Niti Khunger

Complications of tattoos and tattoo removal: Stop and think before you ink

Tattooing is a process of implantation of permanent pigment granules in the skin. Tattoos can be decorative, medical or accidental. There has been a exponential increase in decorative tattooing as a body art in teenagers and young adults. Unfortunately there are no legislations to promote safe tattooing, hence complications are quite common. Superficial and deep local infections, systemic infections, allergic reactions, photodermatitis, granulomatous reactions and lichenoid reactions may occur. Skin diseases localised on the tattooed area, such as eczema, psoriasis, lichen planus, and morphea can be occasionally seen. When used as a camouflage technique, colour mismatch and patient dissatisfaction are common complications. On the other hand, regrets after a tattoo are also seen and requests for tattoo removal are rising. Laser tattoo removal using Q-switched lasers are the safest; however, complications can occur. Acute complications include pain, blistering, crusting and pinpoint hemorrhage. Among the delayed complications pigmentary changes, hypopigmentation and hyperpigmentation, paradoxical darkening of cosmetic tattoos and allergic reactions can be seen. Another common complication is the presence of residual pigmentation or ghost images. Scarring and textural changes are potential irreversible complications. In addition, tattoo removal can be a prolonged tedious procedure, particularly with professional tattoos, which are difficult to erase as compared to amateur tattoos. Hence the adage, stop and think before you ink holds very much true in the present scenario.

Prevalence of Chlamydia trachomatis and its association with other sexually transmitted infections in a tertiary care center in North India

The asymptomatic nature of chlamydial genital infections coupled with the occurrence of severe sequelae in untreated patients, makes the laboratory evaluation of great importance in the diagnosis of the disease. Genital chlamydial infections are the leading cause of preventable sexually transmitted infections (STIs) worldwide, with 43 million new cases in Southeast Asia. The present study was designed to determine the prevalence of genital chlamydial infection in women attending a sexually transmitted disease (STD) outpatient department and to determine the association of the disease with other STIs. A total of 276 female patients with a complaint of genital discharge or ulcer were enrolled for the study. Genital discharge specimens (endocervical, vaginal, and urethral swabs) were collected from all the patients. The patients were investigated for the presence of antigen and antibody of Chlamydia trachomatis with the help of the Direct fluorescent Antibody test (DFA) and the Enzyme Linked Immunosorbant Assay (ELISA), respectively. Investigations for aetio-pathogens of other STIs were carried out using the standard methods. Chlamydial infection was found in 19.9% of the patients (10.1% by DFA technique and 10.9% by ELISA). Both the antigen and antibody were positive in only three (1.1%) cases. The overall incidence of other aetio-pathogens was low. In two (0.7%) cases multiple infections were seen. Chlamydia trachomatis was found to be most commonly associated with Candida albicans . However, there was no co-infection of Chlamydia trachomatis with Neisseria gonorrhoeae .

Mastering surgical skills through simulation-based learning: Practice makes one perfect

Simulation-based learning in surgery is a learning model where an environment similar to real life surgical situation is created for the trainee to learn various surgical skills. It can be used to train a new operator as well to assess his skills. This methodology helps in repetitive practice of surgical skills on nonliving things so that the operator can be near-perfect when operating on a live patient. Various models are available for learning different dermatosurgery skills.

Complications of skin biopsy.

Skin biopsy is the most commonly performed procedure by the dermatologist. Though it is a safe and easy procedure yet complications may arise. Post operative complications like wound infection and bleeding may occur. It is essential to keep the potential complications of skin biopsy in mind and be meticulous in the technique, for better patient outcomes.

