Cosmetic Disfigurement Research Articles

Necrobiotic xanthogranuloma

Necrobiotic xanthogranuloma is a rare, chronic, progressive granulomatous disorder which manifests as yellowish plaques and nodules, most commonly in the periorbital region. The exact aetiology is not known. It is commonly associated with monoclonal gammopathy. Various treatment modalities used include chemotherapy, intralesional and systemic steroids, radiotherapy and surgical excision. We report a case of necrobiotic xanthogranuloma involving the periorbital area causing cosmetic disfigurement.

Successful and safe treatment of hemangioma with oral propranolol in a single institution

PurposeDramatic improvement of hemangioma to propranolol has been recently reported; however, details on dose and duration of treatment, potential risks, and monitoring have not been determined. The objective of this study is to describe and analyze the use of propranolol as a first-line treatment or as a single therapy in management of complicated hemangioma.MethodsA retrospective chart review of eight patients diagnosed with hemangioma and treated with propranolol in Kangbuk Samsung Hospital from February 2010 to April 2011 was performed.ResultsEight patients with hemangioma with functional impairment, cosmetic disfigurement, or rapid growth were treated with propranolol. Five patients had solitary facial hemangioma. The mean age of symptoms at onset was 5 weeks. The median age for starting propranolol treatment was 5.5 months. Propranolol at 2 mg/kg/day was finally administered in divided doses with a gradual increase. Significant regression was observed in seven patients, and shrinkage in size, softening in consistency, and decrease in redness were evident within 4 weeks. Among them, six patients were still taking propranolol, and one patient had stopped after 12 months. Other one patient did not show significant improvement with satisfactory result after 3 months of propranolol use. Treatment with propranolol was well tolerated and had few side effects. No rebound growth was observed in any of the patients.ConclusionWe observed that use of propranolol was very effective in treatment of hemangioma without obvious adverse effects or relapse.

Depigmentation therapies in vitiligo

Depigmentation therapy in vitiligo is an option in those with extensive vitiligo who have failed to respond to medical therapy and have obvious cosmetic disfigurement due to intervening patchy pigmented areas. Various aspects of this therapy such as the cost, treatment time, course, permanency of depigmentation, side effects, and the possibility of repigmentation should first be discussed with the patient. At present, there is no ideal depigmenting therapy available, but many agents in the market have been in use for many years. Monobenzyl ether of hydroquinone (MBEH) is the mainstay and Food and Drug Administration (FDA) approved in USA but takes many months to depigment and is associated with local side effects and risk of repigmentation. Other agents which are also used are 4-methoxy phenol and 88% phenol. Physical therapies for depigmentation include Q-switched ruby and alexandrite lasers and cryotherapy. Second-line agents which can be explored for depigmentation include imatinib mesylate, imiquimod, and diphencyprone. Many possible experimental agents are being explored like various phenol derivatives, melanoma vaccines, interferon gamma, busulfan, etc. A major lacuna still exists in this area and a lot more research is desirable to give satisfactory cosmesis to these patients with extensive vitiligo.

Health-Related Quality of Life in Patients with Nail Disorders

Fingernails and toenails are important organs of our body, serving as protection for the tips of fingers and toes. Fingernails also enhance fine touching and tactile sensitivity, as well as aid in the picking up of small objects. Healthy-looking nails are an important part of an individual's body image, and any nail abnormalities may be considered by patients as a significant cosmetic problem, markedly influencing their self-esteem. However, recent data have indicated that nail lesions are not only important because of cosmetic disfigurement, but may be a symptom of significant morbidity. Severe nail involvement was also shown to negatively impair social functioning and to interfere with work ability, thus markedly influencing a patient's well-being. Based on literature data and our own experience we conclude that nail diseases cause a marked decrease in health-related quality of life in a substantial percentage of patients. Nail changes are an important medical concern for patients and, therefore, nail diseases should raise attention and receive proper care from both physicians and other healthcare providers.

