Cosmetic Disfigurement Research Articles

Role of empirical antitubercular therapy for chronic mastitis—A prospective study

Objectives Chronic mastitis (CM) is an uncommon inflammatory condition of the breast, clinically mimicking malignancy with variable etiological factors. It often recurs, causing cosmetic disfigurement and hampering the quality of life of affected females. Limited literature reveals underlying bacterial infection as causative agents in a few cases, while the majority belong to idiopathic entities. CM can be seen as two histological types—chronic granulomatous mastitis (CGM) and chronic nonspecific inflammatory infiltrates (NGM). Etiological and ethnic variations exist globally, and there is lack of information from India. Understanding this entity is important for undertaking etiology-based therapy and preventing unnecessary mismanagement. Materials and Methods We evaluated the demographic, imaging profile and management protocol of CM patients presenting to a tertiary care center in India. Clinically suspected CM patients were prospectively evaluated by mammography and ultrasound (USG). USG-guided biopsy was performed for histopathological and microbiological analysis and treatment was administered accordingly. Response assessment was conducted at six months through USG and clinical evaluation. Results Out of the 53 clinically suspected CM patients, 48 biopsy-proven CM patients were enrolled (five breast carcinoma cases were excluded). All 48 patients were females, with a mean age of 36 ± 9 years. The most common symptom was a unilateral painful lump with skin discoloration. The etiology was idiopathic in 58.3% of cases, tuberculosis in 29%, and bacterial in 4%. Mammography revealed focal asymmetry, architectural distortion, and trabecular thickening. USG showed tracking fluid collections, microlobulated hypoechoic masses, and skin thickening. Etiology-based treatment was administered, and all patients showed 90–100% resolution between four and six months. Conclusion Mammography and USG are important for raising the suspicion while histopathology and microbiological analysis are mandatory for accurate treatment of CM. In India, idiopathic and tubercular etiology of CM is encountered and patients respond well to therapy.

Smashed skin grafting in stable vitiligo: Efficacy and safety

Background: Vitiligo is a common skin disorder that entails cosmetic disfigurement due to depigmentation and carries a social stigma. Smash grafting is an easy-to-master surgical treatment modality for stable vitiligo that has failed to respond to other treatments. The technique involves procuring a thin skin graft from a donor site, smashing it into the thinnest possible pieces, and grafting the smash onto the dermabraded vitiligo site. Objective: To analyze the efficacy and safety of smash grafting in patients with stable vitiligo. Materials and Methods: Thirty patients underwent smash grafting in stable recalcitrant vitiligo lesions. The patients were randomly placed in groups A and B. Group A received PUVASOL therapy postprocedure, while group B received only sunlight exposure after smash grafting. The patients were followed up every month for 3 months to assess repigmentation of the grafted site compared to the patient’s normal skin color. Results: Repigmentation was noticed at the grafted site starting as early as 3 weeks postprocedure in all the patients, and an increase in pigmentation intensity was observed until the end of the study follow-up. At the end of the 3-month follow-up, 76.66% of the patients had regained 50% or more pigmentation of the involved lesion. Conclusion: Smash grafting provided excellent repigmentation in >75% of patients without any significant complications. It is a simple and effective surgical technique that is underutilized. Furthermore, this procedure is less resource-intensive and easier to master than other surgical techniques for vitiligo.

Skin fibrosis is accompanied by increased expression of secreted frizzled-related protein-2.

Dermal fibrosis is a consequence of damage to skin and is accompanied by dysfunction and cosmetic disfigurement. Improved understanding of the pathological factors driving skin fibrosis is critical to development of therapeutic modalities. Here, we describe that the Wnt signalling antagonist SFRP2 is upregulated in organotypic keratinocyte cultures upon experimental reduced hydration, a model that simulates the aberrant epidermal barrier state characteristic of several skin pathologies, including those that manifest in development of fibrosis. Consistent with this, we find that SFRP2 is overexpressed in both the dermis and epidermis of human hypertrophic scar tissue and lesional tissue of a mouse scleroderma model. Knockdown of SFRP2 expression in human fibroblasts antagonises proliferation and myofibroblast differentiation, including deposition of type I collagen, suggesting that SFRP2 signalling in fibroblasts may contribute to propagation of fibrosis in hypertrophic scar, as well as in other clinical indications characterised by skin fibrosis.

