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Published for the period of December -2024
Cover Star- Actress: Sheena
Photography: Will Simpson
Hair : @flok_by_bekim @bekim_personal
Makeup : @lule_loveshair
Hair asssitant : @cosmocollins
Styled by: @vinaa_shankar
Embracing the Festive Glow with Winter Skin Care and Aesthetic Dermatology
As the festive season ushers in moments of joy, togetherness, and celebration, it also brings with it the cool embrace of winter. While the crisp air and holiday cheer uplift our spirits, the season can also take a toll on our skin, making it a time to focus on care, nourishment, and rejuvenation.
Winter demands extra attention to our skin’s health. The drop in temperature and humidity can lead to dryness, irritation, and dullness, while the festivities often expose us to late nights, makeup, and stress that may further challenge our skin's resilience. This is where the synergy between winter skincare and aesthetic dermatology shines through, offering solutions that keep us glowing inside and out.
From hydration-focused treatments to advanced interventions that repair and rejuvenate, aesthetic dermatology offers a plethora of options tailored to the season. Chemical peels, hyaluronic acid-based treatments, and laser therapies can provide the much-needed boost to combat winter woes while ensuring we look our radiant best for holiday gatherings.
As we navigate this season of celebration, let us also remind ourselves to prioritize self-care. Whether it’s a luxurious skincare routine, a tailored aesthetic procedure, or simply staying hydrated, small efforts can make a big difference.
In this issue, we have articles on Applications of Hyaluronidase in Dermatology, Nail Surgery and Lasers in Nail Disorders, The Evolution and Techniques of Hair Transplant Surgery etc.
We hope these topics inspire continued innovation in the field.
Wishing you all a festive time of renewal and radiance!
HOPE YOU HAVE A GREAT READ
Thanks & Cheers
- Dom Daniel
Executive Editor & Publisher
Editorial Board Advisory Board
Dr. Manu Singh Walia
MD (Dermatology)
Consultant Dermatologist, Mumbai
Dr. Rupa Raote
MBBS, DDV
Dermatologist and Hair Transplant Surgeon The Wellness Co, Mumbai
Hyaluronidase is an enzyme recognized for its unique ability
to break down hyaluronic acid (HA), a key glycosaminoglycan present in the extracellular matrix (ECM) of human tissues. Initially introduced in clinical settings over 60 years ago, hyaluronidase was first employed to facilitate drug absorption, primarily in ophthalmic surgery. Since then, its applications have broadened significantly across medical fields, with dermatology and aesthetic medicine emerging as particularly prominent fields for its use. In dermatology, hyaluronidase is utilized not only for drug diffusion but also as an essential agent in managing complications from HA-based dermal fillers, which have become increasingly popular in
aesthetic treatments.
As non-surgical cosmetic interventions continue to gain traction, the role of hyaluronidase has expanded, making it a cornerstone in modern aesthetic dermatology. This article provides an in-depth exploration of hyaluronidase applications in dermatology, beginning with its historical usage and evolving into advanced, cuttingedge applications. We will examine how this enzyme facilitates not only aesthetic corrections but also plays an innovative role in drug delivery, tumor treatment, and scar management. By analyzing its historical development, current applications, and future potential, this review aims to highlight the full therapeutic scope of hyaluronidase in dermatology.
Historical Background
Hyaluronidase’s clinical utility was first recognized in the early 20th century, primarily for its “spreading effect”—a property that allowed it to enhance the permeability of tissue and promote the diffusion of drugs. The enzyme works by depolymerizing HA, which constitutes a large portion of the ECM, thereby reducing the viscosity of the tissue matrix. This degradation of HA not only facilitates drug movement through tissues but also reduces edema and helps with the dispersion of fluids. Initially approved for ophthalmic surgery, hyaluronidase soon became widely used as an adjunct to local anesthetics, allowing for faster onset and broader diffusion of anesthesia.
By the 1950s, the enzyme had gained popularity for enhancing regional anesthesia in ophthalmology and minor surgeries. Its action on the ECM led to further exploration in dermatology, where its potential to manage HA fillers became apparent with the rise of non-surgical aesthetic procedures. The enzyme’s early applications established a foundation for its current and future use, with dermatology becoming a field in which hyaluronidase’s role has grown significantly over the last two decades.
Mechanisms of Action of Hyaluronidase
Hyaluronidase is an endoglycosidase enzyme that primarily breaks down hyaluronic acid (HA) by cleaving the glycosidic bonds between HA’s disaccharide units. This action reduces the viscosity of the extracellular matrix (ECM), making tissues more permeable and enhancing the diffusion of injected substances, such as local anesthetics or therapeutic agents. In aesthetic dermatology, this property allows hyaluronidase to dissolve HA-based fillers by depolymerizing their HA content, a feature that has made it an essential tool for correcting filler-related complications.
Buhren, B.A., Schrumpf, H., Hoff, NP. et al. Hyaluronidase: from clinical applications to molecular and cellular mechanisms. Eur J Med Res 21, 5 (2016). https://doi. org/10.1186/s40001-016-0201-5
Types of Hyaluronidase
Hyaluronidase exists in six major isoforms: HYAL1, HYAL2, HYAL3, HYAL4, PH-20, and HYALP1. Each isoform has distinct properties,
influencing its activity and tissue interactions. In clinical practice, the most common forms of hyaluronidase are derived from either animal or recombinant human sources, with the following key types being used in dermatology:
1. Bovine and Ovine Hyaluronidase: Extracted primarily from animal testicular tissue, bovine and ovine hyaluronidases have been widely used due to their potent enzymatic activity. Bovinederived products and ovinederived products are wellestablished options in clinical settings. However, animalderived enzymes carry a higher risk of immune reactions, particularly in individuals allergic to animal proteins. A skin test is often recommended before use to mitigate potential allergic responses.
2. Recombinant Human Hyaluronidase: Human recombinant hyaluronidase has emerged as a safer alternative with a reduced risk of immunogenicity. This version is produced through recombinant DNA technology, eliminating animal proteins and offering a more controlled enzymatic activity. Its compatibility with the human immune system makes it suitable for patients with known allergies to animal-derived hyaluronidase.
3. Variability in pH Sensitivity and Enzymatic Action: Hyaluronidases are further classified based on their pH activation range. Acid-active hyaluronidases function optimally at a pH of 3 to 4, while neutralactive forms are effective at a pH range of 5 to 8. In dermatology,
Applications of Hyaluronidase in Dermatology
neutral-active hyaluronidase is generally preferred for localized injections as it aligns with the physiological pH, thereby enhancing its efficacy and patient tolerance during aesthetic corrections.
Factors Influencing Hyaluronidase Activity
The effectiveness of hyaluronidase in aesthetic and therapeutic applications is affected by factors such as HA concentration, degree of crosslinking and the depth of injection. Cross-linked HA fillers, which are designed to be more durable, require higher concentrations of hyaluronidase for effective dissolution. Additionally, the half-life of hyaluronidase in the body is relatively short, ranging from 30 minutes in subcutaneous tissue to a few minutes in plasma. This short duration necessitates precise, localized injections for optimal effect, particularly when treating vascular occlusions or filler-related complications.