Surgical treatment of infantile hemangioma in a multidisciplinary vascular anomalies clinic

Objective(1) Discuss indications for surgical treatment of infantile hemangioma (IH); (2) describe outcomes, management of complications and long term surveillance of surgically treated IH. Study designRetrospective. Subjects and methodsThe charts of children seen in a dedicated vascular anomalies center at a tertiary pediatric hospital were reviewed. ResultsOut of 1012 patients diagnosed with IH over 27 months, 92 patients, predominantly caucasian female, with an average age of 36 months, underwent surgery for 94 lesions. Head and neck lesions accounted for 67% of the population and 51 lesions were located on the face. Surgical indications included bleeding, functional impairment, ulceration and cosmetic disfigurement. Mean surface area was 7.75cm2. Although lesions requiring additional procedures were larger (median 5.5cm2) than single-stage excisions, this difference was not statistically significant (P=0.09). Head and neck lesions were more likely to require multiple modality treatment (P=0.003). There was no identified objective criteria to predict head and neck lesions that are more likely to be associated post-operative complications. ConclusionsMost IH do not require treatment. The majority of infantile hemangioma occurred on the head and neck. When significant functional impairment, ulceration, bleeding, cosmetic deformity is encountered or anticipated, surgical therapy can be performed at any clinical phase with few complications and favorable outcomes.

Patterns and outcome of surgical management of goitres at Bugando Medical Centre in northwestern Tanzania

Despite the well established endemicity of goitres little work has been done on the management of goiters in Tanzania. A cross-sectional study was conducted at Bugando Medical Centre (BMC) in Mwanza, Tanzania to determine the pattern and outcome of surgical management of goitres. Data was collected using a pre-tested, coded questionnaire. A total of 152 patients were studied of which 140 (92.1%) were females and males were 12 (7.9%) (F: M = 11.7: 1). Their ages ranged from 18 to 72 years (mean =38.4± 12.5 years). The mean duration of illness was 9.2 years. The thyroid gland size at admission was grade III in 63.8% of patients. Multinodular goitres were reported in 51.3% of patients. The majority of patients (92.1%) presented with euthyroid goitres and the remaining (7.9%) patients had toxic goitres. Pressure symptoms and cosmetic disfigurement were the common indications for thyroidectomy in 47.4% and 23.7%, respectively. Near total thyroidectomy and total thyroidectomy were the surgical procedures performed for benign and malignant goitres in 47.3% and 8.1% of patients, respectively. Simple multinodular goitres were the most common histopathological pattern accounting for 67.2% of cases. Twelve (7.9%) patients had a histologically proven thyroid malignancy, of which follicular and papillary carcinoma were reported in 41.7% and 33.3% of cases, respectively. Post-operative complications rate was 7.9%. The mean length of hospital stay was 14.4 days (range 3 to 34 days). Five patients died giving a mortality rate of 3.4%. In conclusion, this study has shown that the pattern of surgical goitres seen at Bugando Medical Centre is similar to what is reported from other parts of the world. However, the majority of patients present for surgery very late with huge goitres predisposing them to increased risk of post-operative complications, prolonged length of hospital stay and cost of medical care. It is therefore recommended that health education should be given to the community about the cause, prevention and treatment options so that patients could seek early medical attention.

Giant Frontal Osteoma: Case Report with Review of Literature

Diagnosis of frontal osteoma is usually by chance, but rarely these can produce exceptional ophthalmologic and neurological complications apart from cosmetic disfigurement. Etiology of frontal osteoma may be multifactorial. Surgical management should be site and size specific. A combination of open surgery and endoscopic methods would help confirm complete removal of the tumor. Here we report a fronto-ethmoidal osteoma of size 7.1×5.3×5.1cm which is one of the largest reported in literature. Also, we have done an extensive web search and text based review of the literature on frontal osteoma in terms of its incidence, etiology, pathology, clinical presentation, complications and important developments in management. The available literature and our own experience suggest that even large osteoma arising in the fronto-ethmoid region can be completely removed surgically with minimum complications. The surgical approach can be varied according to the extent of the tumor and patient considerations. A regular follow up is necessary in asymptomatic cases being treated conservatively, in view of the potential complications.

Anophthalmos, Microphthalmos, and Typical Coloboma in the United Kingdom: A Prospective Study of Incidence and Risk

Anophthalmos, microphthalmos, and typical coloboma (AMC) form an interrelated spectrum of congenital eye anomalies that can cause significant visual loss and cosmetic disfigurement in children. This prospective study of children born in the United Kingdom was undertaken to determine the incidence of AMC diagnosed by ophthalmologists and to explore sociodemographic risks. Recruitment was achieved though an established active surveillance system of U.K. ophthalmologists supported by a new research network of interested specialists, the Surveillance of Eye Anomalies (SEA-UK) Special Interest Group. It started October 1, 2006, and continued over 18 months. One hundred thirty-five children were newly diagnosed with AMC. Typical colobomatous defects were the commonest phenotype, and anophthalmos was rare (n = 7). Both eyes were affected in 55.5% of the children. The cumulative incidence of AMC by age 16 years was 11.9 per 100,000 (95% CI, 10.9-15.4). Of the children examined, 41.5% had not seen an ophthalmologist by 3 months of age. The incidence in Scotland was nearly double that in England and Wales. The children of Pakistani ethnicity had a 3.7 (95% CI, 1.9-7.5) times higher risk of AMC than did white children. There was some evidence to suggest a higher incidence in the more socioeconomically deprived. The sibling risk ratio was 210 (95% CI, 25-722). This is the first prospective study of AMC, and it establishes the frequency across the United Kingdom. Comparisons with data quoted in the literature are difficult because study methodologies differ, but the frequency appears to be lower than that quoted for other developed countries. There are geographic and ethnic variations in incidence that warrant further investigation.