Primer on Embolic Agents and Sclerosants for the Treatment of Vascular Malformations.

Vascular malformations (VMs) are a heterogeneous group of arterial, venous, capillary, and/or lymphatic networks that typically are present at birth and grow with the patient. Signs and symptoms associated with VM range from absent to severe, with a broad spectrum of pain, cosmetic disfigurement, and local tissue destruction. Treatment options for these malformations extend from observation to surgical reconstruction. Each treatment modality has a role in the management of vascular anomalies, but also has specific challenges. Observation is not always sufficient, medical therapies may only be available for a subset of patients and are ultimately not curative, and surgical excision may itself be disfiguring or incomplete/not definitive. Sclerotherapy and/or embolotherapy have become a cornerstone of treatment for many types of VMs. These techniques are applicable to a wide range of VMs, are less invasive, have a shorter recovery period, and are repeatable. Although some VMs may not be amenable to percutaneous or endovascular treatment given their location, and multiple sessions may be required for select large and complex VMs, these minimally invasive treatments are often first line and may be definitive in treating VMs. Various agents may be used in sclerotherapy and embolotherapy, each with their own risks and benefits. Although there is a paucity of Level 1 evidence supporting the superiority of one agent over another, longstanding case series and expert experience exist, informing our knowledge of the safety and efficacy of sclerotherapy and embolotherapy. A brief overview of the most used sclerotherapy and embolotherapy agents and their uses is provided.

Multidisciplinary approach to hand arteriovenous malformations: treatment strategies and clinical outcomes - insights from a 25-year experience at a single vascular anomalies center

ObjectiveHand arteriovenous malformations (AVMs) are extremely difficult to manage for their functional importance and cosmetic disfiguration. A single-center retrospective study was conducted to identify long-term outcomes of multidisciplinary team management of hand AVMs. MethodsInstitutional review board approved this retrospective study. Multidisciplinary vascular anomalies center data was reviewed from 1995 to 2023. Patient demographics, Schobinger’s AVM stage, sclerotherapy details, surgical history, and adverse events after sclerotherapy were reviewed. ResultsA total of 150 patients with hand AVMs visited our hospital from 1995 to 2023, with a mean age of 33 years (range, 1-75 years), and 91 were females. Forty-four patients were Schobinger stage II, and 106 were stage III. Sclerotherapy was performed on 101 patients (67%) with 320 sessions. Angiographic devascularization rates after sclerotherapy were: 16 with 100%, 30 with over 90%, 34 with 50% to 90%, 15 with 0% to 50%, and six showed aggravation. Sclerotherapy-related adverse events occurred in 123 of 320 sessions (39%), with 112 minor and 11 major events. Fifteen patients (15%) eventually underwent amputation surgery a mean of 1618 days after sclerotherapy for necrosis (n = 3) and delayed complications (n = 12). Thirteen patients (9%) underwent primary surgical amputation for ulcers or bleeding (all Schobinger stage III). Thirty-six patients (24%) were followed without any procedure. ConclusionsMultidisciplinary management of hand AVMs shows varied long-term outcomes. Although sclerotherapy is effective for many patients, it carries a significant risk of adverse events. The necessity for amputation in some cases highlights the severity of advanced AVMs and the need for individualized treatment approaches.

Evaluation of therapeutic efficacy of tranexamic acid compared to modified Kligman formula in the management of melasma