In vitro antimicrobial susceptibility patterns of Propionibacterium acnes isolated from patients with acne vulgaris

INTRODUCTIONnPropionibacterium acnes has been implicated in the development of acne vulgaris. Rampant use of topical and systemic antibiotics for acne vulgaris has led to resistance due to selective pressure. This study aimed to determine antibiotic resistance of P. acnes.nnnMETHODOLOGYnA total of 102 samples were collected from acne lesions and cultured onto sheeps blood agar and brain-heart infusion agar supplemented with 5 g/L glucose and 2 mg/L furazolidone) (BHIg) under aerobic and anaerobic conditions. Species identification was done by conventional methods and the VITEK2 Compact system. The isolates were tested for penicillin, erythromycin, clindamycin, ciprofloxacin, nadifloxacin, and tetracycline by E-test, and minimum inhibitory concentration (MIC) of minocycline was determined by agar dilution on BHIg. MIC results were interpreted as per EUCAST (European Committee on Antimicrobial Susceptibility Testing) and CLSI (Clinical Laboratory Standards Institute) guidelines.nnnRESULTSnP. acnes was the most common anaerobe (66%) isolated. Resistance rates using EUCAST and CLSI breakpoints were 10.6% and 6.1%, 7.6% and 0%, 7.8% and 0% for erythromycin, clindamycin, and minocycline, respectively. Tetracycline resistance was observed in 9.2% isolates irrespective of the interpretative criteria used. MIC50 and MIC90 values for nadifloxacin (0.25 and 1 µg/mL) were found to be twofold lower than those for ciprofloxacin (0.5 and 1 µg/mL). Similarly, MIC50 and MIC90 values for minocycline (0.125 and 0.5 µg/mL) were also two- to threefold lower than those for tetracycline (0.38 and 1 µg/mL).nnnCONCLUSIONSnTo the best of our knowledge, this is the first study focusing on P. acnes resistance from India.

Angiolymphoid Hyperplasia with Eosinophilia Treated with a Novel Combination Technique of Radiofrequency Ablation and Sclerotherapy

&NA; The authors have indicated no significant interest with commercial supporters. [Correction added after online publication 12‐February‐2010: The author names have been corrected]

Is lesional stability in vitiligo more important than disease stability for performing surgical interventions? results from a multicentric study

Background: Ensuring stability of the disease process is essential for undertaking surgical intervention in vitiligo. However, there is no consensus regarding the minimum duration of stability or the relative importance of disease and lesional stability in selecting patients for vitiligo grafting. Aim: This multicentric study aims to assess the relative importance of lesional and disease stability on selecting patients for vitiligo grafting. Materials and Methods: One hundred seventy patients were recruited into the study and divided into two groups: Group A with lesional stability of >1 year but overall disease stability of only 6-11 months and Group B with overall disease stability of >1 year. Patients underwent either tissue or cellular vitiligo grafting on the selected lesions and the repigmentation achieved was scored from 0 (no repigmentation) to 6 (100% repigmentation). Repigmentation achieved on different sites of the body was compared between the two groups. Adverse effects at both the donor and the recipient sites were also compared. Results: Of the 170 patients who were enrolled, 82 patients were placed in Group A and 88 patients in Group B. Average repigmentation achieved (on scale of 0 to 6) was 3.8 and 4.04 in Group A and Group B, respectively. In Group A, ≥90% repigmentation was achieved in 36.6% (30/82) patients, while 37.5% (33/88) achieved similar results in Group B. Additionally, 47.6% (39/82) and 53.4% (47/88) of cases achieved partial repigmentation in Group A and Group B, respectively. Perigraft halo was the commonest adverse effect observed in both groups. Statistical analysis revealed no significant differences between the two groups with respect to the repigmentation achieved or adverse effects observed. Repigmentation achieved was the best on the face and neck area, while acral areas responded the least. Conclusions: Lesional stability seems to be as relevant as the overall disease stability in selecting patients for surgical intervention in vitiligo.

Procedural Techniques in Management of Topical Corticosteroid Abuse

Topical steroids are one of the most abused creams among dermatological products because of their strong anti-inflammatory action being misused for acne and fungal infections and hypomelanotic activity where they are misused as “fairness creams.” This leads to adverse effects such as skin atrophy, striae, acneiform eruptions, telangiectasia, hypertrichosis, and masking of skin infections. Management of these adverse effects is a long-drawn process due to steroid dependence and difficulty in reversing the cutaneous side effects. Most of these are managed with medical treatment, but occasionally procedural treatments are required to expedite therapy. Chemical peels for the treatment of acne, lasers, and light systems for the treatment of telangiectasia, striae, and hypertrichosis are the common procedures that can be of benefit, if chosen wisely and according to patient’s skin type. The need of the hour is appropriate patient and society education regarding the potential adverse effects of topical corticosteroids following inappropriate use to stem the epidemic of steroid misuse.