Current Applications of Hyaluronidase in Dermatology
Hyaluronidase’s ability to break down hyaluronic acid (HA) has established it as an essential tool in modern dermatology, particularly in aesthetic medicine. With the rapid rise in non-surgical cosmetic procedures using HA-based fillers, hyaluronidase has become indispensable for managing filler-related complications, as well as for various therapeutic and aesthetic applications.
1. Management of HA Filler Complications
The primary use of hyaluronidase in aesthetic dermatology is to dissolve excessive or misplaced HA filler. As the popularity of HA fillers has grown, so too has the demand for corrective interventions. When HA-based fillers lead to overcorrection, asymmetry, or unintended outcomes like the Tyndall effect, hyaluronidase can be used to dissolve the filler material selectively and precisely.
One of the most serious complications of HA fillers is vascular occlusion, which can lead to tissue ischemia and necrosis if not promptly treated. In such cases, hyaluronidase is injected into the affected area to degrade the HA obstructing the blood vessel, restoring blood flow and preventing further tissue damage. Speed is
critical, with the best outcomes observed when hyaluronidase is administered within a few hours of the onset of occlusion. This application has made hyaluronidase an essential emergency drug in aesthetic dermatology practices.
2. Scar and Keloid Treatment
Hyaluronidase has shown promise in the treatment of hypertrophic scars and keloids, conditions characterized by excessive fibrous tissue and HA accumulation within the ECM. By degrading HA, hyaluronidase reduces tissue density and allows for better diffusion of therapeutic agents, such as corticosteroids. This combined approach has been found effective in flattening raised scar tissue, softening scar texture, and reducing redness.
Hyaluronidase is frequently combined with triamcinolone acetonide (TAC) or 5-fluorouracil (5-FU) to enhance scar treatment outcomes. Research indicates that the enzyme facilitates deeper penetration of these drugs into the dense fibrotic tissue, thereby amplifying their effects and reducing the volume of scar tissue. Patients treated with a combination of TAC and hyaluronidase experience higher rates of scar improvement compared to TAC alone, highlighting the enzyme’s utility as an adjunctive agent in scar management. Combination therapies using hyaluronidase in scar management also tend to show a lower incidence of side effects, such as skin atrophy, compared to high-dose corticosteroid monotherapy.
3. Enhancing Local Anesthesia Efficacy
Hyaluronidase has long been used to enhance the efficacy of local anesthetics, particularly in procedures requiring precise anesthesia with rapid onset. By reducing ECM density, hyaluronidase enables faster and broader diffusion of anesthetic agents, thereby increasing the area of numbness and reducing the required dose of the anesthetic. This is especially valuable in delicate areas, such as the face, where effective anesthesia is critical for patient comfort.
Hyaluronidase is commonly added to lidocaine and other anesthetics in dermatologic surgeries, including mole excisions, and minor reconstructive procedures. By enhancing drug diffusion, hyaluronidase allows for more predictable anesthetic effects, reduced injection discomfort, and minimized tissue distortion— qualities particularly beneficial for aesthetic procedures, where precision is key.
4. Treatment of Mucin Deposition Disorders
Hyaluronidase’s ability to degrade HA has led to its use in treating conditions characterized by abnormal mucin (HA) deposition, such as pretibial myxedema, scleredema, scleroderma, and cutis verticis gyrata. These disorders often involve HA-rich ECM buildup, which contributes to skin thickening and dermal stiffness. Hyaluronidase injections help break down the accumulated mucin, softening the affected tissues and improving flexibility.
Pretibial myxedema, associated with thyroid disease, and scleroderma are among the most challenging mucin deposition disorders to treat. Hyaluronidase injections have been reported to alleviate symptoms in such cases, reducing dermal thickness and restoring skin texture. In scleroderma, hyaluronidase’s ECMmodifying effects may reduce skin tightness, offering patients relief from the disease’s debilitating symptoms. While hyaluronidase provides temporary relief in mucin deposition disorders, its effects are typically short-lived, necessitating repeat injections for sustained improvement. Nevertheless, for patients with limited treatment options, hyaluronidase remains a viable option for managing symptoms and enhancing quality of life.
Before (overfilled)
After (dissolving and filler replacement)
Innovative and Future Applications
As research into hyaluronidase progresses, its potential applications in dermatology continue to expand. From enhanced drug delivery systems to precision-guided aesthetic treatments, hyaluronidase shows promise beyond its established uses. Here, we discuss several forward-looking applications that could redefine dermatologic practice and patient care.
1. Drug Delivery Optimization
The growing interest in biologic treatments for chronic dermatologic conditions, such as autoimmune diseases and cancers, has highlighted the need for efficient subcutaneous drug delivery systems. Hyaluronidase can be used as an adjuvant to improve the bioavailability of subcutaneously administered biologics, such as monoclonal antibodies. By breaking down HA in the ECM, hyaluronidase reduces tissue resistance, allowing larger molecules to be absorbed more effectively. This approach could make it possible to administer biologics with less invasive methods, thereby enhancing
patient comfort and compliance. In oncology, hyaluronidase is being investigated as a facilitator for intratumoral delivery of immunotherapeutic agents. For skin cancers or localized dermatologic tumors, hyaluronidase could enhance the diffusion of drugs into tumor tissues, making treatments more targeted and potentially more effective. This approach is still in the early research stages, but it presents exciting possibilities for non-invasive cancer therapy.
2. Treatment of Chronic Edema and Lymphedema
Chronic edema, often resulting from trauma, surgery, or chronic venous insufficiency, presents a significant therapeutic challenge. Recent studies suggest that hyaluronidase may aid in the management of chronic edema by facilitating the breakdown of accumulated HA in swollen tissues, promoting lymphatic drainage and fluid resorption. This application is particularly relevant in postoperative care, where reducing edema can accelerate recovery and improve surgical outcomes.
Hyaluronidase is also being explored as a treatment for lymphedema, a condition characterized by abnormal lymphatic fluid accumulation in the extremities. By degrading HA in the ECM, hyaluronidase may help reduce fluid retention and alleviate the symptoms of lymphedema. Although more studies are needed to confirm its efficacy, this application could provide a new, minimally invasive option for managing this chronic condition.
3. Advanced Imaging for Precision Aesthetics
In the field of aesthetic dermatology, precision is paramount. Ultrasound guidance in hyaluronidase injections has emerged as a technique that enables clinicians to visualize the exact location and depth of HA filler deposits before administering hyaluronidase. This approach allows for more accurate dissolution of fillers, particularly in cases of deep or cross-linked fillers that are otherwise difficult to dissolve effectively. Studies using ultrasound imaging have shown promising results, with significant filler reduction achieved within hours of the injection, minimizing the risk of tissue damage and ensuring more predictable aesthetic outcomes.
Using real-time ultrasound to monitor the effect of hyaluronidase on HA fillers could revolutionize the way aesthetic corrections are performed. This technology allows dermatologists to observe the enzymatic activity of hyaluronidase as it interacts with the filler, enabling finetuned adjustments as needed. Such advancements in imaging could improve patient satisfaction by reducing the risk of overcorrection and ensuring that only the necessary amount of filler is dissolved.
