Left Cheek Research Articles

30% supramolecular salicylic acid peels effectively treats acne vulgaris and reduces facial sebum.

Acne is a chronic inflammatory skin disease with high incidence and recurrence. To study the efficacy of 30% supramolecular salicylic acid (SSA) in the treatment of acne, especially its effect on facial sebum secretion and the skin barrier. Chemical peeling treatment with SSA using self-contrast was performed every 2weeks for a total of four treatments in 25 patients. VISIA photographs and skin parameter measurements were recorded at every treatment, with a 2-week follow-up after the last treatment. We performed skin biopsy and immunohistochemical staining to detect sterol response element-binding proteins (SREBPs), fatty acid synthase (FAS), and cyclooxygenase 2 (COX2), which are important factors involved in the regulation of sebum metabolism. The global acne-grading system (GAGS) score of patients with acne decreased with 30% SSA treatment. The sebum level in the nose (p<0.001), chin (p<0.001), left cheek (p<0.05), and right cheek (p<0.05) improved significantly with increasing number of treatments. The T-zone sebum level (p<0.001) improved more than the U-zone (p<0.01). The VISIA index porphyrin score also reduced (p<0.001). Skin hydration (p<0.001), transepidermal water loss (TEWL) (p<0.05), and pH value (p<0.01)-reflecting the skin barrier-were also improved. Immunohistochemistry showed decreased expression of SREBPs, FAS, and COX2. Peels with 30%SSA effectively treated acne and reduced facial sebum secretion without damaging the skin barrier. Reduction of sebum showed cumulative effect, which suggests that multiple 30%SSA chemical peels are beneficial to acne patients.

Repair of an Extensive Defect of the Left Central Cheek.

Repair of an Extensive Defect of the Left Central Cheek.

No effects of transcranial direct current stimulation on visual evoked potential and peak gamma frequency.

Evidence suggests that the visual evoked potential (VEP) and gamma oscillations elicited by visual stimuli reflect the balance of excitatory and inhibitory (E-I) cortical processes. As tDCS has been shown to modulate E-I balance, the current study investigated whether amplitudes of VEP components (N1 and P2) and peak gamma frequency are modulated by transcranial direct current stimulation (tDCS). Healthy adults underwent two electroencephalography (EEG) recordings while viewing stimuli designed to elicit a robust visual response. Between the two recordings, participants were randomly assigned to three tDCS conditions (anodal-, cathodal-, and sham-tDCS) or received no-tDCS. tDCS electrodes were placed over the occipital cortex (Oz) and the left cheek with an intensity of 2mA for 10min. Data of 39 participants were analysed for VEP amplitudes and peak gamma frequency using mixed-model ANOVAs. The results showed no main effects of tDCS in any metric. Possible explanations for the absence of tDCS effects are discussed.

Lentigo Maligna on a Difficult Location of the Face Treated with 5% Imiquimod: A Case Report of 2-Year Follow-Up.

Topical imiquimod is an off-label alternative treatment for lentigo maligna used when surgery cannot be performed. Severe inflammatory response induced by this drug may generate many complaints and force patients to discontinue use. We present a case in which interval treatment with 5% topical imiquimod was implemented for severe inflammatory response. An 82-year-old Caucasian woman presented with a large, irregularly pigmented lesion on her left cheek within the scar of a previously excised melanocytic lesion diagnosed as junctional nevus. Based on dermatoscopical examination confirmed by histopathological description, lentigo maligna was diagnosed. Since the lesion was large and covered the lower left eyelid and due to the risk of disfigurement, the patient refused surgical excision. Therefore, treatment with imiquimod 5% once daily, five times per week, was offered. After 5 weeks, the treatment was stopped because of intense inflammatory reaction and ulceration. On the follow-up visit after 3 months, videodermatoscopical examination revealed changes in the pigmentation of the lentigo maligna including the presence of residual gray dots and fading of the previous dark brown and black colors. The inflammatory response had almost resolved. The second course of treatment with imiquimod five times a week was implemented again for 5 weeks, and after a 2-month interval the third course with the same regimen was started. Total clearance of the lesion was achieved, which was confirmed by videodermatoscopical examination. During the 2-year follow-up, no relapse was observed based on dermatoscopical examination. We propose interval treatment with topical imiquimod 5% lentigo maligna for severe inflammatory reactions in patients with contraindications to surgery. This could help patients overcome this typical response effect and decrease their cessation of treatment.