Accelerated wound healing: Harnessing the power of platelets, biomaterials, stem cells and gene therapy

The goal of accelerated wound healing is reduced morbidity and less scarring, that can result in tremendous savings of time and money, besides improving the quality of life. Various techniques are being introduced to improve wound care and hasten wound closure. Any injury or break in the skin sets into motion a sequence of events to repair the wound that is characterised by the movement of specialised cells into the wound site. This process of wound healing has four distinct phases that overlap with each other; haemostasis, inflammation, proliferation and remodelling.[1] Wound healing begins as soon as the tissue is injured. As blood spills into the site of injury, the platelets come into contact with exposed collagen and extracellular matrix, releasing clotting factors, to achieve haemostasis as well as essential growth factors (GFs) and cytokines to repair the wound. These GFs include platelet‐derived GF, transforming GF beta, vascular endothelial GF (VEGF), platelet‐derived epidermal GF, insulin‐like GF‐I and basic fibroblast GF (bFGF) to name a few. Neutrophils followed by the macrophages then begin to phagocytose bacteria, damaged tissue and other foreign materials, as part of the inflammatory phase. Following this, fibroblasts migrate and begin the proliferative phase which deposits new extracellular matrix and collagen. During the final remodelling phase, the newly laid collagen matrix becomes organised and cross‐linked. Numerous cell‐signalling events and cytokines are required to orchestrate these events, and there is a constant endeavour to accelerate wound healing when it is lagging or is deficient. This can be achieved using various regenerative techniques.

Crossing surgical borders: Where are we, where are we going and can we find the way?

213 There has been intense debate nowadays on what surgical procedures a speciality must do or must not do, particularly among dermatosurgeons, plastic surgeons, oculoplastic and maxillofacial surgeons. Now, dentists and gynaecologists have jumped the fray with each specialist treading on anothers toes. Should dermatosurgeons do blepharoplasty or leave it to the oculoplastic surgeon, should plastic surgeons do chemical peels, vitiligo surgery and non‑invasive or minimally invasive lasers or let it be the domain of dermatologists? Should maxillofacial surgeons do hair transplant, should dentists do botulinum toxin injections? Who should do liposuction and who should do non‑invasive body contouring? Should gynaecologists do aesthetic treatment and should dermatosurgeons and plastic surgeons do non‑invasive vaginal tightening or leave it to the gynaecologist? Which speciality is best for facial cancer surgery; the dermatosurgeon, Mohs surgeon, plastic surgeon, maxillofacial surgeon or the cancer surgeon? This blurring of surgical borders is causing confusion and heartburn, especially when it comes to teaching and training. Have we lost the wisdom in our quest for money and knowledge? The main reason for this confusion is the evolution of medicine and surgery. The introduction of minimally invasive procedures has forced everyone to change. Patients want least invasive procedures, with minimal downtime. Technological advances in machines such as lasers, radiofrequency and therapeutic ultrasound make aesthetic rejuvenation simpler. Procedures such as soft tissue fillers for face, lip and nose contouring, botulinum toxin for wrinkle reduction and follicular unit extraction in hair transplant make aesthetic surgery easier and accessible to learn and master, irrespective of basic training. This paradigm shift in aesthetic medicine and surgery has led to blurring of borders. New data released by the American Society of Plastic Surgeons show a shift in the types of procedures patients have chosen, with minimally invasive procedures such as botulinum toxin Type A (up 1% from 2014 and 759% since 2000), soft tissue fillers (up 6% from 2014 and 274% since 2000), chemical peels (up 5% from 2014 and 14% since 2000), laser hair removal (unchanged from 2014, but up 52% since 2000) and microdermabrasion (down 9% from 2014 and 8% since 2000) showing a steep rise, while traditional plastic surgery procedures such as breast augmentation, liposuction, nose reshaping and eyelid surgery showing a gradual decline from 2000. [1] Hawks in associations cry for regulations and restrictions, while the doves want to settle for a middle path. Can associations dictate what another speciality …