Basal Cell Carcinoma of the Face Diagnosed and X-rays Treated at Department of Dermatovenerology Sarajevo During the Period of 1996-2000

Introduction: Basal and squamous cell carcinomas are often grouped together and referred to as non-melanoma skin cancer. Basal cell carcinoma is the most common form of skin cancer. Basal cell skin cancer occurs on the face,nose, scalp, ears, hands, shoulders and back. Squamous cell carcinoma is the second most common type of skin malignancy. They are most often found on the face especially lower lip. Material and methods: The retrospective study included all patients by whom BCC was diagnosed during the period from January 1996 till December 2000 in Dermatology Department Clinical Center University of Sarajevo. Results: Number of BCC was 188. Male 98, female 90. Localization of BCC on the body in percents: upper lip: 8%, neck: 5%, trunk: 4%, hands: 7%, face: 76%. Representation of BCC on face: cheeks: 51, nose: 47, temporal region: 18, forhead: 17, periocular region:7, upper lip: 3. All of the patients were x-rays treated and cured without any failure, with one incident of radiodermatitis and one apparation of recurrences. Discussion: The prognosis for patients with BCC is excellent, with a 100% survival rate for cases that have not spread to other sites. Nevertheless, if BCC is allowed to progress, it can result in significant morbidity, and cosmetic disfigurement is common. Conclusion: The choice of therapeutic method depend on size, location, clinical type of BCC, age, general condition and attitude of the patient. Therapeutic methods can be surgery excision, cryosurgery, electrosurgery, radiotherapy and local cytostatics. Radiotherapy is indicated when BCC localization is inconvenient for surgical excision and it gives great results.

Current drug therapies for infantile hemangioma: focused on beta blocker

I hemangioma (IH), a common vascular tumor from vascular birth marks, used to be untreated due to its natural course of spontaneous regression with few exceptions like cosmetic disfigurement, functional or life impairment. It has been treated through a variety of methods like the topical and systemic corticosteroid, surgery, laser, etc. Among them, systemic corticosteroid, which has been used most commonly, may sometimes cause troublesome side effects such as temporary growth retardation or personality change, so it is often clinically inapplicable. Recently, however, it was reported that treatment using beta blocker for IH is more effective with fewer side effects than conventional treatments. Oral beta blocker has been used for IH patients who concerns about presenting ulcerative lesions, impending cosmetic sequelae or functional and life impairment. Before the administration of beta blocker, the patient goes through inquiry about clinical history, physical examination, electrocardiogram and echocardiography in order to determine the applicability. During the hospital stay, vital signs and blood glucose level are checked regularly to rule out side effects of beta blocker, and the dosage is increased gradually up to 2 mg/kg/day and the same dose is maintained continuously after discharge with same dosage. After considering many previous studies about beta blocker for IH patients, we reached an interim conclusion. The treatment of IH using beta blocker is effective, highly satisfactory and safe with no side effects though the selection from various beta blockers, evaluation methods of therapeutic efficacy and its duration and end point of treatment need to be confirmed.

Facial melanoses: Indian perspective

Facial melanoses (FM) are a common presentation in Indian patients, causing cosmetic disfigurement with considerable psychological impact. Some of the well defined causes of FM include melasma, Riehl's melanosis, Lichen planus pigmentosus, erythema dyschromicum perstans (EDP), erythrosis, and poikiloderma of Civatte. But there is considerable overlap in features amongst the clinical entities. Etiology in most of the causes is unknown, but some factors such as UV radiation in melasma, exposure to chemicals in EDP, exposure to allergens in Riehl's melanosis are implicated. Diagnosis is generally based on clinical features. The treatment of FM includes removal of aggravating factors, vigorous photoprotection, and some form of active pigment reduction either with topical agents or physical modes of treatment. Topical agents include hydroquinone (HQ), which is the most commonly used agent, often in combination with retinoic acid, corticosteroids, azelaic acid, kojic acid, and glycolic acid. Chemical peels are important modalities of physical therapy, other forms include lasers and dermabrasion.