Background: Facial melanoses (FM) are a common presentation in Indian patients, causing cosmetic disfigurement with considerable psychological impact. Melasma is an acquired non-inflammatory hypermelanosis of multifactorial etiology with significant cosmetic deformity. Different treatment modalities have been tried in different studies with varying outcomes. Recent clinical trials with tranexamic acid (TXA) are promising. Objective: To compare the therapeutic efficacy of TXA topical application after micro-needling and intralesional TXA with the modified Kligman formula in the management of melasma. Materials and Methods: This is a prospective, randomized, open-label study with a sample size of 45 patients with melasma fulfilling inclusion and exclusion criteria. They were randomly divided into three groups of 15 each. Group A individuals were advised to apply a modified Kligman formula daily at night for 3 months, Group B individuals weekly micro-needling followed by TXA application for 3 months, and Group C individuals intralesional TXA (4 mg/mL) weekly for 3 months. Clinical and dermoscopic images were taken at each visit, including modified Melasma Area Severity Index (MASI) scoring, patient global assessment, and physician global assessment to assess the clinical response. Results: Group A showed a 42% improvement in MASI score by the end of 12 weeks, Group B showed a 30% improvement, and Group C showed a 36% improvement. When statistically compared with the Analysis of Variance test, there was no significant difference (P = 0.62) between the three groups. However, in individual groups, there was a significant difference (P < 0.05) in MASI at 0 and 12 weeks. Dermoscopic images showed perilesional hypopigmentation and telangiectasias with a modified Kligman formula, which was not seen with TXA. Patient assessment score revealed satisfaction with the modified Kligman formula because of home application and lack of pain. Conclusion: The modified Kligman formula is found to be superior in the treatment of melasma, because of the synergistic activity of its components. However, it has its demerits of long-term usage like hypopigmentation and telangiectasias. Hence, TXA that showed comparable results with the Kligman formula can be used either as a primary modality or as an adjuvant supportive therapy for maintenance.

Techniques and Surgical Nuances of Management of Comminuted Fronto-Orbital Depressed Fractures: A Single-Surgeon Experience

AbstractCompound fronto-orbital depressed fractures (FODFs) are complex fractures involving the frontal and orbital bones, with associated lacerated wounds on the skin. Repairing such fractures is challenging and requires a multidisciplinary approach. Surgical indications include cerebrospinal fluid rhinorrhea, exposed brain matter, frontal sinus fractures, vision impairment, and cosmetic disfigurement. The repair is typically done using titanium implants (low-profile plates [LPPs] and screws) for a good functional outcome.In this case series of 10 patients operated by a single surgeon (RG), we present different techniques for repairing FODF. Early surgery (< 48 hours) was performed to minimize infection risk.Surgical steps included elevation of depressed fragments, dural repair, and reconstruction of orbital walls using LPP. Some cases required inside-out fixation or suture fixation for better alignment of fragments. Autograft was used for severe bone loss.The results showed good functional outcomes with minimal infection rates. Primary single-stage repair using titanium implants provided satisfactory cosmesis. The use of inside-out repair and sutures was beneficial in specific cases.In conclusion, primary repair of FODF with titanium implants is safe and effective, reducing morbidity and cost. Early surgery and proper techniques are crucial for successful outcomes. Longer follow-up is needed to assess long-term viability and bone resorption.

A Systematic Review on Management of Infantile Hemangiomas: How Far We Have Reached in this Past Decade

Infantile hemangioma (IH) is a common condition in children. It may lead to cosmetic disfigurement, functional impairment, and various complications. There are various treatment options available for this condition. This article aims to discuss the various therapeutic options available for the treatment of IH. We searched PubMed, Google Scholar, and Embase (from December 2013 to December 2023) for human studies/case reports/case series assessing the management of IH. We reviewed 198 papers including different therapeutic regimens. β-blockers other than propranolol, such as nadolol, timolol, atenolol, acebutolol, and captopril, have shown comparable results to propranolol. Pulsed dye laser (PDL) and neodymium-doped yttrium aluminum garnet laser have shown promising results. Other therapies observed were sclerotherapy, cryotherapy, and surgical resection. A conventional combination of β-blockers with a laser might be the first-line treatment to arrest the growth of IH. PDL has shown promising results.

Glimpses on Rare Cases of Thigh Swellings – A Case Series

Swelling in the thigh is one of the commonly presenting condition in surgical OPD which draws curiosity among surgeons about the exact pathology and their management. These long standing swellings are mostly soft tissue tumors which are usually painless but draws attention due to their increasing size and cosmetic disfigurement. We are presenting six unusual cases of thigh swellings which are pathologically rare including Giant Baker’s cyst, Hydatid cyst and Schwannoma of thigh. One patient with secondary metastatic inguinal lymph nodes from malignant melanoma was referred to cancer institute for further management. All other patients were evaluated and surgically managed by excision and biopsy. There were no post-operative complications during 3 months follow-up period.

