Management of the Sequelae of Skin Grafting: Pruritis, Folliculitis, Pigmentation Changes, and More.

Scars commonly give rise to unpredictable, potentially irritating, cutaneous complications including pruritis, folliculitis, and pigment changes. These problems can be self-limiting and are prevalent in many burn cases, although their expression varies among individuals. A better understanding of the presentation, risk factors, and pathophysiology of these long-term sequelae allows for more comprehensive care of burn survivors.

Combination treatment algorithm for pigmentary disorders of the face: A prospective observational study in Asian patients.

BACKGROUND: Most patients with facial pigmentary disorders have multiple disorders. However, there is no definitive treatment algorithm improving various pigmentary disorders simultaneously. OBJECTIVES: To investigate the clinical efficacy and safety of the combination of the Q-switched alexandrite and the carbon dioxide lasers with ZO SKIN HEALTHⓇ for facial pigmentary disorders. PATIENTS/METHODS: This prospective observational study enrolled 251 patients with at least one facial pigmentary disorder. We assessed treatment efficacy and investigated which disorders were most responsive to combination treatment and the relationship between doctors' skills, outcomes, and dropout rates. RESULTS: There were 246 patients with lentigo senilis, 186 with moles, 79 with melasma, 53 with seborrheic keratosis, 17 with acquired dermal melanocytosis (ADM), and 16 with freckles. Overall, 227 patients completed treatment. Post-treatment outcomes were excellent in 97, good in 113, fair in 17, and poor in 0 patients. Freckles were the most responsive, and ADM was the least responsive. Patient withdrawal and treatment outcomes did not differ significantly based on the doctors' skills. Overall, 3.2% of patients had adverse events. CONCLUSIONS: Our combination algorithm improved several pigmentary disorders of the face simultaneously, regardless of the doctors' proficiency level.

Presentación clínica de pigmentación melánica fisiológica / Clinical presentation of physiologic melanin pigmentation

Las pigmentaciones de la cavidad oral son comunes, éstas pueden representar diversas entidades clínicas, desde cambios fisiológicos hasta cambios malignos. Las pigmentaciones en la encía se conocen como pigmentaciones melánicas o melanosis gingival; en la encía se observan como tinciones oscuras ocasionadas por la acumulación de melanina en la zona. Éstas se consideran comunes, pueden representar variación normal en la pigmentación de melanina de la mucosa oral, hasta representar procesos malignos. En general, las personas de piel más oscura presentan frecuentemente mayor pigmentación de melanina oral que las personas de piel clara. Las variaciones en la pigmentación fisiológica oral están determinadas genéticamente a menos que estén asociadas con alguna enfermedad subyacente (AU)

Pigmentation of the oral cavity is common, it can represent diverse clinical entities, from physiological changes to malignant changes. Gum pigmentations are known as melanic pigmentations or gingival melanosis, and are observed as dark stains caused by the accumulation of melanin in the localized area. These are considered common, they can represent normal variation in melanin pigmentation of the oral mucosa, or malignant processes. In general, people with darker skin often exhibit greater pigmentation of oral melanin than people with fair skin. Variations in oral physiological pigmentation are genetically determined unless they are associated with some underlying disease (AU)

Efficacy and safety of the picosecond 755-nm alexandrite laser for treatment of dermal pigmentation in Asians-a retrospective study.