4. Personalized and Recombinant Hyaluronidase Formulations
New recombinant variants of hyaluronidase are being developed with altered pH stability and reduced immunogenicity. These variants are designed to remain active
for longer periods and resist rapid degradation within the body, making them suitable for more prolonged or systemic treatments. Such innovations could open doors for broader therapeutic uses, potentially including systemic delivery of hydrophobic drugs or treatments for chronic inflammatory skin conditions.
5. Applications in Tissue Engineering and Regenerative Medicine
Hyaluronidase’s ability to alter the ECM has spurred interest in its use in tissue engineering, particularly for wound healing and skin regeneration. By temporarily reducing HA content in the ECM, hyaluronidase can create an environment that facilitates the infiltration of regenerative cells, such as fibroblasts and stem cells. This approach could accelerate the repair of damaged skin, making it valuable for post-surgical wound healing and regenerative therapies.
Conclusion
Hyaluronidase has become an indispensable enzyme in dermatology, particularly in the realm of aesthetic medicine, where it plays a critical role in managing complications associated with hyaluronic acid (HA) fillers. From its early days as an adjunct in ophthalmology and minor surgeries, hyaluronidase’s clinical utility has expanded significantly, driven by a better understanding of its biochemical interactions with the extracellular matrix (ECM). Today, it is widely used not only for correcting filler-related issues but also as a valuable agent in scar treatment, mucin deposition disorders, and
enhanced drug delivery.
As ongoing research explores its potential in chronic edema management, regenerative medicine, and tumor therapy, hyaluronidase transforms dermatologic and aesthetic practices even further. Emerging innovations, including ultrasound-guided precision injections, tailored recombinant formulations, and next-generation variants with optimized stability, promise to enhance the safety and efficacy of hyaluronidase-based treatments. Furthermore, its integration into drug delivery systems and tissue engineering applications could lead to new innovations for patient care, offering less invasive, more effective solutions for chronic conditions and surgical recovery. By embracing both its established and experimental uses, practitioners can leverage hyaluronidase to achieve superior outcomes, setting new standards in dermatologic treatment and aesthetic excellence.
Applications
Injections of Poly-L-lactic acid promote gradual skin rejuvenation.
A randomized, placebo-controlled study evaluated the effects of poly-L-lactic acid (PLLA) injections on skin rejuvenation, revealing significant improvements in skin quality over time. In this study involving 10 healthy women aged 30-65 years, those receiving PLLA injections showed a 1.34-point increase on the global aesthetic improvement scale at the 18week follow-up, while the saline group exhibited no improvement. Histological assessments indicated that PLLA stimulated dermal remodelling without signs of inflammation or damage; treated skin demonstrated increased vascularization and morphological changes, such as reduced elastin fragmentation, consistent with rejuvenation processes. The findings suggest that PLLA effectively enhances
skin quality through biostimulation of fibroblasts and collagen production over time.
Delphi Study Provides New Perspectives on Food Allergy Testing in Atopic Dermatitis
A Delphi consensus study explored the link between atopic dermatitis (AD) and food allergies (FA), revealing that up to 50% of children with AD are food-sensitized, and clinical food allergy prevalence is 39.2% among infants with severe AD. Many parents restrict foods without professional guidance, risking loss of tolerance and IgE-mediated allergies. The study highlighted inconsistencies in FA testing, as positive skin prick test (SPT) results do not always indicate
clinical allergies, and no universal guidelines exist for interpretation. The Delphi panel developed dietary guidelines for caregivers of children under 2, established criteria for SPT results, and created a flowchart for diagnostic pathways. Although the study offers practical guidance, it warns against over-reliance on FA tests, which may detract from effective AD management. These findings contribute to the ongoing debate on FA testing in AD, with further evidence expected from the TIGER trial to inform clinical practices. Clinicians should balance parental concerns with evidence-based approaches to avoid unnecessary food restrictions while effectively managing AD.
5-Fluorouracil is the Most Economical Treatment Option for Actinic Keratosis.
A recent Australian study evaluated the costeffectiveness of 5-fluorouracil (5-FU), imiquimod (IMQ), and methyl-aminolevulinate photodynamic therapy (MAL-PDT) for actinic keratosis (AK) over 12 months. With the highest global incidence of AK affecting 40-60% of Caucasians over 40, Australia has no subsidized field therapies. The study included patients aged 18 and older with five or more AK lesions, using a decision tree model based on data from a multicentre trial and Australian clinics. Results showed 5-FU was significantly cheaper (AU$201 per patient) than IMQ (AU$940) and MAL-PDT (AU$8058) while demonstrating superior efficacy. Limitations included generalizability concerns and restricted access to MAL-PDT. The findings suggest 5-FU as the first-line therapy for actinic damage,
aiding policymakers in advocating for its subsidization. This is the first Australian cost-effectiveness study on field therapies for AK, underscoring the significance of 5-FU in managing the rising AK burden in the aging population.
Survey Reveals Deficiencies in Muscle Preservation Among Medical Weight Loss Participants.
BLT Aesthetics recently released findings from a survey involving nearly 2,000 U.S. participants, highlighting challenges in muscle preservation and facial aesthetics among medical weight loss patients. While 88.4% recognize that rapid weight loss can lead to muscle loss, 33.1% do not take measures to maintain muscle mass, despite 41.3% valuing muscle
maintenance. The survey also revealed that 68% struggle with muscle building as they age, regardless of weight loss medication use, and 69.6% believe weight loss can make them appear older. Additionally, 72.5% feel their appearance affects their wellness and confidence. The findings emphasize the need for awareness of non-invasive options to address these concerns.
Restoring Confidence: The Evolution and Techniques of Hair Transplant Surgery
Dr. Rupa Raote
MBBS, DDV
Dermatologist and Hair Transplant Surgeon
The Wellness Co, Mumbai
Introduction
Hair loss, a prevalent condition affecting approximately 67%
of men and 24% of women, presents with symptoms that may include thinning hair, characterized by a progressive reduction in hair density, and the emergence of bald patches that can occur abruptly. In males, a receding hairline is particularly notable, marked by a posterior shift from the forehead. Patients may also report excessive shedding during grooming activities, alongside alterations in hair texture resulting in finer, weaker, or more brittle strands.