Effect of Phototherapy on Demodex Parasıte Densıty.

Demodex parasites are the most common ectoparasites in humans. One of the factors in the pathogenesis of an increase in parasite density is immunosuppression. In this prospective study, we aimed to evaluate the effect of phototherapy-induced immunosuppression on Demodex density. Thirty-five patients receiving phototherapy were included in the study. The number of parasites in the samples taken from the right cheek, left cheek, forehead, nose and chin of the patients, by standardized skin surface biopsy method, were recorded before phototherapy and in the third month of treatment. Of the 35 patients, the female-to-male ratio was found to be 2.1:1. There was no statistically significant difference between the ages of the male and female patients. The increase in the number of parasites in the right cheek, left cheek, nose and chin in the third month was statistically significant; whereas the increase in the forehead was not. The results of our study showed that phototherapy can cause an increase in Demodex density, and these findings are compatible with those of other studies in the literature. Since our study aims to evaluate density at the beginning and the end of the third month of phototherapy, it differs from other studies by indicating the effect of phototherapy more accurately.

A case of a delayed granulomatous reaction on the face following microneedling: A case report

Background:Microneedling is a common non-invasive procedure used for a variety of dermatologic conditions. It is associated with a low rate of adverse events which are typically temporary. Hypersensitivity reactions, including granuloma formation, are a rare adverse event, with only 10 cases previously reported.Case Summary:We report a case of a 49-year-old female who presented with asymptomatic edematous erythematous annular plaques on her left cheek following a microneedling procedure in which a Vitamin C cosmeceutical was applied to the skin beforehand. Skin biopsy confirmed non-necrotizing granulomatous dermatitis with negative tissue cultures. Systemic workup for sarcoidosis was negative.Conclusion:Delayed facial granulomatous reaction is an uncommon adverse event following microneedling. Increased risk may be related to peri-procedure use of cosmeceuticals such as Vitamin C. Given the popularity of microneedling, and that it is an unregulated procedure, it is important for dermatologists to be aware of this possible sequela in order to counsel patients appropriately and understand management options.

Amelanotic Malignant Melanoma of Buccal Mucosa: A Case Report

Amelanotic melanoma is an atypical variation from pigmented malignant melanoma. The clinical lack of pigment compromises the physician’s clinical diagnosis of the lesion. Presence of certain features like red hair, freckles, photosensitivity, previous history or family history predispose the possibility of occurrence of amelanotic melanoma. As the name suggests, the lesions lack pigmentations clinically and mimic many benign and malignant lesions which can be life threatening and thus, cause a diagnostic challenge. Hence, clinicians are expected to have a high suspicion on such lesions, and also judiciously employ biopsy ,thus eluding the possibility of emerging of lethal lesions. About 50% of head and melanomas occur in the oral cavity. Of all the melanomas, 2% are amelanotic and majority of them occur in oral cavity. These lesions pose a greater degree of threat, because of the possibility of delayed diagnosis. The timely clinical and laboratory diagnosis favours the patient prognosis. No specific aetiologic factors or risk factors have been recognised for oral melanomas. Hereby, the authors present a case of 60-year-old female patients with ulceroproliferative growth in the left cheek region, which was provisionally diagnosed as malignant ulcer, immunohistochemical investigation of the biopsied sections revealed the diagnosis of amelanotic melanoma. The present case report illustrates the need of addition of a panel of Immunohistochemistry (IHC) markers in the routine diagnosis. The application of such panels avoid the delay in diagnosis and scale-up the prognosis.