Q-Switched laser devices have been a standard treatment modality for dermal pigmentary disorders since the 1990s. However, the adverse events are sometimes intolerable even if the efficacy has been well accepted. These adverse events stop the patient from continuing the treatment and cause other cosmetic issues. Since 2012, the first picosecond laser for cosmetic applications was approved; it seems promising for treating pigmentary disorders in a new way, but lack strong evidence. We evaluated the efficacy and safety of a 755-nm picosecond laser for treatment of dermal pigmentary disorders in Asians. This is a 2-year retrospective study. We reviewed 36 female cases, including 8 cases of nevus of Ota and 28 cases of acquired bilateral nevus of Ota-like macules. Institutional Review Board (IRB) approval was granted by the Chang Gung Memorial Hospital medical research ethics committee (IRB 201900833B0). The epidemiologic data was collected. These patients have been treated with the 755-nm picosecond laser for 1 to 4 sessions at variable treatment interval. Our parameter settings were fluence of 2.73-3.98 J/cm2, with a spot size of 2.9 to 2.4 mm under the 650-ps mode. The pulse duration is 650 ps and fluence range is from 2.73 to 3.98 J/cm. Photographs were taken prior to every treatment and 1 month following the treatment. Two dermatologists conducted the clinical evaluation independently. Clinical improvement was observed in all with a minimal side effect. A total of 88.89% of patients had moderate to marked improvement in following 1 to 4 sessions. Transient swelling and erythema were observed in all patients but resolved within 24 h. Only one patient (2.78%) developed hypopigmentation and two patients (5.56%) had hyperpigmentation temporarily. Faster clearance could be achieved by the picosecond 755-nm laser for treating dermal pigmentary disorders in Asians. The treatment course is well tolerable and has minimal side effects.

Sequential delivery of long-pulsed 755-nm alexandrite laser and long-pulsed 1,064-nm neodymium:yttrium-aluminum-garnet laser treatment for pigmented disorders.

BACKGROUND: Long-pulsed (LP) lasers at pulse durations of 1-300 ms have been used to destroy nests of nevi cells by selectively targeting pigment chromophores. OBJECTIVE: To evaluate dual-wavelength LP laser-induced tissue reactions. METHODS: The patterns of LP 755-nm alexandrite (Alex) and/or 1064-nm neodymium (Nd):yttrium-aluminum-garnet (YAG) laser-induced tissue reactions were macroscopically evaluated using a tattoo-embedded phantom. Additionally, a pilot in vivo human study was performed for common acquired melanocytic nevus, of which dermoscopic images and high-speed cinematographs were obtained. RESULTS: Combinations of Nd:YAG and Alex laser treatments at interpulse intervals of 10 or 20 ms generated round to oval zones of photothermal and photoacoustic injury in two distinctive areas containing disintegrated tattoo particles. Treatment at interpulse intervals of 10 or 20 ms between Alex and Nd:YAG pulses elicited lesser degrees of thermal damage to surrounding tissues, compared to treatment at 100 or 200 ms. Immediately after combined LP laser treatment of human nevus lesions in vivo, Nd:YAG-Alex treatment at a 20-ms interpulse interval exhibited more remarkable crusting and erosive appearances than Alex-Nd:YAG treatment. CONCLUSION: For treating pigmented disorders, sequential delivery of LP Nd:YAG and Alex pulses at short interpulse intervals of 10-20 ms can effectively destroy nests of pigment chromophores.

Modified shave surgery combined with nail window technique for the treatment of longitudinal melanonychia: Evaluation of the method on a series of 67 cases.

BACKGROUND: Nail matrix histopathologic examination is still the criterion standard to diagnose longitudinal melanonychia (LM). OBJECTIVE: To introduce modified shave surgery combined with the nail window technique for managing LM and evaluate the postoperative outcome of the procedure. METHODS: We retrospectively reviewed the medical records of 67 patients with LM who underwent shave surgery combined with the longitudinal-strip nail window technique at our institution from March 2015 to June 2018. RESULTS: Pathologic diagnosis was accessible in all cases, and 60 cases were assessable for the postoperative outcomes. A total of 45 cases (75.0%) had no postoperative nail dystrophy, and recurrence of nail pigmentation was found in only 8 cases (13.3%). LIMITATIONS: This was a retrospective study. CONCLUSION: Modified shave surgery combined with the nail window technique is the preferable management for LM cases, with limited postoperative nail dystrophy and recurrence of pigmentation.

A comparison of gingival depigmentation by Er:YAG laser and Kirkland knife: osmotic pressure and visual analog scale.