Increased scalp visibility due to thinning hair and discomfort such as itching or inflammation may indicate underlying pathological conditions. The hair growth cycle is comprised of three distinct phases: anagen, which is the active growth phase lasting two to seven years; catagen, a brief transitional phase lasting two to three weeks; and telogen, a resting phase that lasts approximately three months before hair shedding occurs. Disruptions in this cycle, including prolonged telogen or
premature transition to catagen, can precipitate hair loss. Factors such as hormonal fluctuations, nutritional deficiencies, and various medical conditions can interfere with this balance, leading to disorders like telogen effluvium and androgenic alopecia. In men, androgens, particularly dihydrotestosterone (DHT), play a significant role in follicular miniaturization, while in women, hormonal changes related to menopause, pregnancy, and thyroid disorders are critical factors. Moreover, autoimmune disorders, nutritional deficiencies, and certain pharmacological agents may also contribute to the onset of alopecia.1
The diagnosis of alopecia involves a comprehensive assessment with several key steps. Initially, the clinician gathers an extensive medical history, including familial predisposition, current medications, psychosocial stressors, dietary habits, and hair care practices.1 A physical examination of the scalp and hair follicles is performed to identify characteristic patterns of hair loss
and any signs of inflammation or infection. The pull test may be utilized to quantify shedding, and a scalp biopsy may be indicated to investigate conditions like scarring alopecia. Laboratory tests can identify systemic factors such as thyroid dysfunction or iron deficiency. Trichoscopy is employed to non-invasively examine the scalp and hair follicles. Referral to a dermatologist may be necessary for cases associated with specific skin conditions. These evaluations enable the healthcare provider to accurately diagnose the cause of hair loss and recommend appropriate treatments.2
Various non-surgical options, such as minoxidil, finasteride, dutasteride, low-level laser therapy, platelet-rich plasma, adenosine, and ketoconazole, can effectively slow down hair loss and promote new hair growth. However, for those with specific type of alopecia seeking more substantial restoration is hair transplantation using follicular-unit grafting is often the preferred surgical approach, providing a more natural and fuller appearance.1, 2
Hair transplantation is a surgical intervention designed to address various forms of hair loss, including androgenic alopecia and alopecia areata. The procedure involves the extraction of hair follicles from a donor site, typically located in the occipital or lateral regions of the scalp, followed by their transplantation into areas exhibiting thinning or absent hair. This minimally invasive technique facilitates the restoration of hair density, yielding results that closely resemble the natural hair pattern,
as the transplanted follicles continue to grow in their new environment.2
Micropunches and micrografts are advanced techniques employed in hair restoration, primarily integrated within the Follicular Unit Extraction (FUE) methodology. Micropunches, generally ranging from 0.7mm to 0.8 mm in diameter, facilitate the precise extraction of individual hair follicles while minimizing collateral tissue trauma, thereby preserving the integrity of the surrounding dermal architecture. This technique allows for the procurement of micrografts, which consist of small clusters of hair follicles, thereby promoting the establishment of natural hairlines and optimal hair density. Notably, the scarring associated with micropunch and micrograft procedures is markedly diminished compared to traditional Follicular Unit Transplantation (FUT), which often results in a linear scar at the donor site. Consequently, the minimal scarring associated with these techniques enhances patient satisfaction and aesthetic outcomes, establishing them as increasingly preferred options in contemporary hair restoration practices.
Recent advancements in methodologies, such as follicular unit extraction (FUE), follicular unit transplantation (FUT), and Direct Hair Transplantation (DHT)—a modification of FUT— have significantly enhanced both the efficacy and aesthetic outcomes of hair restoration. These innovations establish hair transplantation as a viable and sought-after solution for individuals seeking permanent management of hair loss. 2
Pre-operative evaluation
Comprehensive blood investigations were conducted, including assessments of hemoglobin levels, total leukocyte count, differential leukocyte count, platelet count, bleeding time, clotting time, prothrombin time, activated partial thromboplastin time, random blood glucose, and serological tests for anti-retroviral antibodies (HIV-1 and HIV-2), Hepatitis B surface antigen, and anti-Hepatitis C antibodies. Additionally, vital signs, including blood pressure and body weight, were recorded. Clearance for the hair transplant procedure was obtained from the attending general physician. Upon confirmation of normal laboratory findings, written informed consent was secured from the patient prior to the surgical intervention.2
Preparation of the Donor Area
Local anaesthesia is administered for the entire procedure such as lignocaine which is mixed with normal saline, along with adrenaline. The hair in the donor area, located in the occipital region, is trimmed to a length of 2–4 mm. The local anaesthetic solution is then injected just below the donor area. Following this, normal saline is injected into the entire donor zone to achieve tumescent swelling. After allowing 10–20 minutes for the anaesthetic to take effect and minimize bleeding, the donor area should feel firm, ensuring effective anaesthesia and reducing blood loss during the procedure.3
Harvesting
The donor strip for hair transplantation can be harvested using either a single-bladed knife or a multibladed knife with three to seven blades, enabling the extraction of multiple parallel strips of varying widths (1.5 mm, 2 mm, or 2.5 mm). Following the harvest, the surgical site is typically closed with staples or sutures, frequently employing deep sutures in the galea or subcutaneous tissue to minimize scarring. In contrast, Follicular Unit Extraction (FUE) involves the direct excision of follicular units utilizing a specialized 1 mm punch. These micropunches, ranging from 0.7 mm to 0.8 mm in diameter, allow for the precise removal of individual follicles while minimizing tissue trauma, thus reducing scarring and promoting faster healing. This technique enhances graft survival rates and overall aesthetic outcomes, making micropunches indispensable in contemporary hair restoration practices. However, FUE carries a risk of transection, which can result in larger 'dot scars.' Special precautions must be taken when harvesting lightcolored or white hairs, and patients are often advised to dye their hair preoperatively to improve visibility.3
Direct
Hair Transplantation (DHT) represents a minimally invasive modification of follicular unit transplantation that involves the direct extraction of individual hair follicles from the donor site using a precision tool of 1 mm or smaller. This approach minimizes trauma to the surrounding tissue and obviates the requirement for a linear incision. The extracted follicles are subsequently
implanted immediately with a specialized tool, providing optimal control over the angle and depth of placement to achieve a natural appearance. DHT enhances hair density and is particularly advantageous for patients with limited donor hair availability, including those with lighter hair pigmentation. Postoperative management typically includes the application of topical agents to promote graft viability and facilitate healing, positioning DHT as a significant advancement in hair restoration that prioritizes both patient comfort and surgical efficacy.3
Graft Preparation
The harvested strips are immediately placed in chilled saline to maintain hydration, which is vital for graft survival. The strips are then divided into smaller units, with each graft containing one to four hairs. Good lighting and careful dissection are essential to avoid contamination and to ensure accuracy. Some surgeons use special techniques to minimize scab visibility post-surgery.3
Preparation of the Recipient Area
Local anesthesia is administered to the recipient area, and the area is tumesced with saline to reduce bleeding. It's important to create slits that follow the natural hair direction, ensuring a natural appearance. Various tools, including needles and specialized instruments, are used to create these slits. Extra care is needed in patients with previous surgeries due to scarring.3
Graft Insertion
Anesthesia for the recipient area in hair transplantation involves
supratrochlear and supraorbital nerve blocks, along with a ring block in the frontal region. Adequate tumescent infiltration with normal saline is crucial, while the use of adrenaline is avoided due to its potential to increase telogen effluvium and impair graft uptake, particularly in women. Ensuring turgidity of the recipient area minimizes bleeding and discomfort during the procedure. Micrografting is a refined technique involving the precise extraction and implantation of individual hair follicles or small follicular groups (micrografts). This method enables the creation of natural hairlines and optimal density by aligning graft placement with the patient’s hair growth patterns. Incisions are made using No. 18, 20 or 23 gauge needles, requiring ultra high density hairline with 800-1000 grafts for a normative hairline. Proper positioning of micrografts flush with the surrounding skin is essential to prevent complications such as pitting or a cobblestone appearance.3