A-T flap for cheek reconstruction

The cheek is the largest anatomical unit of the face. In this area, surgical skin cancer treatment must aim for its complete eradication and the best aesthetic-functional result. A 69-year-old woman presented with a 3.5 cm tumor in the left cheek for three years. Biopsy showed moderately differentiated squamous cell carcinoma. We performed an A-T flap, where the surgical defect corresponded to the “A” and the junction of the inferior orbital, nasofacial, and nasolabial grooves, to the top of the “T”. The patient evolved without recurrence and had an excellent aesthetic-functional aspect.

The Law of the Left Cheek: On Involuntary Con jectures while Quoting from Memory in Light of Statistical Analysis

The Law of the Left Cheek: On Involuntary Con jectures while Quoting from Memory in Light of Statistical Analysis

Comparison between the diagnosis of acne vulgaris by teledermatology and face-to-face consultations

Background: Acne vulgaris is a common skin disorder in the pilosebaceous unit that is self-limited, especially in adolescents. Adam Malik Hospital in Medan reported the incidence of acne vulgaris to be 1.10%. Telemedicine has become popular in recent years, especially during the COVID-19 pandemic. SAF teledermatology using digital cameras has also increased patient service satisfaction, promising diagnostic reliability and clinical outcomes similar to face-to-face visits. This study aimed to compare teledermatology's diagnostic test parameters and accuracy and face-to-face consultations in diagnosing acne vulgaris.Methods: This study was an observational analytic study with a cross-sectional design involving 110 suspected acne vulgaris. The characteristics of sex and age were recorded. The resident established the diagnosis of acne vulgaris directly and teledermatologically by the consultant based on photo documentation of 5 facial lesion areas, namely the forehead, chin, right cheek, left cheek, and the entire face, along with the photo with photos from the history submitted by the resident. Diagnostic tests were carried out, including sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and an agreement test.Results: Acne vulgaris was more common in women (76 patients, 69.1%) and patients aged 18-22 years (55 patients, 50%). Of 110 patients, 105 were diagnosed with acne vulgaris by face-to-face consultations and teledermatology. Teledermatology showed 100% sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. The agreement test between teledermatology and face-to-face consultations was 1, indicating favorable agreement.Conclusion: There was no significant difference in the diagnosis of acne vulgaris through teledermatology and face-to-face consultations.

EMBOLIZATION IN RECURRENT SOFT TISSUE AMELOBLASTOMA EXCISION OF THE MANDIBLE

Background: Recurrent ameloblastoma can occur after radical treatment, 13.3% up to 19% involves soft tissue. Case of recurrent mandibular ameloblastoma in soft tissue, bleeding is one of the risks that often occurs. One way to reduce intraoperative bleeding is by embolization. Purpose this studi to report the benefits of embolization to reduce intraoperative bleeding in the action of recurrent ameloblastoma in soft tissue. Method: Female patient 32 years old came to RSUP Dr. Sardjito with complaint of lump on her left cheek, with history of post-hemimandibulectomy ameloblastoma 14 years ago. Objective examination of the asymmetrical patient's face with swelling extends to the cheek and pain when pressed, and the size is around 10x10 cm. Embolization using PVA and gelfoam material done before the excision of the tumor to reduce the risk of bleeding. The excision in this case is using lip split method, with bleeding during surgery around 250 ml. Biopsy results after excision are multicystic ameloblastoma, some are follicular types and some are plexiform types Conclusion: The use of embolization in the case of recurrent mandibular ameloblastoma in soft tissue can reduce tumor size and reduce bleeding during surgery.

Treatment of superficial benign vascular tumors by high intensity focused ultrasound: Observations in two illustrative cases.