Single miniplate osteosynthesis in angle fracture

Aim:The present study was designed to study the feasibility of single miniplate osteosynthesis in the fracture of angle of mandible.Materials and Methods:in this study 110 patient were included and treated with single miniplate osteosynthesis at upper border along champy's line of osteosynthesis.Results:All the cases were treated successfully, common complications which we have observed in this study, cosmetic disfigurement, delayed union, infection, wound dehiscence and paresthesia.Conclusion:Single miniplate fixation in unfavorable fracture is questionable and hence these fracture require some alternative method (locking plate, etc.) for fixation.

1064 nm Q switched Nd: YAG laser treatment of nevus of Ota: An Indian open label prospective study of 50 patients

Nevus of Ota is very common in Asians. Estimated male to female ratio is 1:4.8. Patients seek treatment early in life due to psychological trauma and cosmetic disfigurement. The creation of high power, short pulse Q switched lasers has recently provided tools for considerable therapeutic advances in the treatment of dermal pigmented lesions. To determine the efficacy and side-effect profile of Q switched Nd:YAG Laser (QSNYL) in fifty Indian patients. Fifty patients of nevus of Ota underwent multiple treatments (average 5 sessions) at monthly intervals carried out over a period of 2 years with QSNYL (Med-lite C6). Of the 50 patients, 2 were males; and the rest were females. Skin types treated included phototype IV and V. The response after subsequent treatments was documented through serial photographs that were taken before and after every treatment session. Response to the treatment was graded based on quartile grading scale. Near total improvement was seen in 8%, marked improvement in 22%, moderate improvement in 38% and 32% patients reported less than 25% clearing of the lesion. All patients reported some improvement. Transient postinflammatory hyperpigmentation was observed in 4 (8%) patients, which cleared with use of sunscreens and bleaching agents within 2 months. No textural change or scarring was observed in any patient. QSNYL is an easy-to-perform and effective treatment in cases of nevus of Ota in Indian patients with few side effects.

Psoriasis as a psychodermatology disease

<p>Skin lesions have a strong influence on the mental health. Literature indicates the complex interrelationships between psychosocial factors and psoriasis, which substantially reduce the quality of life of these patients. These interrelationships are based on numerous interactions that exist between the immune, nervous and endocrine systems and they are the basis of interactions that exist between mental and somatic health and the environment. Psychodermatology was developed as a new interdisciplinary field, a connection between psychiatry and dermatology. More than just cosmetic disfigurement, psoriasis is associated with various psychopathological problems that may have an impact on patients, their families and society. Numerous psychological disturbances occur in patients with psoriasis. Also, a significant psychiatric comorbidity was found in patients with psoriasis. Exacerbation of psoriasis leads to a deterioration of mental health. The treatment of psoriasis requires an interdisciplinary approach of a dermatologist and a psychiatrist. Various forms of psychological interventions have been proposed as a potentially useful addition to a standard pharmacological treatment of psoriasis. </p>

A Surgical Approach for Stable Lesions of Linear Scleroderma

A 29-year-old Japanese woman presented with alopecia lesions in her occipital region and was diagnosed as linear scleroderma. Topical steroids along with psoralen and UVA light therapy were applied, but the lesion persisted. A surgical approach was therefore selected to treat the lesion. The resection was successful without any recurrence for 1 year. Sclerotic lesions on the exposed areas can cause cosmetic disfigurement, and surgery may be a useful modality for treating stable linear scleroderma.

Propranolol as first-line treatment for rapidly proliferating Infantile Haemangiomas

Infantile haemangioma is the commonest childhood tumour and approximately 10% requires treatment.(1,2) Recent reports have highlighted the impressive efficacy of propranolol in treating rapidly proliferating haemangioma. The aims of our study were to prospectively assess the efficacy of propranolol as a first line treatment for problematic haemangioma, and develop a treatment regime. 31 consecutive patients with rapidly proliferating infantile haemangioma with functional impairment or cosmetic disfigurement were treated with propranolol as a first line treatment. All patients had cardiovascular pre-treatment work-up and commenced on propranolol at 3 mg/kg/day. A rapid halt in haemangioma proliferation was seen in 100% of patients and significant regression in 87% of patients. This treatment is well tolerated and has little side effects. Since this study, our unit has adopted the policy of using propranolol as a first line treatment for all problematic proliferative infantile haemangiomas.

