Current problems in dermatology最新文献

Stretch marks (striae distensae) are common dermal scarring associated with weight gain, overweight, and pregnancy. Scarring is caused by overstretching of the skin's dermis with permanent structural alteration of the collagen network fibers. Some individuals have naturally weak connective tissue and may develop major stretch marks without being overweight. Stretch marks can develop during puberty and after physical exercise with rapid muscle growth. Cortisone treatment and anabolic steroids often cause stretch marks. Stretch marks are of major cosmetic concern to many. They are red and swollen in the early sate and white and irregular in texture in the later stage. Many men and women suffer from poor self-esteem caused by stretch marks. Medical tattooing of stretch marks, also known as microneedling, can correct the skin pigmentation color in the normal direction, but not the actual textural change. However, abnormal texture may be modified by microneedling, by nonablative laser treatment, or by microdermabrasion. Treatments can also be combined, e.g., initial use of a method to flatten the skin, followed by tattooing to correct the color. Treatment options and strategies are reviewed.

Cosmetic tattooing and medical tattooing of the face share basic principles and to some degree types and spectrum of technical and clinical complications known from decorative tattooing of other parts of the body. Cosmetic tattoos recently have grown exponentially in popularity in industrialized countries all over the world. The different complications and their clinical symptoms, pathophysiology, diagnosis, treatment, and prevention are analyzed versus culprit pigments and updated. Eyeliner tattooing is associated with special complications because of the subtle anatomy and the closeness to the eye, and the risk of meibomian gland damage. The spectrum of cosmetic tattoo complications includes early-onset complications (infections particularly with herpes simplex, healing issues, aesthetic and technical mistakes with regret), and late-onset complications (color fading and color shift, "blowout" pigment escape to surrounding skin, papules, nodules, granulomas associated with sarcoidosis, allergic reactions in lip tattoos with lichenoid dermatitis, eye irritation, and fibrosis and scaring especially after microblading); miscellaneous complications include severe burn sensation in tattoos during magnetic resonance imaging later in life. Corneal tattooing and subconjunctival/episcleral tattooing performed on medical indication by ophthalmologists, and for decoration by tattooists carry special risk of intraocular complications. It is recommended for the purpose of research harmonization that terms and diagnostic classification of tattoo adverse events follow the system introduced by the Tattoo Clinic of Copenhagen and already accepted in specialized tattoo clinics in other centers.

Tattooing for medical purposes may have been around more than 5,300 years ago, but most of the interest and changes have occurred during the last 100 years as a consequence of scientific advances leading to quicker, cleaner, and less painful insertion of pigment into the skin as well as advances in medical knowledge allowing for more relevant individual information to be transmitted by the embedded pigment. These changes are ongoing. Cosmetic tattooing or tattooing for camouflage of body surface imperfections, likewise, has advanced during the last 50 years concurrently with the rise of social media, internet access, and the popularity of personal electronic visuals.

Needles, machines, and techniques used for professional cosmetic and medical tattooing have reached a high level of sophistication. Best utensils are combined with operator's insight - the key to best results. Nowadays, a broad range of different tattoo needles serving different purposes are available. The chapter reviews round, flat, triangular, magnum, nano, polished, textured needles, etc. and their coding and preferred use in practice. The chapter is intended to be the vade mecum for practitioners in the field, the newcomer as well as the experienced, in private setting as well as in hospital.

Tattooists and their customers are under special risk of airborne infection because of the short distance during the procedure and the unavoidable exchange of expired and inhaled air potentially containing droplets holding pathogenic germs. Moreover, the manual procedure involves a significant risk of contamination through physical contact. A range of personal protective equipment (PPE) is available, including three-layered disposable surgical masks, cotton masks, respirators without or with expiration valve, visors and shields, goggles, medical gloves and aprons. Disinfectant fluids and wipes are used for skin and physical objects. Alcohol is used but may evaporate too fast and lose biocidal efficiency; it carries risk of fire. Alternatives such as chlorine and a range of new disinfectants listed in the EU biocide directive should be considered as alternatives. PPEs and disinfectants are subject to formal testing and classification. EU and US requirements are visited. No PPE and no disinfectant have 100% efficiency. Efficiency of masks is influenced negatively by the reduced breathability from masks and respirators with leakage of air between mask perimeter and the skin. Gloves have micro-porosity dependent on wear time and already after 30 min become less efficient. The humid microclimate under masks and gloves easily causes skin problems. Thus, there are many pros and cons to consider. Thoughts on ideal aim, sound sense and realistic application of PPE and disinfectants in daily routine in tattoo parlours are provided, the risk and health of the tattooist included.

Cosmetic and medical tattooing are in rapid growth on all continents. The tattoos contribute to self-esteem and quality of life. Clients and patients have many different backgrounds and often highest aesthetic expectations, which the professionals shall meet. In this situation, correct, relevant, and personalized information on effectiveness, technique, procedures, and risks is highly important to reach a shared goal without misunderstanding and conflict. Information and agreement between provider and client are crystalized in the informed consent document. This article reviews the many aspects of pre-procedure client information explained in a book format providing information, which is of direct practical usefulness.