Postoperative Care
Patients typically leave the clinic the same day without a bandage, though some surgeons may use one cautiously. Swelling is common, and medication may be prescribed to manage it. Hair washing should be gentle a few days post-surgery, with tight clothing and harsh products avoided for several weeks. Minoxidil can help promote hair growth. Scabs will fall off in the weeks following surgery, and new hair growth usually begins around three months, with full results visible in six to nine months. If a second procedure is needed, it should be scheduled
Restoring Confidence: The Evolution and Techniques of Hair Transplant Surgery
at least three to six months after the first. Temporary numbness in the donor area may occur, and density in completely bald areas should be discussed during the consultation.3
Result
Patient 1
Before treatment After treatment
Patient 2
Patient 3
After treatment
Patient 4 Before treatment After
Before treatment
Discussion
After treatment
Hair loss is a pervasive issue that significantly impacts individuals' psychological well-being. Many experience feelings of diminished self-esteem and body image, often leading to anxiety and depression. The emotional distress associated with hair loss can create a cycle of negative self-perception, further exacerbating mental health challenges. Therefore, addressing the psychological implications of hair loss is crucial, as individuals benefit from support and treatment that acknowledges both their emotional and physical experiences.1 Hair transplantation offers numerous benefits for individuals experiencing hair loss. It provides a permanent solution by using the patient's own hair follicles, ensuring natural growth and texture that integrates seamlessly with existing hair. The procedure can significantly enhance self-esteem and confidence, allowing individuals to regain a youthful appearance. Unlike temporary solutions such as topical treatments or wigs, hair transplantation results in longlasting effects, with transplanted hair continuing to grow naturally.2 Additionally, advancements in techniques, such as Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT), have minimized scarring and recovery time, making the procedure more accessible and less invasive.4, 5 Overall, hair transplantation not only restores hair but also positively impacts emotional well-being and quality of life. The ideal candidate for hair transplantation presents with a healthy scalp, overall good health, sufficient donor hair supply, and realistic expectations regarding outcomes. Indications for hair transplantation encompass male and female pattern hair loss, specifically Norwood stages III to V for men and Ludwig stage II for women.3 Additionally, it is indicated for conditions such as traction alopecia, frontal fibrosing alopecia, lichen planopilaris, and folliculitis decalvans, as well as for the placement of pubic, facial, and body hair in transgender patients, and the restoration of facial hair, including eyebrows, beards, and sideburns, following trauma or burns. However, the active phases of frontal fibrosing alopecia, lichen planopilaris, and folliculitis decalvans are contraindications
for hair transplantation; patients with folliculitis decalvans must demonstrate a prolonged absence of active disease for several years before consideration for the procedure.1 After the treatment, care is essential for optimal recovery following hair transplantation. Patients should be instructed to maintain moisture in the affected areas by gently applying saline with a spray bottle and using emollients on the donor site for several days. Scalp washing with baby shampoo may begin, while avoiding high-pressure water sources. Suture removal is scheduled, and patients can resume topical minoxidil after the treatment, with continuation of oral finasteride and low-level light therapy recommended to maximize results.4 Ongoing monitoring by a wound care nurse or clinician experienced in postoperative hair transplantation is crucial to identify potential complications such as infection and ingrown hairs. Patients should be informed that loss of implanted hairs may occur shortly after the procedure and that it may take several months for new growth to appear. Additionally, transient "shock loss" of surrounding native hair may occur at both the donor and recipient sites, with full recovery expected within a few months. Ultimately, successful hair transplantation can significantly enhance quality of life by improving self-esteem and social interactions, fostering a renewed sense of confidence in personal and professional environments.3
Conclusion
Hair transplantation has emerged as a highly effective solution for addressing various
forms of hair loss, significantly improving aesthetic outcomes and quality of life for patients. By utilizing advanced techniques such as Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT), individuals experience natural-looking results and enhanced self-esteem, positively impacting their social and professional interactions. As technology continues to evolve, future prospects in hair transplantation may include innovations that improve graft survival rates and refine treatment methods. These advancements
2. Sethi P, Bansal A. Direct hair transplantation: a modified follicular unit extraction technique. J Cutan Aesthet Surg. 2013 Apr; 6(2):1005. doi: 10.4103/0974-2077.112672. PMID:
24023433; PMCID: PMC3764754.
3. Khanna M. Hair transplantation surgery. Indian J Plast Surg. 2008 Oct; 41(Suppl):S56-63. PMID: 20174544; PMCID: PMC2825128.
4. Ekelem C, Pham C, Atanaskova Mesinkovska N. A Systematic Review of the Outcome of Hair Transplantation in Primary Scarring Alopecia. Skin
promise to enhance the efficacy of hair restoration techniques, making them even more accessible and successful for those seeking relief from hair loss.
5. Dua A, Dua K. Follicular unit extraction hair transplant. J Cutan Aesthet Surg. 2010 May; 3(2):76-81. doi: 10.4103/0974-2077.69015. PMID: 21031064; PMCID: PMC2956961.
Male pattern hair loss-androgenetic alopecia
Maintains hair density
Minoxidil stimulates hair follicles via vasodilation, also slows hair loss.
Finasteride blocks type II 5 reductase inhibitor and inhibits the production of male hormone DHT (dihydrotestosterone), and slows down hair loss.
Topical Finasteride overcomes the systemic effects of oral finasteride.
Finasteride is a frequently prescribed drug in the therapeutic management of male androgenetic alopecia.
Oral administration of finasteride, enhances hair regrowth in the male balding.
Actress Sheena , South Asian Ambassador For Human Rights And Dedicated Social Justice Advocate, Former Miss Kolkata And "I Am Voice" Titleholder At I Am She–Miss Universe India, Who Reveals Her Skincare And Haircare Routine Under The Guidance of Dermatologist .
In this exclusive interview, Actress Sheena shares her comprehensive skincare and haircare routines, offering valuable insights into addressing common concerns such as dullness, dryness, and sensitivity. She emphasizes the
importance of personalized approaches and carefully selects products that suit her unique skin and hair needs. Despite her demanding schedule, Sheena remains dedicated to maintaining healthy skin and hair through tailored, effective routines, suggested by her Dermatologist.
1. Can you share a bit about your journey as an actor and how you’ve evolved over the years?
My journey as an Actor began on stage when I was just two years old—that’s when I knew I wanted to perform. Growing up in Calcutta and later studying Drama and Sculpture, I found my instincts in the arts early on. I immersed myself in theatre for years, working with the brilliant Director Arvind Gaur, which laid a strong foundation. Since then, I’ve had the chance to play a range of complex characters, from Avali Jijabai in Sant Tukaram, my debut in Hindi cinema, to my role as a She-devil in the international thriller Series Bhayaava, and a lady cop in my first Telugu film. Every character is a part of me and a step in my journey, constantly evolving and deepening my craft. My role as the South Asian Ambassador for
Human Rights, reaching millions with messages of empathy and equality, has given my career even greater purpose. I’m not just an Actor—I’m here to be a Voice for Change.
2. What are some essential practices you rely on to keep your skin and hair healthy, especially with a hectic schedule?
Consistency is essential in maintaining skin and hair health, especially as an actor. Hydration is the foundation, so I drink plenty of water daily and start my mornings with lukewarm water and lemon to cleanse and energize. My skincare routine is simple, consisting of cleansing, toning, and moisturizing with Dermatologist-recommended products suited to my skin type, complemented by regular facials to keep my skin fresh. For my hair, I use nourishing oils and
treatments to maintain strength and shine, despite the styling and heat exposure.
