Journal of Cutaneous and Aesthetic Surgery最新文献

Objectives: Dark circles are one of the most common aesthetic concerns in India. While several treatment options exist, none address both volume deficiency and skin quality simultaneously. We felt that fat grafting and nanofat provided a novel treatment option to address both aspects of dark circles in one treatment.

Material and methods: Patient records were examined from 2017 to 2021. A total of 28 patients were identified as having undergone fat grafting and nanofat for dark circles specifically. The patients were analyzed for age, gender, volumes injected, and outcomes based on patient self-assessment.

Results: A total of 36 patients underwent fat grafting ranging from the age of 20 to 40 (average 31). All procedures were done under local anesthesia as day care procedures. The volumes injected range from 2 cc/side to 8 cc/side, with an average of 4.36 cc. Using the Likert scale, 28 (77%) rated their results as very satisfied. Six (17%) rated it as satisfied. One rated it as neutral and two rated it as average, and underwent a second session of fat grafting where another 2 cc was injected per side.

Conclusion: Fat grafting and nanofat are an exciting treatment option for the treatment of dark circles, which is usually regarded as a recalcitrant problem. It has the advantages of addressing both volume and skin quality, being a single-stage procedure, and producing comparatively long-lasting results.

Basal cell carcinoma (BCC) represents the commonest cutaneous malignancy globally. Its diagnosis in patients with skin of color is often delayed due to its low prevalence which reduces clinical suspicion and its indolent course. Studies on BCC in India are few. Considering that it is a locally invasive tumor commonly seen in the head and neck region, its management calls for the complete clearance of the cancer accompanied by minimal cosmetic disfigurement. One modality fitting the said requirements is Mohs micrographic surgery. However, the facilities for the same are limited in our country. We report here cases of histologically confirmed BCC managed successively with Mohs surgery, a technique associated with low recurrence rates while also being aesthetically superior when compared to traditional surgical excision.

Vitiligo is a chronic skin disorder characterized by the loss of melanocytes, leading to depigmented patches on the skin. The global lifetime prevalence of vitiligo diagnosed by a physician or dermatologist was estimated at 0•36% in the general population, 0•67% in the adult population adults, and 0•24% in the child population. Vitiligo prevalence was higher in adults than in children across all regions. Central Europe and south Asia reported the highest prevalence 0•52% and 0•52%, respectively, in the general population. Vitiligo significantly impacts patients' quality of life, causing psychological distress and social stigmatization. While medical treatments such as corticosteroids and phototherapy exist, they often fail to achieve satisfactory repigmentation, particularly in extensive or recalcitrant cases. In recent years, surgical interventions have gained prominence as effective alternatives for managing vitiligo. Techniques such as autologous melanocyte transplantation, suction blister grafting, split-thickness skin grafting, and punch grafting offer promising repigmentation results. However, the lack of standardized protocols and guidelines for vitiligo surgery presents challenges in patient selection, procedural approaches, and post-operative care. This study aims to review current surgical techniques, assess patient-specific factors influencing surgical success, and evaluate long-term outcomes, including repigmentation rates and patient satisfaction. Key factors include disease stability, lesion characteristics, and the involvement of exposed areas. Moreover, the study emphasizes the importance of post-operative adjuvant therapy, such as topical tacrolimus and excimer therapy, to enhance surgical outcomes. By establishing evidence-based protocols for vitiligo surgery, this study seeks to improve treatment efficacy and patient care, addressing gaps in current practices and advancing the field toward more consistent and successful outcomes in vitiligo management.

Objectives: The study aimed to compare the efficacy of two treatment modalities in vitiligo vulgaris that is - potent topical corticosteroid (betamethasone-dipropionate lotion 0.05%) with FrCO₂ laser versus Potent topical corticosteroid (PTS) alone, and to observe side effects if any.