Background: The aim of this study was to compare osmotic pressure (OP) 1 week after the gingival depigmentation in two diffeent methods: Er: YAG laser and Kirkland knife. Methods: This study included 20 patients, 13 women, and 7 men who had esthetic complaints of gingival melanin hyperpigmentation. The left side of the maxilla and mandible were depigmented with Er:YAG laser using air and water spray and the right side was removed with a Kirkland knife. Gingival biopsies were obtained from attached gingiva of operation sides with approximate dimensions of 2 mm × 2 mm before and 1 week after the depigmentation. The visual analog scale (VAS) was used to evaluate the pain level experienced by each patient. Results: Patients reported no pain at the gingivoplasty sides after 4 days and at the laser sides after 3 days. There were not statistical differences between laser and gingivoplasty groups according to values of OP (P > 0.05). Conclusion: According to results of wound healing, OP and VAS, two depigmentation procedures can be used safely and effectively.

New technical method to correct secondary vermilion deformities with cleft lip.

Various techniques for correcting whistling deformities that occurred after primary surgery for cleft lip have been reported. These techniques are mainly intended to correct the lack of volume of the red lip. However, irregularity of the dry-wet lip junction (mucocutaneous junction) in the red lip has rarely been mentioned. If the wet lip is located in an exposed area, not only is the aesthetic appearance poor but also uncomfortable complications such as a crusted or bleeding lip repeatedly occur under a dry condition. A new technique for correcting the irregular line of the dry-wet lip junction is described in this report. The technique is simple. After removal of the exposed wet lip, flaps are designed on both dry lip sides of the defect as M-W-M plasty and are transposed toward the defect. The dog-ears are small; the scar is inconspicuous because it is incorporated with the wrinkle line, and scar contracture is prevented. In addition, more soft tissues may be included to correct a mild whistling deformity.

Treatment of flat and elevated pigmented disorders with a 755-nm alexandrite picosecond laser: clinical and histological evaluation.

The novel picosecond lasers, initially developed for faster tattoo removal, have also shown great efficacy in endogenous pigmentary disorders. To describe the efficacy and safety profile of an alexandrite (755-nm) picosecond laser in a wide range of pigmented flat and elevated cutaneous lesions. A retrospective study was performed in which we collected all the clinical images of patients treated with the 755-nm alexandrite picosecond laser for 12 months (November 2016-November 2017). Clinical features were obtained from their medical charts. Patients treated for tattoo removal were excluded. All the images were analyzed by three blind physicians attending to a visual analogue scale (VAS) from 0 to 5 (0, no change; 1, 1-24% clearance; 2, 25-49% clearance; 3, 50-74% clearance; 4, 75-99% clearance; 5, complete clearance). Patient satisfaction was obtained from a subjective survey including four items: very satisfied, satisfied, non-satisfied, and totally dissatisfied. Thirty-seven patients were included (12 males; 25 females). The mean age of the study was 42.35 years. Twenty-five patients (68%) were treated for different pigmented flat disorders such as solar and mucosal lentigines (5), stasis dermatitis (4), or nevus of Ota (4), among other diagnoses. Twelve patients (32%) were treated for epidermal elevated lesions such as warts (5), epidermal nevi (2), and seborrheic keratosis (3), among other elevated lesions. Mean number of laser treatment was 3.02 sessions while mean follow-up after last laser treatment was 4.02 months. Mean VAS score of the three observers was 3.44 (61% of clearance) for pigmentary flat disorders and 3.60 (67%) for elevated lesions. Adverse effects reported were mild blistering in the first 2-5 days following laser treatment in some of the patients. Overall satisfaction among the patients included was high. The novel 755-nm picosecond alexandrite laser is effective not only for the resolution of pigmented flat lesions of different nature but also for the treatment of the more difficult elevated pigmented lesions.

Gingival depigmentation using Er:YAG laser and scalpel technique: A six-month prospective clinical study.