Symposia du 27e congrès de la SFE

Nodular goitres are enlargements of the thyroid gland. In the absence of thyroid dysfunction, autoimmune thyroid disease, thyroiditis and thyroid malignancy, they constitute an entity described as non-toxic nodular goitre, which occurs both endemically and sporadically. In the early phase of goitrogenesis, goitres are diffuse and, with time, such goitres tend to become nodular. Concomitantly, thyroid function often becomes autonomous, and therefore the patients gradually develop hyperthyroidism. Some non-toxic goitre patients have no symptoms at all, or just complaints of cosmetic disfigurement. In the diagnostic evaluation protocol, neck palpation and several imaging methods are available: ultrasonography (US), the new developed US elastography, scintigraphy, computed tomography (CT) scan and magnetic resonance imaging (MRI). Fine-needle aspiration biopsy (FNAB) provides the most direct and specific information about a thyroid nodule. Recently, a combination of cytology and molecular testing has shown significant improvement in the diagnostic accuracy and allowed for better prediction of malignancy in thyroid nodular disease.

Cutaneous Sarcoidosis

Sarcoidosis is a systemic disease with skin manifestations. Skin manifestations are classified as nonspecific if they are not characterized by granulomatous inflammation and specific if the lesions have granulomas histologically. Erythema nodosum is the most common nonspecific skin manifestation, and it portends a good prognosis. Specific skin lesions have a varied clinical appearance, although often they can be distinguished by their yellow translucent character. Despite the potential variable appearance, there are common clinical presentations. Lupus pernio lesions are nodular violaceous specific skin lesions found predominantly on the face associated with scarring and a poor prognosis. Treatment of cutaneous sarcoidosis is primarily done to avoid scarring and cosmetic disfigurement. Local and systemic corticosteroids are the mainstay of treatment for the disease. Corticosteroid-sparing agents used to manage the disease include antimalarials, methotrexate, and tetracycline antibiotics. Tumor necrosis factor-alpha (TNF-alpha) antagonists such as infliximab may have a role in cutaneous sarcoidosis, especially in refractory cases that are resistant to the standard regimens.

An Unusual Case of Turban Tumor Syndrome Treated With Total Scalp Excision and Advancement Flap and Skin Graft Reconstruction

We report an unusual case of aggressive turban tumor syndrome in a 38-year-old woman with nodules covering her scalp and involving her face, neck, chest, and back. To address concerns regarding hygiene of the scalp and cosmetic disfigurement, she underwent total scalp excision with advancement flap and skin graft reconstruction. Histologic examination of the scalp tumors revealed a predominance of spiradenomas, along with cylindromas and trichoepitheliomas, and tumors containing elements of all 3 of these adnexal neoplasms. We review the literature regarding turban tumor syndrome including the genetic basis for this condition, clinical features, pathology, and treatment.

Combined AlloDerm ® and thin skin grafting for the treatment of postburn dyspigmented scar contracture of the upper extremity

Postburn dyspigmented scar contractures of the upper extremity often require aesthetic improvement. The ideal reconstruction of this deformity remains a challenge because the various available skin grafts and flaps result in skin colour mismatches, prominent marginal scars and donor morbidity. Postburn scar contractures and dyspigmented areas of the upper extremity can be improved by a combination of dermabrasion and Alloderm(®) graft over scar-releasing defect. Their raw surfaces are subsequently re-surfaced with thin split-thickness skin graft (0.005-0007 inches thick). Twenty-seven patients with wide dyspigmented scar contractures of the upper extremity underwent the combined techniques described by us. The median patient age at burn incidents was 3 years and at operation was 24 years. Median thin skin graft area was 180cm(2), and the median AlloDerm(®) graft area was 40cm(2). Thin skin and AlloDerm(®) grafts took root completely in all patients without re-grafting. Follow-up periods ranged from 30 to 67 months (average 47.6 months). Re-pigmentation was achieved in all cases and all scar contractures were adequately released and treated with an AlloDerm(®) graft. Paired differences between preoperative and postoperative parameters as determined by the Vancouver Scar Scale (VSS) were significant. Focal hypertrophic scar and reddish-coloured graft sites gradually improved over 3-4 years postoperatively. Graft margin and donor scars were inconspicuous. Our described combined technique was found to treat these deformities effectively. We suggest that the use of Alloderm(®) and thin skin grafting be considered in patients concerned about this type of cosmetic disfigurement.