BackgroundExisting therapeutic methods for reduction or removal of superficial vascular malformations and tumors have high risks of scarring and other complications that result in aesthetic appearance less favorable than the baseline. Patients are often cautioned against intervention, which can lead to psychosocial problems and low self‐esteem. Improved treatment modalities are therefore relevant from both medical and aesthetic perspectives.MethodsTwo volunteer subjects were treated with a medical 20 MHz high intensity focused ultrasound device developed for dermatological conditions. One patient was given three treatments to remove a superficial congenital hemangioma on the left middle cheek. The other patient was given a single treatment to remove seven cherry angiomas on the thighs. Handpieces with nominal focal depths of 0.8 – 1.8 mm below the skin surface were used to administer acoustic energy of 1.1 – 1.2 J/dose. An integrated dermoscope in the handpiece was used to monitor the treatment in real‐time.ResultsDuring treatment, blood in the capillary network of the lesions was coagulated immediately, and capillary walls were collapsed due to the thermal and mechanical effects of the high intensity focused ultrasound. During the healing phase, the areas regenerated a normal skin structure with very limited scar or dyspigmentation. At follow‐up, a clear aesthetic improvement was observed over the baseline for all treated targets with the exception of two cherry angiomas, where focal depth and/or dose coverage had not been optimal.ConclusionHigh intensity focused ultrasound is concluded to be a safe and efficient skin treatment for benign superficial vascular malformations and tumors.

Use of quantum molecular resonance energy for managing postrhinoseptoplasty perilesional edema and ecchymosis.

Quantum molecular resonance (QMR) technology employs nonionizing high-frequency waves ranging from 4 to 64MHz to generate low-intensity quanta of energy that interacts with cellular components. To evaluate the efficacy and safety of QMR treatment on postoperative perilesional edema and ecchymosis in patients with rhinoseptoplasty or revision rhinoseptoplasty. In total, 30 patients were treated with QMR stimulation therapy (QMR group) once daily for 5days, while another 30 patients were treated with conventional icepack application (control group). The duration of perilesional edema and ecchymosis were comparatively evaluated according to anatomic regions. In both groups, the longest duration of postoperative edema and ecchymosis was found on the left anterior cheek, followed by the right anterior cheek, left lower eyelid, right lower eyelid, and right and left upper eyelids. The mean duration of overall postoperative perilesional edema was significantly shorter in the QMR group (2.0±0.8days) than the control group (4.6±2.0days); the mean duration of overall ecchymosis was also markedly shorter in the QMR group (2.9±1.5days) than control group (7.5±2.9days). Patient satisfaction after postoperative QMR treatment was rated as 2.2±0.8, whereas patient satisfaction in control group was rated as 1.6±0.9. Our clinical study demonstrated that postrhinoseptoplasty QMR treatment effectively reduces the duration of postoperative perilesional edema and ecchymosis without remarkable side effects. We suggest that QMR treatment can be considered as an alternative option for noninvasively managing postrhinoseptoplasty perilesional edema and ecchymosis.

Nicolau Syndrome after Endodontic Treatment: A Case Report

Calcium hydroxide has been used successfully in root canal therapy for many years. However, it can cause serious damage if it is inadvertently displaced into surrounding vital structures, resulting in thrombosis if displaced into blood vessels, damaging connective tissue, and causing skin necrosis. These adverse reactions are known as Nicolau syndrome (NS) or embolia cutis medicamentosa. Very few case reports have been published about these adverse effects of injecting calcium hydroxide beyond the apex during root canal therapy. A 16-year-old female patient was referred to the endodontic department of Hamad Dental Center for assessment after treatment by the maxillofacial surgery department for swelling and tissue necrosis that occurred after endodontic treatment in another clinic. When the patient initially attended the maxillofacial surgery department, she presented with swelling on the left side in the region of the maxillary left first permanent molar. On examination, there was a change in the color of the skin of the left cheek in that area along with some reported paralysis of the left side of her lips. Analgesics and antibiotics had already been prescribed at the referring clinic. Two weeks later, the patient developed a necrotic patch of skin on the same area. Subsequent evaluation at the endodontic department of Hamad Dental Center led to a diagnosis of NS. NS is a very rare iatrogenic condition. Displacing calcium hydroxide beyond the apex might increase the chance of NS. Clinicians should avoid overinstrumentation and forced injection of calcium hydroxide to prevent NS.