OBJECTIVE: To compare the 6-month clinical efficacy of Er:YAG laser and standard scalpel technique in treating gingival hyperpigmentation. METHOD AND MATERIALS: Patients requesting treatment for moderate to severe gingival hyperpigmentation in the maxilla were enrolled in this split-mouth study. The contralateral maxillary sides were randomly assigned to receive either Er:YAG laser (continuous wavelength of 2,940 nm) with a noncontact tip or the standard scalpel technique. Dummett oral pigmentation index (DOPI) and Hedin melanin index (HMI) were compared at the baseline and at 1 and 2 weeks, and 1, 3, and 6 months following the treatment. Bleeding Index, total treatment time, patient preference, pain perception at the first 3 days, wound healing, and level of satisfaction were also compared. Mann-Whitney test, Kruskal-Wallis test, and chi-square test were used to test the significance between variables. A P value of less than or equal to .05 was considered statistically significant. RESULTS: Of the 22 patients enrolled, 20 completed this study. After assessing DOPI and HMI at 1 and 2 weeks, and at 1-, 3-, and 6-month follow-up appointments, both Er:YAG laser and scalpel were significantly effective in treating gingival hyperpigmentation when compared to baseline (P < .001) but with no statistically significant difference between the two treatment methods (P > .05). More patients preferred the scalpel technique as it was associated with slightly shorter treatment time and less postoperative pain when compared to Er:YAG laser, but with no statistical significance (P > .05). Er:YAG laser sites showed minimal bleeding and more rapid wound healing (P < .001). CONCLUSION: Both Er:YAG laser and scalpel technique achieved similar outcomes regarding the efficacy of gingival depigmentation, postoperative pain perception, and the time required for the treatment. Laser therapy requires more advanced technology and is associated with higher financial costs. Therefore, the scalpel technique is still considered the gold standard treatment for gingival depigmentation.

Surgical management of leukoderma after burn: A review.

Burns are a common and sometimes devastating injury causing a significant amount of pain, disability, and occasionally death. Burns can have serious aesthetic and functional consequences such as pigmentary changes and formation of scar tissue. Hypopigmentation or depigmentation is often a result of partial- or full-thickness burns, which is referred to as leukoderma after burn. Thus, this study is aimed at systematically reviewing the surgical options for treating leukoderma after burn in order to gain insight into the advantages, disadvantages, and future implications of each surgical technique. The surgical procedures reviewed include dermabrasion with thin split thickness grafting, epidermal cell suspension spray, suction blister epidermal minigrafting, minigrafting, cultured epithelium, noncultured keratinocyte suspension, and chip skin grafting.

The Effect of SLT Laser Application on Iris to Treat Sectorial Heterochromia: A Promising Technique.

The purpose of this study is to report a new and promising method for changing iris color in a sectorial heterochromia iridis patient. A 22-year-old man with a complaint of innate color disparity between his eyes presented to our clinic to seek medical advice. He underwent a comprehensive ophthalmic examination, including visual acuity, biomicroscopy, fundoscopy, intraocular pressure measurements, endothelial cell count, and evaluation of iridocorneal angle. The causes of acquired heterochromia were excluded. After a detailed explanation of the procedure and probable side effects, the patient underwent an application with a laser device that produces a frequency-doubled 532 nm wavelength Nd:YAG laser beam with a spot size of 400 µm (selective laser trabeculoplasty laser device). The heterochromic areas (brown) were divided into zones and a gradual treatment pattern was performed to avoid inflammation and flare. The patient showed no side effects such as increased intraocular pressure, pain, corneal edema, hypopyon formation, decrease in visual acuity, synechia, or iris defect. After two complete sessions, the color difference disappeared and a solid eye color was achieved.

Cases of primary malignant melanoma and melanocytosis of the esophagus observed by magnifying endoscopy: Application to differential diagnosis: case series.

RATIONALE: Primary malignant melanoma of the esophagus (PMME) is a rare disease with an extremely poor prognosis. In contrast, melanocytosis is a benign condition defined as melanocytic proliferation with melanin deposition. PMME is often accompanied by melanocytosis, but differentiating between them is difficult because of their similar appearance. PATIENT CONCERNS: Here, we reported 3 PMME cases, 2 with melanocytosis. DIAGNOSES: Magnifying endoscopy revealed characteristic non-uniform pigmented spots along deformed intrapapillary capillary loops (IPCLs) in PMME, while melanocytosis showed fine granule-like or linearly arranged spots and intact IPCLs. INTERVENTIONS: The patients underwent endoscopic or surgical resection of each lesion. OUTCOMES: Histologically, magnified images reflected melanocyte growth. For cases 1 and 2, the patients remained disease-free for 61 and 15 months after endoscopic resection, respectively. In case 3, liver metastases developed two months after surgery, and the patient died from liver failure after six months. LESSONS: This is the first report describing differences in magnified views of the 2 diseases, which aids a differential diagnosis.