3. How do you adapt your skincare routine when preparing for a role that requires heavy makeup or extensive shoot hours? When preparing for roles with heavy makeup or long hours under studio lights, my focus is on thorough cleansing and keeping my skin wellmoisturized. I incorporate facial icing daily to reduce puffiness and soothe the skin. Following my Dermatologist’s advice, I use mild, calming products to avoid irritation. After shoots, I double cleanse to remove all makeup and apply a rich moisturizer to counteract dryness from makeup and prolonged lighting exposure.
4. What specific skin concerns have you encountered throughout your career, and how have you addressed them?
Throughout my career, I’ve occasionally dealt with breakouts and dullness, especially during intense filming schedules. My Dermatologist plays a key role, recommending targeted skincare products suited to my skin type. I also prioritize nourishing my skin from within by ensuring a balanced intake of vitamins, minerals, and essential nutrients. Consistent skincare and overall wellness are vital in keeping my skin healthy, radiant and glowing skin.
5. How often do you visit a Dermatologist, and what prompted you to start these visits?
I visit my Dermatologist as needed, typically once a week, to ensure I'm using the most suitable products for my skin and to address any emerging concerns. The demands of my acting career—frequent makeup application and prolonged exposure to studio lighting— prompted me to start these visits. It became essential to seek Dermatologist guidance to maintain the health and integrity of my skin under these conditions.
6. How do you manage long hours under harsh lights, and has your Dermatologist recommended anything for your skin and hair health?
To manage long hours under harsh lights, I focus on hydration and protection. My Dermatologist recommended using gentle, soothing products that won’t irritate my skin. I also
use facial mists and apply barrier creams to shield my skin from dryness and damage caused by studio lighting. For my hair, deep conditioning hair treatments are a key part of my routine to counteract the effects of heat styling.
7. What lifestyle choices do you make to support your skin and hair health?
I follow a disciplined wellness routine, starting my day with water and lemon, followed by exercise. I prioritize hydration, consuming vitamins and minerals to nourish my body, which in turn supports my skin and hair health. I also believe in the importance of spiritual wellness, maintaining balance in all aspects of my life for overall well-being.
8. If you could create a skincare or haircare product based on your experiences, what specific needs would it address? If I were to create a skincare product, it would focus on hydration, simplicity, and the use of natural ingredients. The product would be designed to nourish and protect the skin without being harsh, particularly for those with demanding schedules. It would align with my belief in treating the body as a temple, offering a gentle yet effective solution for maintaining healthy, radiant skin amidst the pressures of daily life.
9. One piece of advice from your Dermatologist that has significantly impacted your skincare routine?
One of the most impactful pieces of advice from my Dermatologist has been the importance of
using products that suit my skin type, particularly for maintaining hydration and preventing irritation. The key advice has been to always double-cleanse after shoots to ensure there is no makeup residue left, which has significantly impacted how I maintain my skin’s health, especially after long filming days.
10. What key strategies and considerations would you recommend to someone seeking to develop a more effective and personalized skin and hair care routine?
To develop an effective skin and hair care routine, prioritize hydration, consistency, and product selection tailored to your individual needs. Ensure adequate hydration by drinking plenty of water, and maintain a simple yet effective routine focused on cleansing, toning, and moisturizing for the skin, alongside nourishing oils for the hair. Adapt your routine to your specific environment and lifestyle, and seek professional guidance from a Dermatologist for personalized recommendations and maintain a balanced diet. Protect from environmental stressors and adjust your routine as needed.
To view the Interview, scan the QR code
Study Shows a 90% Decrease in Acne Severity with Triple-Frequency Local Dynamic Micro-Massage.
Acne vulgaris is a prevalent chronic inflammatory skin disorder, traditionally linked to pilosebaceous unit dysfunction but now recognized for its early inflammatory role and the involvement of caveolin-1 (CAV1). Reduced CAV1 expression is associated with various skin conditions, while treatments enhancing CAV1, such as 30% supramolecular salicylic acid, can decrease inflammation. Recent studies on Triple-Frequency
Local Dynamic Micro-Massage (TF-LDM) ultrasound therapy show its effectiveness in treating mild to severe acne by stimulating cellular repair. A retrospective study of 24 patients revealed a significant average reduction in acne severity of 73.7% post-treatment, increasing to 90.1% at follow-up, with high patient satisfaction and minimal adverse effects.
These findings position TF-LDM as an effective, non-invasive alternative to pharmacological therapies for inflammatory acne, warranting further research to optimize its use and explore its potential for other inflammatory skin disorders.
Enhancing the Management of Solar Lentiginous Using the Vasculature Salvage Laser Surgery System
Solar lentiginous are benign lesions that, while harmless, can impact aesthetics and quality of life due to melanin accumulation from sun exposure. Traditional treatments like topical agents and Q-switched Nd:YAG lasers often lead to complications such as erythema and post-inflammatory hyperpigmentation (PIH), highlighting the need for safer alternatives. The Vasculature Salvage Laser Surgery (VSLS) system, which uses a 532-nm nanosecond Nd:YAG laser, has shown promise in effectively clearing these lesions with minimal complications. A case series of six Korean patients demonstrated complete removal of refractory lesions after a single VSLS session, with only mild erythema observed. VSLS features a contact cooling mechanism to reduce thermal damage and improve comfort, along with an autoderm lesion recognition algorithm for precise targeting. This advancement is particularly beneficial for patients with darker skin tones, who are more susceptible to adverse effects from conventional treatments. While results are promising, further research is essential to assess its long-term safety and efficacy. Integrating VSLS into dermatological practice can enhance treatment options and improve patient satisfaction.
Treats Hydrates & Retains Skin Moisture
Hydrates dry skin
Barrier Repair
Manage skin conditions such as eczema, Psoriasis, Rosacea, Icthtyosis
Anti-Aging
Post treatment care
Dimethicone
Lecithin
Ceramide 1,2,3,4,6II
Cetyl-pg hydroxyethyl palmitamide
Sodium PCA
Tocopheryl Acetate
Laminaria Digitata Extract
Sodium Hyaluronate
Olea Europea Fruit Oil
Nail Surgery and Lasers in Nail Disorders Part-II
Dr. S. Manjula Nagarajan D.D., M.D., (Dermatology) Consultant Dermatologist, Erode
Treatment of ingrown toe nail (onychocryptosis or ungus incartus)
Stage 1
In stage 1 of ingrown toenail treatment, conservative treatment for ingrown toenails initially involves the use of topical and systemic antibiotics, alongside nonsteroidal anti-inflammatory drugs (NSAIDs), to manage inflammation and infection. In cases where an abscess is present, prompt incision and drainage (I&D) are performed to evacuate pus and alleviate pressure. Following I&D, the next step involves utilizing gutter splint treatment. This method employs vinyl intravenous tubing, which is affixed around the affected toe with tape or cyanoacrylate adhesive. This splint helps to maintain proper alignment of the nail and reduces pressure on the affected area. Additionally, depending on the extent of tissue involvement and to facilitate optimal healing, the toe may
be further supported with sutures or wound closure strips.3, 5
Figure 6: Gutter splint treatment
Stage 2 and 3
For stage 2 and 3 severity levels, surgical intervention is recommended. The procedure begins with local anaesthesia using 2% lignocaine injected at the base of the great toe. A tourniquet is applied to minimize bleeding during surgery. The nail plate is then carefully resected using a dental drill, removing a wedge-shaped section along with any granulation tissue and affected nail bed tissue
located approximately 2mm lateral to the nail plate.3, 5
Surgical removal of the germinal matrix, the area responsible for nail growth, is conducted using electro cautery followed by chemical cautery with phenol applied using a cotton-tipped applicator. The nail bed is meticulously sutured to promote proper healing. After completing the procedure, the tourniquet is removed, and the toe is dressed with a hydrogel paraffin-embedded dressing to provide a moist environment conducive to healing.3, 5
Fig. 6 (a): Local anaesthesia using 2% lignocaine injected at the base of the great toe
Fig. 6 (b): A tourniquet is applied to minimize bleeding during surgery.