A case of facial skin ulcer caused by Mycolicibacterium mageritense after tennis ball bruising

A 69-year-old Japanese woman with untreated rheumatoid arthritis was hit on her left cheek by a tennis ball in November 20XX. Later, an ulcer gradually appeared on her left cheek. She presented to Komaki Municipal Hospital on September, 20(XX+1). Dermatological and histopathological findings are shown in Figures 1 and 2, respectively. The patient was administered topical and oral antifungal medications, however the ulcer region did not improve.

The Beneficial Effects of Collagen Tripeptide on Deep Wrinkling and Skin Moisturization: A Randomized Controlled Trial

Dietary collagen is now widely considered as an effective supplement to improve skin appearance by improving elasticity and moisturization. However, because the mechanism of absorption in the body is not clear, collagen-peptides are developed as an active ingredient in the health care market for skin. The aim of this study was to assess whether oral administration of collagen tripeptide (CTP) improves wrinkling and skin hydration. This was a double-blind, randomized, placebo-controlled trial. We evaluated skin changes after oral intake of CTP in participants 40-55 years of age who had wrinkles around their eyes and dry skin. They received either a test product with CTP (n=35) or a placebo (n=38) for 12 weeks. At weeks 0, 6, and 12, water contents were measured on the right and left cheek with a Corneometer®, and eye wrinkles were evaluated on both sides around the eyes by Primos CR. In the CTP group, roughness parameters were significantly reduced around the eyes. Additionally, the difference between the CTP and placebo groups was statistically significant. The capacitance for moisture significantly increased after oral supplementation of CTP. Interestingly, the capacitance was significant between the CTP and placebo groups after excluding participants who did not use sunscreen, used colored makeup at least five times a week, or slept less than 5 hours a day. Additionally, more 45 years of age women were significantly increased skin moisture compared to placebo group. Administration of CTP was well-tolerated, and no notable adverse effects were reported in either group. Oral supplementation of CTP is safe and helpful to the skin appearance, improving wrinkle formation and skin hydration.

FUNGAL DECEIT IN THE SETTING OF MYELODYSPLASTIC SYNDROME

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Myelodysplastic syndrome (MDS) refers to an heterogenous group of clonal hematopoietic disorders, characterized by peripheral blood cytopenia. This disorder may present with clinical manifestations of anemia, thrombocytopenia or neutropenia, including symptomatic anemia, progression to acute myeloid leukemia or infections. Patients with MDS and severe neutropenia are at high risk for bacterial infections, however infections may rarely occur secondary to fungal invasion. CASE PRESENTATION: This is a 71-year-old female with history of hypertension, hyperlipidemia, coronary artery disease and MDS with positive RAEB2 and p53, treated with decitabine. She was initially admitted with diagnosis of symptomatic anemia, after developing general malaise, with associated shortness of breath and lightheadedness 2 days prior. Denied fever, cough, chest pain, abdominal pain, hematemesis, hematochezia, melena, insect bites or recent travel. Vital signs showed temperature of 37°C, heart rate in 109 bpm and blood pressure of 115/70 mmHg. Initial physical exam was remarkable for conjunctival pallor. Laboratories revealed leukocytopenia of 0.7 x10^3/uL, anemia of 6.1 g/dL, thrombocytopenia in 95 x10^3/ uL and absolute neutrophil count in 0 cells/uL. Chest x-ray revealed no acute cardiopulmonary pathologies. She underwent transfusion of 2 units of PRBCs, after which hemoglobin levels reached 8.2 g/dL. Nevertheless, on the third day, she developed fever of 39.4C and non-productive cough, for which ongoing diagnosis of neutropenic fever was considered. Cultures were taken and was started on cefepime. Upon examination, she had decreased breath sounds and developed 1.5cm circular violaceous lesion on the left cheek, circular violaceous lesion on the hard palate, as well as, multiple 0.5cm circular violaceous lesions on the left lower extremity and abdomen. Chest CT scan exhibited bilateral upper consolidations, raising concern for possible disseminated Fusarium fungal infection, for which amphotericin B was started. Biopsies of the lower extremity's lesion, revealed cutaneous hemorrhage, however biopsy of the hard palate's lesion revealed aspergillus spp. These findings were consistent with invasive aspergillosis. DISCUSSION: Invasive aspergillosis refers to illness caused by pulmonary or extrapulmonary dissemination of Aspergillus spp. This condition is uncommon and occurs primarily in immunocompromised patients associated with therapy for hematologic malignancies, hematopoietic cell transplant or solid organ transplantation. Management should focus on prevention, prompt diagnosis, as well as early initiation of antifungal therapy. Surgery is reserved for severe cases. CONCLUSIONS: Tissue invasion is an unusual presentation of invasive aspergillosis, however its appearance in an immunocompromised individual should raise suspicion of fungal dissemination and further evaluation should be pursued. REFERENCE #1: M. Kousha, et al. European Respiratory Review 2011 20: 156-174 DISCLOSURES: No relevant relationships by Zulmarie Maisonet, source=Web Response No relevant relationships by Ivanisse Ortiz Velez, source=Web Response No relevant relationships by Francisco Tirado-Polo, source=Web Response No relevant relationships by Beltran Torres, source=Web Response No relevant relationships by Sharon Velez-Maymi, source=Web Response

