compartment). The tear trough region is located at the OOM bony origin at the medial canthus where no specific ligament was found. The grafted fat volume stabilized at two or three months after the procedure, instead of six months as stated in literature, with excellent results and no severe complications. Tear trough is a personal characteristic, a natural anatomical depression caused by subcutaneous irregularity and can worsen with age. The lack of volume is not effectively corrected by surgeries and thus it must be filled. Fat grafting has several advantages over alloplastic fillers, although it may be more difficult. Fat graft is autologous and abundant, and tissue transplantation could enhance skin quality. Fat grafting is a simple, safe, and effective solution for adding extra volume to correct the deflation phenomenon of the midface aging process. There is no specific anatomical plane for volume injection; the fat graft must be evenly distributed in the deep and superficial plane for uniformity.

  • Open Access

    Reviews

    Article ID: 8

    Frontier in hair loss and trichoscopy: A review

    by Ebtisam Elghblawi

    Journal of Surgical Dermatology, Vol.1, No.2, 2016; 3743 Views

    DOI: https://doi.org/10.18282/jsd.v1.i2.8

    Skin surfaces have always been examined using dermoscopy, a familiar tool which is useful to magnify and examine skin especially in cases of pigmented skin lesions. However, to examine the hair and scalp, a practical tool called trichoscopy has surfaced recently and has proven to be handy and functional in diagnosing most hair-related diseases. It is also referred to as dermoscopy of the hair and the scalp. It can aid in assessing active diseases in the scalp and hair, such as yellow dots, dystrophic hairs, cadaverized black dots, white dots, and exclamation mark hairs – all of which denote specific criteria for hair diseases. Trichoscopy is a very newly developed non-invasive technique for hair image analysis. It permits non-invasive visualization of hair shafts at higher intensification (about ×70 and ×100) and enables measurement of hair shaft width without the need for removing hair for diagnostic reasons. Moreover, it helps in vivo visualization of the epidermal portion of hair follicles and perifollicular epidermis (orifices). Consequently, it is valuable as it permits the inspection of structures that are otherwise not seen by the naked eye. Trichoscopy is the new frontier for the diagnosis of hair and scalp disease. Nowadays, a trichoscope is considered a must for dermatologists and it is a hot topic in the treatment of hair diseases. There is pooled evidence that the utilization of trichoscopy in the clinical setting for evaluating hair disorders can improve its diagnostic capability beyond simple clinical scrutiny. Trichoscopy can identify both hair shaft and hair opening abnormalities without the need for hair sampling, as well as distinguish between different scalp and hair diseases. Furthermore, it can give easy and quick evaluation of the hair with a follow-up to determine progress and prognosis of the disease with photos. It can also aid in some genetic hair shaft dystrophies such as trichorrhexis nodosa, trichorrhexis invaginata, monilethrix, pili annulati, and pili torti. The limitation of trichoscopy is that it needs prior knowledge to apply it effectively in order to mandate an efficient use by correctly interpreting the findings and their significance. In cases where there are unsettled discrepancies, a histopathological investigation is needed. The interest in trichoscopy has vastly increased and has become an indispensable tool in evaluating patients with hair loss. The aim of this review is to supplement existing knowledge on trichoscopy with recent readings of different scalp and hair conditions that are commonly encountered in clinical settings.

  • Open Access

    Case Reports

    Article ID: 33

    Treatment of multiple scalp cylindroma

    by Radmilo Rončević, Dušan Rončević

    Journal of Surgical Dermatology, Vol.1, No.2, 2016; 2560 Views

    DOI: https://doi.org/10.18282/jsd.v1.i2.33

    Cylindroma is a rare, benign adnexal tumor of the skin. The most frequent tumor location is the head, especially the scalp, and neck area. This type of tumor can occur as solitary or multiple tumors. Tumor diagnosis is relatively easy and is based on clinical findings and biopsy. The therapy of choice is surgical excision with parts or entire scalp excision depending on whether it is solitary or multiple tumor. We presented a 65-year-old male patient with multiple scalp tumors of 0.5–6 cm in diameter. An entire scalp excision was performed and the postoperative wounds (i.e., the periosteum of the skull and the fascia galea) were covered with free skin graft of partial thickness. In order to prevent profuse bleeding, we placed a tourniquet around his head and performed bilateral temporary ligature of temporal artery prior to surgery. During the nine-year follow-up, there were no new tumors or tumor recurrence reported.