Primary pigmented nodular adrenocortical disease: literature review and case report of a 6-year-old boy.

Cushing's syndrome is rare in childhood and is usually caused by a pituitary adenoma. Primary hyperfunction of adrenal glands is less frequent, particularly primary pigmented nodular adrenocortical disease (PPNAD). It occurs usually in children and adolescents, with female preponderance, while Cushing's disease has increased frequency in prepubertal males. A case of a 6-year-old boy is presented with isolated non-familiar PPNAD. The clinical pattern involved Cushingoid appearance, hypertension, virilization and depressive mood. Laboratory analyses showed loss of circadian rhythm of cortisol, undetectable adrenocorticotropic hormone (ACTH) level, impaired fasting glucose, polycythemia and elevated white blood count (WBC). Radiology investigation revealed a slightly enlarged medial branch of the left adrenal gland and a normal right one, so a unilateral adrenalectomy was performed. Pathohistology described multiple dark brownish pigmented nodules of various sizes confined to the cortex. Contralateral adrenalectomy was done 3 months later. Follow-up of 3 years was uneventful, except for one adrenal crisis during an intercurrent respiratory illness.

Treatment Concept for a Patient with a High Smile Line and Gingival Pigmentation: A Case Report.

Today, innovative restorative materials and techniques allow for minimally invasive prosthetic procedures, which are paramount to the preservation of hard and soft dental tissues. An integrated approach combining dental and esthetic medical therapies could be useful to improve the quality of life of patients, improving function, esthetics, and self-confidence. Oral esthetics depends on several variables, including tooth visibility and proportions as well as healthy gingival tissues. Proper integration between teeth and periodontal tissues plays an important role in esthetic success, which is mainly represented by an appealing smile. The present case report was aimed at describing the multidisciplinary treatment of a woman who was unsatisfied with the shape of her central incisors and the dark gingival pigmentation displayed by a high smile line. The patient was treated with minimally invasive combined periodontal, prosthetic, and esthetic medical techniques. The described multidisciplinary approach based on surgical gingival depigmentation, adhesive ceramic veneers, and selective botulinum toxin injection was effective in solving the undesired high smile line and achieving patient satisfaction.

[Discolouration of Upper Lid Skin - Prurigo nodularis]. / Hautverfärbung am Oberlid ­ Prurigo nodularis.

An abnormal change in skin colour is designated as discolouration of the skin. A 73-year-old male patient with circumscribed discolouration of the upper lid margin near the lacrimal pathway is presented. Slit lamp biomicroscopy showed no other signs of pathomorphological change. An excisional biopsy was performed. The whole abnormal area was removed. The oculoplastic procedure was the surest way to establish a definite diagnosis of Prurigo nodularis.

Pigmentation Disorders: Diagnosis and Management.

Pigmentation disorders are commonly diagnosed, evaluated, and treated in primary care practices. Typical hyperpigmentation disorders include postinflammatory hyperpigmentation, melasma, solar lentigines, ephelides (freckles), and café au lait macules. These conditions are generally benign but can be distressing to patients. Appropriate dermatologic history, skin examination, and skin biopsy, when appropriate, can help exclude melanoma and its precursors. In addition to addressing the underlying condition, hyperpigmentation is treated with topical agents, chemical peels, cryotherapy, light or laser therapy, or a combination of these methods. Café au lait macules are treated with surgical excision or laser therapy if treatment is desired. Hypopigmentation disorders include vitiligo, pityriasis alba, tinea versicolor, and postinflammatory hypopigmentation. Treatment of vitiligo depends on the distribution and extent of skin involvement, and includes topical corticosteroids and calcineurin inhibitors, ultraviolet A therapy (with or without psoralens), narrowband ultraviolet B therapy, and cosmetic coverage. Patients with stable, self-limited vitiligo may be candidates for surgical grafting techniques, whereas those with extensive disease may be candidates for depigmentation therapy to make skin tone appear more even. Other hypopigmentation disorders may improve or resolve with treatment of the underlying condition.