Symptoms: Middle Ear Mass and Hearing Loss

Symptoms: Middle Ear Mass and Hearing Loss

Cutaneous Rosai-Dorfman disease: A case report

Pure cutaneous Rosai-Dorfman is distinguished from classic Rosai-Dorfman disease by isolated skin involvement without lymphadenopathy or systemic symptoms. Herein, we report a case of a 30 year-old-man with 16 months history of a slowly enlarging, asymptomatic, purple plaque on her left cheek following cutaneous leishmaniasis successfully treated. The histopathological examination showed dense infiltration of inflammatory cells involving the entire dermis, consisting of large macrophages with emperipolesis, S100 and CD68 positive, lymphocytes and plasma cells. The patient was treated with intralesional triamcinolone with a significant improvement. The present article aimed to emphasise the clinical, histological differential diagnosis and to share the tumoral presentation of cutaneous Rosai-Dorfman disease.

Osteosarcoma of the maxilla presenting as a chronic pyogenic abscess: A case report.

IntroductionOsteosarcoma of the maxilla is recorded as the least common of all bone malignancies. It exhibits a clinical behavior and natural history distinct from their counterparts of the trunk and extremities. Transformation from a chronic pyogenic abscess of the maxilla is even more unusual.Case summaryA 70 year old lady presented to our hospital with a hard, fixed and tender bony swelling in her left cheek. She had initially presented to a different hospital with a similar presentation which was excised after imaging and post excision was found to be a chronic pyogenic abscess. The swelling reappeared within one year and on re-excision was found to be a low grade paraosteal osteosarcoma of the hard palate. CECT and PET-CT work-up at our hospital showed a left maxillary sinus growth with prominent neck lymph nodes along with mediastinal lymphadenopathy and pulmonary metastasis. Final histopathology revealed ulcerated stratified squamous epithelium mucosa overlying a lesion suggestive of osteosarcoma.DiscussionComplete surgical excision with negative margins continues to be the mainstay of treatment, but osteosarcomas of maxillofacial region pose difficulties in obtaining tumour free margins because of their complex anatomy around the cranium. Surgery may be complemented by radiotherapy with or without chemotherapy. Small size of the tumour and low-grade histology have been assumed to reflect a better prognosis.ConclusionOsteosarcoma of maxillofacial region has variable appearance clinically as well as radiologically posing a diagnostic challenge for clinicians. Any chronic abscess or recurrent cheek swelling thus necessitates further suspicion and requires a full work-up to rule out this high risk malignancy.