Fig. 6 (c): The nail plate is resected using a dental drill, removing a wedge-shaped section along with granulation tissue.
Fig. 6 (d): Affected nail bed tissue located approximately 2mm lateral to the nail plate. Germinal matrix is removed surgically, using electro cautery followed by chemical cautery with phenol applied using a cotton-tipped applicator.
Fig. 6 (e): The nail bed is meticulously sutured to promote proper healing
Figure 6: (a,b,c,d & e ) : Nail removal surgery for 2nd and 3rd stage
Post-operative care
• After surgery, diligent postoperative care is crucial to ensure proper healing and minimize complications.
• One key aspect is the regular changing of dressings, scheduled daily for the 1st week following the procedure. This routine helps to keep the surgical site clean and protected from potential infections.
• It typically takes about a week for initial post-operative pain to subside, though individual experiences may vary.3, 5
• Complete healing of the surgical site generally occurs over a period of 6 to 8 weeks, during which patients are advised to follow medical instructions closely and avoid strenuous activities that could disrupt the healing process.
• Expected complications such as bleeding and infection necessitate vigilant monitoring and prompt medical attention if any signs or symptoms arise. By adhering to these guidelines, patients can support optimal recovery and minimize risks associated with the surgery.3, 5 After care
• After the healing process following nail surgery, proper aftercare is essential to promote the natural growth and health of the nail.3, 5
• The artificial nail remains secured with nail glue until the original nail fully regrows, ensuring protection and stability during this transitional period.3, 5
• It's advisable to wear shoes that provide ample room to prevent pressure on the healing nail.3, 5
• Steri shoes or other protective footwear may be recommended to safeguard the area from potential trauma or infection.3, 5
• Patients are advised to avoid smoking and drinking alcohol as these habits can impair healing.3, 5
• Swimming should be avoided until the nail is fully healed, and strenuous activities should be minimized to prevent undue stress on the affected area.3, 5
• Daily lukewarm water soaks can aid in maintaining cleanliness and promoting nail growth until the new nail
forms completely, after which periodic soaking may still be beneficial for nail health maintenance.3, 5
Preventive measures for recurrence of unguis incarnatus
To prevent recurrence of Unguis Incarnatus (ingrown toenails) following nail avulsion surgery combined with germinal matricectomy using electrocauterization and phenolization, several precautionary measures should be strictly observed.3, 5
• Taking care of feet is crucial, especially when dealing with ingrown toenails.3, 5
• Avoiding undersized shoes and ensuring a proper fit can prevent undue pressure on the nails. 3, 5
• Soaking feet in warm water with Epsom salt twice daily helps to reduce inflammation and discomfort. 3, 5
• Regular oil massages using jojoba, tea tree, olive, sweet almond, or argan oils can soften the skin around the nails and promote healing.3, 5
• Using a wedge of cotton or dental floss under the ingrown toenail can gently lift it and prevent further embedding.3, 5
• It's essential to avoid injuring the toenail and to protect it from fungal infections by maintaining good hygiene practices.3, 5
• Additionally, a diet rich in fresh vegetables, lean meats, nuts, and protein supports overall nail health and
enhances the body's healing process. 3, 5
By following these steps, we can effectively manage and prevent issues with ingrown toenails, promoting comfort and wellness in feet.
Onchomycosis
Onychomycosis, commonly referred to as fungal nail infection, is characterized by the invasion of fungi into the nails, typically affecting toenails more frequently than fingernails. Typically starting as, a yellow or white spot beneath the nail's edge, this condition can advance, resulting in thickened, discolored, brittle nails, occasionally leading to nail crumbling. Onychomycosis may also lead to discomfort or pain, particularly in advanced stages where the nail becomes significantly distorted. Treatment for onychomycosis focuses on eliminating the fungal infection and restoring nail health. Topical antifungal medications applied directly to the nail and surrounding skin, these treat mild to moderate cases of onychomycosis by targeting the fungal infection locally. Oral antifungal medications taken by mouth, these are more effective for moderate to severe onychomycosis that hasn't responded to topical treatments. Treatment duration varies, often requiring several months for complete clearance. Total nail avulsion for severe or resistant cases,
where the nail is extensively affected, complete removal of the nail plate and underlying nail matrix may be necessary. This surgical procedure aims to eradicate the infection and promote healthy nail regrowth under local anaesthesia. Post-operative care includes wound care and possibly continued antifungal therapy to prevent recurrence during nail regrowth.3, 5
Types of nail surgery
1. Nail Biopsy
Nail biopsy, crucial for diagnosing various nail disorders, can target different sites within the nail complex, including the matrix, nail bed, nail plate, and nail groove. Biopsy from the matrix aim to assess the root cause of nail abnormalities, while those from the nail bed and plate focus on surface-level conditions.3, 5
Different types of biopsy, such as punch, excisional (including longitudinal and elliptical), and shave biopsies, offer distinct approaches to sample collection. Punch biopsy involve removing a small cylindrical section of tissue.3, 5 Excisional biopsy entail the complete removal of abnormal tissue, either longitudinally or elliptically.3,5 Shave biopsy scrape off superficial layers for examination. Each type is selected based on the suspected condition and the depth of tissue required for analysis, ensuring accurate diagnosis and appropriate treatment planning for patients with nail-related concerns.3, 5
2. Incision and
Drainage (I&D): Incision and Drainage (I&D) is a pivotal procedure in the management of paronychial abscesses and subungual hematomas, conditions that prominently impact nail health and induce considerable discomfort.6
Incision and drainage involves a meticulous incision at the affected site to facilitate drainage of purulent exudate in paronychial abscesses or hematomas, thereby alleviating
pain and fostering expedited healing. Post-procedural care encompasses thorough wound cleansing, potential gauze packing for continued drainage optimization, and administration of antibiotics prophylactically to mitigate infectious complications. Incision and drainage serves as an effective therapeutic intervention, concluding in enhanced overall nail integrity and patient comfort.6
Paronychial abscess incision and drainage
Paronychia is an infection of the proximal and lateral nail folds of fingernails and toenails, encompassing the tissue around the nail root and sides. It can occur spontaneously or as a result of trauma or manipulation. Contributing factors include habits like nail-biting, trauma, manicures, ingrown nails, or manipulation of hangnails. Surgical drainage becomes necessary when there is an abscess containing pus in the soft tissues adjacent to the nail. In cases involving the toes, paronychia often correlates with ingrown toenails. While treatment strategies may overlap, this discussion primarily focuses on the management of acute paronychia and its drainage in the hand. For minor abscesses affecting the eponychium, the eponychial fold can be gently lifted transversely. Localized collections of pus can be alleviated by