Benign Lipomatous Soft Tissue Tumors in Nigerians: An Analysis of the Clinical and Morphological Features of a Common but Important Entity.

Introduction Benign lipomatous tumors are soft tissue tumors that exhibit a predominant adipocytic phenotype. Lipomas are the archetype and are the most common benign soft tissue tumors in adults but relatively uncommon in children. Their sex incidence is equivocal. They sometimes occur in combination with other mesenchymal elements, giving rise to variants including fibrolipoma, angiolipoma, myolipoma, spindle cell lipoma, chondroid lipoma, osteolipoma, and chondrolipoma. Their clinical significance is mainly due to the cosmetic disfigurement of patients and the differential diagnosis of malignant soft tissue tumors. Occasionally, due to their large size or presence near vital organs, they may cause life-threatening and/or excruciating pressure symptoms. This study was purposed to address the dearth of local studies on the clinical and morphological characteristics of benign lipomatous tumors in Nigerians, to compare these with those of other populations, and to establish baseline data. Materials and methods This was a retrospective study of all benign lipomatous tumors seen in the anatomic pathology and forensic medicine department of Asokoro District Hospital, Abuja, Federal Capital Territory, Nigeria, over an eight-year period. Surgical pathology reports were retrieved for patients' biodata and clinical information. The appropriate slides were retrieved, and reviewed, and new sections were cut where necessary. The tumors were classified according to the 2020 World Health Organization (WHO) guidelines and categorized based on size as small, medium, or giant. The data obtained were analyzed, and the results were presented as tables, bar charts, ratios, and percentages. Results Four hundred and eighteen cases met the inclusion criteria. Of these, 58.4% (244/418), occurred in females, while 41.6% (174/418) occurred in males. The age range was six to 91 years, while the median age was 42 years. The least number of cases, 0.5% (2/418), were seen in patients aged less than 10 years, while the majority, 35.4% (148/418), occurred in the fifth decade, followed by 27.8% (116/418) in the fourth. Size-wise, the majority of tumors, 60% (253/418), were medium, followed by small, 22.8% (95/418). Giant-sized tumors significantly accounted for 16.7% (70/418) of the cases. The diagnostic spectrum comprised conventional lipoma and variants such as fibrolipoma, spindle cell lipoma, pleomorphic lipoma, angiolipoma, chondrolipoma, intramuscular lipoma, and osteolipoma. Lipoma and fibrolipoma dominated with 87.1% (364/418) and 10.0% (42/418), respectively, while the rest accounted for <3%. The majority, 31.8% (133/418), occurred in the back/shoulder region, followed by the lower limb with 18.2% (76/418). Only two cases occurred in the abdominal/pelvic region. More tumors occurred in females in all the regions except the head and neck, which had a male-to-female ratio of 1.5:1. Multiple site tumors were more common in males in a ratio of 2.5:1. Most, 41.1% (39/95), of the small-sized tumors, occurred in the head/neck region, largely involving the face, 48.7% (19/39). Conclusion Our study showed many similarities in the clinical and morphological features of benign lipomatous tumors between Nigerians and other regions of the world. A notable finding, however, was the significantly higher proportion of giant benign lipomatous tumors when compared tostudies from other regions, a finding that warrants further studies.

Effectiveness of combination use of intralesional steroid with 5-fluorouracil in the treatment of keloid patients