Furrows, lines and wrinkles with distensibility and retractility are a biological need of skin in the service of skin integrity, plasticity and joint motion. The fundamental segmentation and linearity of skin is genetically coded, manifested early in embryonal life and remarkably constant throughout life. The basic pattern established early in embryonal life when facial segments expand and fuse is confounded by overlapping linearities of different backgrounds. Embryonal skin and skin in childhood, puberty, adult life and senescence undergo a general change in the direction of disturbed structure, nevertheless respecting the originally coded and segmented linearity. The fundamental linearity is expressed as the naso-frontal, maxillary and mandibular segments of the primitive face and the extremity buds forming extremities. The sensory nerves in this phase of morphogenesis follow and invade the segments of the face, trunk and extremities and form dermatomes,replicating the tissue segments. Early on, CREST cells migrate from behind, from the neural crest, and seed a normally hidden linearity in the tissues, which may appear as scleroderma lines, particularly the vertical "en coup de sabre" line(s) in the front. Later in pregnancy, during the phase of volume expansion, the resultant horizontal force applied to the outer skin results in gliding of epidermal structures relative to the underlying dermis, resulting in hair streams and whorls and bizarre V-shaped figures known as Blaschko's lines.Hairs in this process achieve their final distribution and inclination relative to the skin surface, known as Voigt's hairstreams and whorls. The dermatoglyphic lines and whorls of finger pulps share features with the two linearities explained by outer skin gliding. The fibre network of the dermis has uneven pretension, and circular wounds retract and become oval, systematically mapped as Langer's lines. Surgical incision lines influenced by static and dynamic forces to normal skin are described as Kraissl's linesand Borge's linesused to guide surgical incisions.Gravity acts as a constant vertical force on the face and entire body and results over years in gravitational lines, furrows and "hanging" skin. The sun creates its own pattern of disturbed linearity, photodamage lines and patterns that overrule the minute triangularlinearity, with accumulation of elastotic material in the dermis. Poor lifestyle and medical and psychiatric disease are associated with preterm skin ageing and increased furrowing. Skin linearity is complex with overlapping patterns. A broad insight into the essentials of skin linearity from the embryonal state to aged skin and senescence with an understanding and consideration of the ever-active influence of the genetic coding on skin linearities and ageing, including the forceful autoregulation aiming at the restauration of the natural state of the skin organ at any time and irrespective of interventions, is mandatory for professional

Alternatives or complements to laser tattoo removal are needed. Laser removal requires 8-12 sessions and can easily take longer than a year. Some colors cannot be removed, and scars may appear. Applied to allergic reactions in red tattoos, lasers can boost the allergy. A recently developed 20 MHz high-intensity focused ultrasound (HIFU) is introduced as a complementary method to lasers, but also as a stand-alone treatment for selected groups. 20 MHz HIFU allows for application of high-power ultrasound energy to very small focal targets in the dermis, and thereby precise confinement of thermal lesions in the outer layers of human skin, precisely where tattoo inks are deposited. HIFU treatment is "color blind" and can target any type of colored pigment in the dermis. It produces a controlled thermal lesion (up to 65°C) with superficial necrosis followed by an eschar with embedded tattoo pigment. This eschar, containing the tattoo pigment, is discharged over some weeks, and finally replaced by healed skin. HIFU can efficiently remove tattoos of any color in only 1-3 sessions. It can be applied to tattoos when lasers fail to produce efficient removal. The types of side effects are the same as with lasers. The operator shall be trained and knowledgeable. 20 MHz HIFU can furthermore be used in clinical and esthetic dermatology for various other applications, and a range of applications are open in clinical dermatology.

This chapter explains the international regulative framework on equipment and inks for cosmetic and medical tattooing. In the following text, the word "tattooing" refers to body tattooing, permanent makeup, and microblading. From a global perspective, regulation of equipment for cosmetic (decorative) tattooing, and especially inks, is inconsistent and mainly based on a diversity of national laws. In contrast, regulation of equipment for medical tattooing is subjected to the internationally harmonized medical devices regulation. Even though dermal invasiveness and biological mode of action are identical for cosmetic and medical tattooing, the regulatory requirements are separated in two divergent regulative frameworks.

Emerging virus diseases are a major threat to humans and public health. Over the past two decades, there has been mounting interest in the increasing number of viruses causing unexpected illnesses and epidemics among humans. Emerging diseases also include as yet unrecognisable infections, or a previously recognised infection that has expanded into new ecological niche often accompanied by a significant change in pathogenicity. In the wake of these discoveries, the need for stronger infection prevention measures for personal services such as tattooing and cosmetic tattooing procedures needs to be revisited and re-established through more rigorous measures. This study provides an overview of some of the more common viruses and highlights their covert and sometimes non-symptomatic nature that tattooing practitioners need to be mindful of. It also presents precautionary measures that practitioners must take to protect against cross-contamination through infection prevention protocols. This study also looks at the importance of education and updates in education and the role of mandatory regulations.