Material and methods: Sixty cases with stable vitiligo (vitiligo vulgaris including focal vitiligo) >12 years of age with <27% body surface area were included in the study. The Institutional Ethics Committee approval was taken. After taking consent and clinical photographs, cases were randomly allocated into two groups of 30 patients each: Group A received FrCO₂ laser (power-6W, random mode) once a month + twice daily application of PTS (betamethasone dipropionate lotion 0.05%) over patches and Group B applied PTS only twice daily (betamethasone dipropionate lotion 0.05%). The response was assessed at the end of 3 months.

Results: The mean vitiligo area scoring index (VASI) score at baseline for Group A was 1.17 ± 0.59, and after 3 months was 0.60 ± 0.56. For Group B, the mean VASI at baseline was 0.87 ± 0.35 and after 3 months was 0.63 ± 0.50. The p value of group B was 0.003 and for group A was 0.001. Even though the reduction in mean VASI was statistically significant in both groups, Group A showed a better response. Group A showed good to excellent response in 16.67% while Group B only cases in 3.3%. This suggests that the addition of FrCO₂ to steroids may provide superior repigmentation.

Conclusion: The addition of FrCO₂ laser to topical corticosteroids offers a safe and promising approach and can be considered in patients who are unresponsive to other treatment modalities.

Vitiligo, a chronic skin disorder characterized by depigmented patches, often presents challenges in management due to the unpredictable nature of repigmentation. Mini punch grafting, a surgical technique, is a widely accepted treatment for stable vitiligo. This article focuses on the innovative use of customized short punches in mini punch grafting. The aim is to provide insights into their advantages, the customization process, and their role in improving outcomes for vitiligo patients.

Suction blister epidermal grafting (SBEG) is a standard technique for treating vitiligo on challenging areas like fingertips and lips but often results in pigment halos and difficulties with small, curved surfaces. We propose a modified SBEG technique, utilizing trypsinization of one blister graft to improve melanocyte spread and reduce peri-graft halo. Trypsin ethylenediaminetetraacetic acid (EDTA) solution is introduced into a selected blister, creating a cell suspension applied to dermabraded gaps and peripheries, including eyelid margins. At 5-month follow-up, complete re-pigmentation with no halo effect was achieved, indicating this modified approach's potential in enhancing SBEG outcomes for complex sites.

Objectives: Vitiligo significantly impacts patients' quality of life. Current evidence indicates that combination therapy results in faster improvement, enhancing patient adherence to treatment and leading to higher satisfaction among patients. In this study, we compare the efficacy of combined fractional carbon dioxide (FCO₂) laser and excimer lamp with platelet-rich plasma (PRP) or topical tacrolimus in patients with refractory vitiligo.

Material and methods: This is a prospective, single-blind, randomized split-body clinical trial involving 41 patients with resistant focal patches of vitiligo vulgaris. Each patient had two similar lesions randomly assigned to receive either a combination of FCO₂ laser, excimer lamp, and intradermal PRP injections or a combination of FCO₂ laser, excimer lamp, and topical 0.1% tacrolimus (applied twice daily for 12 weeks). The FCO₂ laser and PRP treatments were administered in three monthly sessions, and the excimer lamp was used twice a week over 12 weeks. The efficacy of treatment was assessed based on the physician's assessment and patient's satisfaction.

Results: Despite significant improvement in both treatment groups during the course of treatment, the PRP group showed significantly superior efficacy (more than 50% improvement) compared to the tacrolimus group (56.1% and 26.8%, respectively). Furthermore, the PRP group exhibited greater improvement in resistant acral areas compared to the tacrolimus group (51.2% and 19.5%, respectively).

Conclusion: The combination of FCO₂, an excimer lamp, and PRP demonstrates superior efficacy, particularly in resistant acral areas. As a result, this combination can be recommended in difficult-to-treat areas in patients with vitiligo.

Epidermal graft produced by suction is useful in treating vitiligo. However, it is very difficult to handle thin, flimsy, and translucent epidermis due to its in-curling and wrinkling properties. This is due to the hemispherical blister roof surface area which is twice its circular base. The correction of the epidermal surface and its resizing is a cumbersome and time-consuming task during epidermal grafting. To combat these problems, the blister roof is patched with micropore adhesive tape as a novel technique for harvestation and transfer of the suction blister graft.