Background: Keloids are a common problem with significant recurrence rates despite intralesional steroid treatment and 5-fluorouracil in combination with triamcinolone may be superior to triamcinolone alone. Objectives: To evaluate the effectiveness of the combination use of intralesional steroids with 5-fluorouracil in the treatment of keloid. Methods: The study was a descriptive cross-sectional study and was conducted at the Department of Dermatology and Venereology, Khwaja Yunus Ali Medical College (KYAMC), Enayetpur, Sirajganj, from July 2020 to June 2021. A total of 100 patients with keloid were included in this study. These patients were subjected to history, clinical examination, and investigations. In all cases, informed written consent was taken from the Participants and a separate case record form was used during data collection. Collected data were analyzed by the statistical software IBM SPSS 25. Results: This study shows that the majority (68%) of patients belonged to the age group of 21-30 years. The mean age was 26.43±7.77 years. Regarding sex, 56% were females and 44% were males with a male-female ratio of 1.3:1. 52% of patients had a duration of lesion up to 1 year, 22% of patients had 1-2 years and 26% of patients had &gt;2 years. The most common site of keloid was the chest (38%), then face (32%), upper extremity (16%), shoulder (6%), back (4%). The most common presenting symptoms were pruritis (56%), then 38% were cosmetic disfigurement, 32% were skin discoloration, 28% were pain and 18% were restriction of movement. Trauma was the commonest factor seen in 34% of the patients followed by ear piercing (22%) and infection (20%). Other causes were spontaneous (10%), acne (6%), burns (6%), and post-surgical keloid (2%). 16 had a positive family history of the keloid disease. The majority (70%) had good outcomes followed by excellent outcomes in 22% and 8% had average outcomes. It was observed that most patients (88%) did not have any adverse effects. Only 12% had adverse effects seen as skin ulceration (6%), skin atrophy (4%) and telangiectasia (2%). Conclusion: This study revealed that the combination use of intralesional steroids with 5-fluorouracil in the treatment of keloid seems to offer the balanced benefit of faster and more efficacious response with fewer adverse effects. Treatment has to be individualized and can be combined with one or more modalities to aim for better efficacy and safety. Mediscope 2024;11(1): 41-47

Skin Diseases in Patients With Primary Psychiatric Conditions in Northern India: A Cross-Sectional Study.

The relationship between skin diseases and psychiatric illnesses is bi-directional and is manifested as cause and effect. Psychiatric disorders such as stress, anxiety, and depression are seen to be instrumental in the development and progression of dermatological diseases on one hand, while on the other hand, cosmetic disfigurement caused by dermatological diseases is responsible for psychological distress in patients. The present study was conducted to investigate the spectrum of dermatological disorders in psychiatric patients to offer them holistic treatment andprovide them with a better quality of life. This cross-sectional, observational study wasconducted at a tertiary medical care center. A total of 170 psychiatric patients referred to the dermatology department for different dermatological manifestations were enrolled in the study. A demographic profile of the patients was done, and an association between dermatological diseases and psychiatric illnesses was done. Out of 170 study participants, 88 (51.8%) were females, and the rest (82, 48.2%) were males.A total of 13 major types of dermatological conditions were noted; among them, fungal infection (43, 25.3%) was the most common, followed by eczema (18, 10.6%), parasitic infestation (17, 10.0%), pigmentary disorder (13, 7.6%), acne (11, 6.5%), bacterial infection (11, 6.5%), pruritic disorder (11, 6.5%), hair disorder (9, 5.3%), drug reaction (9, 5.3%), papulosquamous disorder (7, 4.1%), and viral infection (6, 3.5%). Skin conditions other than the above-mentioned were present in 15 (8.8%) patients.The most common psychiatric illness in the present study was major depressive disorder (41, 24.1%), followed by generalized anxiety disorder (38, 22.4%) and psychosis not otherwise specified (34, 20.0%). Other psychiatric illnesses included in the study were bipolar affective disorder (22, 12.9%), schizophrenia (18, 10.6%), obsessive-compulsive disorder (12, 7.1%), and mixed anxiety depressive disorder (5, 2.9%). The findings of the present study depict that psychiatric patients with dermatological manifestations show a spectrum of dermatological conditions, primarily of infectious (fungal, parasitic, or viral) nature. This might be associated with a relatively poor hygienic status of psychiatric patients and thus their increased susceptibility to these disorders. Most of the time, the susceptibility to these skin conditions seemed to be opportunistic and unaffected by the type, duration, and level of control of psychiatric illness.

Guide Flange Prosthesis: A Case Report

This article introduces the concept of guide flange prosthesis as a rehabilitative solution for patients undergoing hemi-mandibulectomy due to oral squamous cell carcinoma (OSCC). OSCC is a prevalent malignancy, particularly in India, necessitating surgical resection that often leads to functional impairments and aesthetic challenges. Mandibular continuity loss results in issues like mandibular deviation, occlusal plane rotation, and cosmetic disfigurement. The guide flange prosthesis, discussed through a case report of a 45-year-old male post-hemi-mandibulectomy, aims to stabilize the remaining mandibular segment, reduce deviation, and enhance chewing function. The article emphasizes the importance of comprehensive rehabilitation, especially when dental implants may be contra-indicated due to radiotherapy. The case involves the fabrication process of the prosthesis using perforated partial impression trays, irreversible hydrocolloid, and a stainless steel orthodontic wire substructure. The patient's successful adaptation to the guide flange prosthesis, providing stability and improved mastication, highlights its significance in the post-resection phase. The article also discusses the prevalence of oral cancers in India, surgical interventions, and the role of innovative approaches like guide flange prostheses in addressing the challenges of oral cancer reconstruction. Overall, the integration of surgical techniques and prosthetic interventions offers hope for enhanced outcomes in the complex landscape of oral cancer rehabilitation.

Warts Among Patients Visited Two Private Dermatology Clinics in Aden, Yemen: A Retrospective, Descriptive Study

Background: Cutaneous warts are benign lesions that occur in the mucosa and skin. Objectives: To find out the distribution of cutaneous warts related to sex and age, and to determine the occupation of patients, type of cutaneous warts, site, duration from onset of the disease, complication and treatment. Materials and methods: Two hundred and twelve patients were presented to our clinics in Aden, during the period January 2020 to December 2022 with cutaneous warts. Data including sex, age, occupation, type of warts, site of warts, duration from onset of warts, complications and treatment. Data are presented as mean values with the standard deviation (SD). Results: The study patients were 118 (55.7%) males and 94 (44.3%) females. The age of the study patients ranged between 4 to 65 years. The mean age of the study patients was 27.3 ± 13.7 years. Most of the patients 68 (32.1%) were of age group 21 – 30 years followed by the age group 31 - 40 years with 48 (22.7%) (p = 0.000). Most of occupation of the study patients were laborer (43.4%). Common types of cutaneous warts were predominant (40.6%) (p = 0.000). Face was predominant site in (28.3%) patients. Itching complications found in (25.5%) followed by cosmetic disfigurement (17.9%). Cryotherapy treatments were predominant with (52.8%). Conclusion: Cutaneous warts occurred in younger patients and located on face, upper and lower extremities, sole, genital site, and neck &amp; axilla. Most treatment was cryotherapy. Further studies are needed, to identify the epidemiology of these cutaneous diseases in Aden. Keywords: Cutaneous warts, patients, private clinic, Aden, Yemen.

Osteoid osteoma total resection at frontal bone. case report

Frontal osteomas are benign neoformations, which often remain asymptomatic throughout a patient’s life or develop a cosmetic disfigurement. Diagnosis is usually by chance, and can result from various stimuli, such as accidental or surgical trauma, acne scars, and skin tumors, however in the absence of currently known triggering factors. Case report: 85 years female patient who reports the onset of the current disease 20 years prior to the first medical consult, characterized by a progressive frontal tumor growth that was self-detected, with an aesthetical awkwardness and progressive headache. At the frontal region she had an impressive increase in volume is evidence emerging from the external cortical of the frontal bone, non-mobile consistency, adhered to deep planes. For this reason, a simple tomographic study was performed and shows a probable osteoid osteoma. The patient was taken to the operation room, performed a transverse incision in the line of implantation of the scalp, division through planes and soft tissues until reaching a bone lesion at the expense of the external table of the left frontal region, and was completely resected. The histological results of the biopsy reports an osteoid osteoma. Discussion: despite the increasing use of endoscopic procedures, open approach via coronal incision remains the gold standard for frontal sinus osteoma with lower recurrence rates. Conclusion: Osteoid osteomas are a relatively frequent benign bone tumors that have a slow growth and are usually asymptomatic, however with the past of the years can develop headache and cosmetic uncomforted.

Effect of Chalazion on Corneal Astigmatism

A common eyelid disease chalazion causes eye morbidity due to inflammation and cosmetic disfigurement. Important factors in corneal refractive surgery, intraocular lens power calculations for cataract surgery and visual acuity assessments are corneal topographic changes. For better outcome of ocular surgery corneal astigmatism should be corrected earlier. The aim of this study is to evaluate changes in corneal astigmatism according to chalazion size and location. Methods: This cross-sectional study was conducted in saveetha medical college and hospitals, Thandalam , Department of Ophthalmology Outpatient department. A total of 44 eyes from 33 patients were included in the chalazion group and 70 eyes from 46 patients comprised the control group. Chalazia were classified according to location and size. An autokeratorefractometer and a dual-Scheimpflug analyzer were utilized to evaluate corneal changes. Result: Oblique astigmatism was greater in the chalazion group compared with the control group (p &lt; 0.05). Astigmatism by simulated keratometry (simK), steep K by simK, total root mean square, second order aberration, oblique astigmatism, and vertical astigmatism were significantly greater in the upper eyelid group (p &lt; 0.05). Astigmatism by simK, second order aberration, oblique astigmatism, and vertical astigmatism were significantly greater in the large-sized chalazion group (p &lt; 0.05). Corneal wavefront aberration was the greatest in the upper eyelid chalazion group, whole area group, and large-sized chalazion group (p &lt; 0.05). Conclusions: Large-sized chalazion in the upper eyelid should be treated in the early phase as great changes in corneal topography were noticed. Corneal topography should be performed preoperatively before chalazion is treated.

Evaluation of Micro-Needling Followed by Tranexamic Acid Cream versus Micro-Needling Followed by Tranexamic Acid Solution in Treatment of Melasma: A Comparative Split Face Study

Abstract Background Melasma is a common pigmentary disorder clinically characterized by symmetric light brown to bluish-gray macules and patches with irregular, sharp borders that affect cutaneous areas, particularly the face and neck. It is commonly identified in women of reproductive ages and more commonly described in darker-skinned patients with Fitzpatrick skin types IV to VI residing in high-intensity ultraviolet radiation worldwide. It causes significant cosmetic disfigurement, psychosocial stress, and embarrassment, affecting patients’ quality of life. Objectives To evaluate the efficacy and safety of microneedling followed by tranexamic acid (TXA) cream application versus microneedling followed by tranexamic acid solution in the treatment of facial melasma. Patients and Methods This prospective split-face comparative study included thirty female patients with different types of melasma, their ages ranged from 25 to 40 years. They were recruited from the Dermatology outpatient clinic of Ain Shams University Hospitals. All patients have been treated with TXA for 3 sessions; one session every month (the right side of the face was treated by microneedling followed by TXA 5 % cream while the left side of the face was treated by microneedling followed by TXA solution 5%). Additionally, the right side of the face was treated with TXA 5% cream, and the left side applied with placebo cream twice daily for 3 months. Assessment was done by Hemi Melasma Area and Severity Index score (Hemi -MASI), patients’ satisfaction score, clinical digital photography, dermoscopic examination and area percentage of melanin concentration assessed by histopathological examination. Results Our findings showed significant improvement in different types of melasma regarding Hemi MASI score, patients’ satisfaction score, and area percentage of melanin concentration assessed by histopathological examination by Fontana-Masson stain (FM) one month after 3rd treatment session in both sides of the face. However, a minor melasma recurrence was observed two months after 3rd treatment session on both sides of the face. Meanwhile, no significant difference was observed in the treatment response of microneedling followed by TXA cream versus microneedling followed by TXA solution one month after 1st and 2nd sessions regarding Hemi MASI score, while a significant difference was observed one month after the 3rd session. Conclusion Topical TXA appears to be a promising therapeutic option in the treatment of melasma without serious adverse effects. Topical TXA cream, which was applied twice daily by the patient combined with microneedling sessions with TXA cream, has better results in comparison with microneedling sessions with TXA solution with placebo cream.

Public perceptions of abortion complications

Misinformation contributes to the perception that abortion has substantial health risks, despite the known safety of medication and aspiration abortion. We lack detailed information about which health risks the public believes are most likely. This study aimed to describe public perception of short- and long-term risks of abortion. We conducted a cross-sectional survey of US residents aged ≥18 years using Amazon Mechanical Turk (MTurk). We collected information regarding participant demographics, reproductive history, political views, and position on abortion restrictions. We provided participants with a list of 9 short-term and 15 long-term possible complications and asked them to indicate whether they occurred never (0%), very rarely (<1%), rarely (1%-5%), occasionally (5%-20%), or frequently (>20%) following abortion. We used descriptive statistics to understand our population demographics and to capture the perceived incidence of all complications. We created a binary indicator of answering all risk estimates incorrectly vs at least 1 estimate correctly, separately for all long-term possible complications, and the 2 short-term risks of infection and bleeding. We determined the proportion of individuals who responded incorrectly to all questions in each category and used multivariable logistic regression to identify factors associated with incorrect perceptions about the risks of abortion. For all listed complications, participant (N=1057) estimates of risk were higher than the known incidence. For both short-term risks of bleeding and infection, over 40% of participants reported that these outcomes occur occasionally or frequently. Similarly, for both long-term risks of depression and anxiety, over 60% of respondents reported that these outcomes occur occasionally or frequently after abortion. Participants reported that possible complications known to not be associated with abortion, including hair loss, future pregnancy complications, breast cancer, and cosmetic disfigurement, occurred at least rarely. Nearly one-quarter of participants responded that death occurs occasionally or frequently (in over 5% of abortions), and 79% of participants responded that breast cancer can result from abortion. One-quarter (24.9%) of participants incorrectly overestimated both short-term outcomes of infection and bleeding, whereas 19.5% answered all long-term complication questions incorrectly, including outcomes that never occur. On multivariable analyses, we identified that the participants most likely to incorrectly identify risks of abortion identified as Asian or Black race/ethnicity, were from rural communities, or believed that abortion should have more legal restrictions. The public perceives abortion to be much riskier than it actually is. This information can be used to develop targeted clinical and public health efforts to disseminate the true risks of abortion.

Acquired Hallux Varus Deformity Correction: Pivotless Distraction Technique.

Acquired hallux varus deformity secondary to postburn contracture is a rare condition. It causes cosmetic disfigurement, pain, and inability to wear a shoe. Soft-tissue procedures and tendon transfers have been described for correction; however, these may require multiple operations and the outcome may be poor. We report a 6-year-old neglected case of hallux varus deformity secondary to burn contracture successfully managed by contracture release with pivotless distraction technique using a biplanar distractor and skin grafting with Z-plasty in the same procedure. The deformity was corrected to a lesser extent and with good functional outcomes. The scar was excised and Z-plasty was performed. The medial joint capsule was released. We used gradual differential distraction with monitoring on sequential radiographs. Pain-free flexion of 45° and extension of 40° were achieved and the patient was able to wear shoes after 4 weeks postoperatively. Hallux varus is a multidimensional deformity. A severe and rigid deformity might not respond well to tendon transfers in a single stage. Our described technique can be used to correct rigid hallux varus deformity with preservation of joint function.

A Comparative Study to Evaluate the Efficacy of Fractional CO2 Laser + PRP Vs. Fractional CO2 Laser Alone in Patients with Vitiligo.

Vitiligo is a multifactorial acquired disorder clinically characterized by amelanotic lesions on the skin, due to destruction of melanocytes. The course of vitiligo is unpredictable. Vitiligo causes significant psychological impact and cosmetic disfigurement. Treatment of vitiligo is challenging and requires a multidisciplinary approach. A prospective comparative interventional study was carried out from October 2018 to March 2020. The study enrolled 60 stable vitiligo patients divided into groups A and B. Group A (30 patients) was treated with both fractional CO2 laser and autologous platelet-rich plasma (PRP) injection. Group B (30 patients) was treated with fractional CO2 laser alone. A total of four sessions were conducted in each group at 1-month interval along with photographic assessment. Final assessment was done 1 month after the completion of four sessions. In group A, the median values of repigmentation and visual-analog score (VAS) were 3 and 7, and in group B, the median values of repigmentation and VAS were 1 and 2, respectively. Lesions over the trunk showed the best response followed by face and extremities lesions. Acral lesions showed the least response. A combination of fractional CO2 laser and PRP is superior to fractional CO2 laser alone in the treatment of stable vitiligo.