Figure 7: Total nail avulsion
making a small incision at the most fluctuant point of the swelling.6
8:
Subungual haematoma
Subungual hematoma occurs when blood accumulates beneath the nail bed due to trauma, often causing intense pain from pressure buildup. To alleviate discomfort and prevent potential complications such as nail bed injury or infection, subungual hematoma drainage is performed. Initially, the extent of the hematoma is assessed to determine the need for intervention, followed by the application of local anaesthesia to minimize discomfort during the procedure. Using sterile instruments, small holes are carefully made in the nail to allow the trapped blood to drain out. Post-procedure, patients are advised on proper nail care to manage bruising and discoloration as the nail grows out, with pain management medications provided as needed. Followup appointments ensure proper healing and monitor
for any signs of infection or complications like nail deformity or hematoma recurrence.3, 5
Figure 9 : Subungual haematoma drainage
3. Intralesional Injection: Intralesional drug administration is a targeted therapy method crucial for treating inflammatory nail conditions by delivering medications directly to the nail unit. Two primary types include:
1. Intramatrix injections: Target the nail matrix to treat nail growth disorders like psoriasis, promoting healthy nail growth and appearance.7
2. Intrabed injections: Aim at the nail bed to manage conditions such as chronic paronychia and nail bed infections, aiding healing and restoring nail integrity.7
Intraregional injections deliver targeted medications directly to skin and nail areas. Triamcinolone acetonide (TA) and methylprednisolone (MX) at concentrations of 2.5-10 mg/mL and 25 mg/ mL respectively, reduce inflammation in conditions like psoriasis and dermatitis. Corticosteroids (CX) at 50 mg/mL are crucial for severe inflammation. Botulinum toxin (BM), 1-3 units, treats nail dystrophy by improving nail plate adherence. The Mumps, Measles, and Rubella (MMR) vaccine treats specific nail conditions, while vitamin D3 injections at 15 mg/mL address deficiencies affecting dermatologic symptoms. Biological agents like secukinumab target interleukin-17A to suppress inflammation in conditions such as psoriasis. Terbinafine cream (CRM) injections localize treatment for nail fungal infections, minimizing systemic side effects and targeting fungal pathogens directly. The localized delivery of medication through intralesional injections offers several advantages over systemic administration and topical application. It minimizes the risk of systemic side effects associated with oral medications and ensures that the medication
Figure
Incision and drainage in paronychial abscess
reaches the specific site of pathology effectively. This targeted approach enhances therapeutic outcomes and patient comfort, making intralesional injections a valuable treatment option for various nail disorders.7
The rationale behind intralesional therapy in nail disorders
Intra-lesional injections play a crucial role by effectively treating unreachable parts of the nail unit with minimal invasiveness as possible. This approach avoids physiological or pathological barriers that might hinder drug penetration, ensuring medications reach therapeutic levels at the site of action. Moreover, intralesional injections establish a tissue depot, enabling prolonged release of the drug. This feature is particularly beneficial in conditions requiring extended therapy due to the slow rate of nail growth. By maintaining sustained and effective drug levels in the tissue, intralesional injections help prevent relapse of nail disorders, ensuring comprehensive and longlasting treatment outcomes. These advantages underscore the importance of intralesional therapy in dermatologic care, offering targeted and efficient treatment solutions for complex nail conditions.7
Tips and tricks to minimize pain during nail injections:
1. Administer Injections Slowly: Injecting the
medication slowly helps reduce the discomfort experienced by the patient by allowing the tissues to adjust gradually.7
2. Use Luer-Lok Needle 30G: The use of a 30-gauge needle, such as the Luer-Lok Needle, is beneficial as it is thinner and causes less pain during insertion.7
3. Target Dorsal Aspects of Finger: Injecting into the dorsal aspects of the finger is advantageous because it minimizes the risk of injury to sensitive structures and nerves on the palmar side.7
4. Talkasethesia: It refer to communication techniques used to distract patients or alleviate anxiety during the procedure, which can indirectly reduce pain perception.7
5. Address Apprehensive Patients: For patients who are anxious or fearful, various methods can help reduce their discomfort, including:
• EMLA Cream: Topical anaesthesia like EMLA cream numbs the skin before injection, minimizing pain.7
• TAS (Tactile Stimulation): Gentle rubbing or tapping near the injection site can provide distraction and reduce pain perception.7
• Icepacks/Cold Air: Cold therapy can numb the skin and reduce pain sensation.7
• Vibration: Vibrating devices can distract patients from the injection discomfort.7
• Pressure Proximal Digital Block: Applying pressure around the injection site can reduce pain perception.7
6. The solution- Body Temperature: Maintaining a comfortable room temperature can help relax the patient and reduce their perception of pain.7
7. Derma Jet: It refer to a needle-free injection system that uses high-pressure streams to administer medication, potentially reducing pain and anxiety associated with traditional needle injections.7
Figure 10: A schematic representation of intramatrix injections
is provided. The arrow indicates the needle's path of entry, with the arrowhead denoting the eventual positioning of the bevel beneath the proximal nail fold. The green zone indicates the anticipated region where the drug is dispersed following infiltration.
Figure 11: A schematic illustration depicting intramtrix injections is presented. The arrow indicates the needle's entry from the distal nail fold, passing beneath the distal free edge of the nail plate. The extent of penetration determines the drug infiltration area, as indicated by the green zone.
Figure 12: Intralesional therapy with triamcinolone acetonide in twenty nail dystrophy
References
1. de Berker D. Nail anatomy. Clin Dermatol. 2013;31(5):509-515. doi:10.1016/j. clindermatol.2013.06.006
2. McCarthy DJ. Anatomic considerations of the human nail. Clin Podiatr Med Surg. 1995;12(2):163-181.
3. Wollina U, Nenoff P, Haroske G, Haenssle HA. The Diagnosis and Treatment of Nail Disorders. Dtsch Arztebl Int. 2016;113(29-30):509-518.
doi:10.3238/arztebl.2016.0509.
4. Dika E, Starace M, Alessandrini A, et al. The Histopathologic Evaluation of Diagnostic Procedures in Nail Melanoma. Dermatol Pract Concept. Published online April 1, 2023. doi:10.5826/dpc.1302a92
5. Beuscher TL, Kelechi TJ. Onychomycosis: Diagnosis, Treatment, and Prevention. J Wound Ostomy Continence Nurs. 2019;46(4):333-335.
doi:10.1097/WON.0000000000000556
6. Macneal P, Milroy C. Paronychia Drainage. In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 5, 2023.
7. Grover C, Bansal S. A Compendium of Intralesional Therapies in Nail Disorders. Indian Dermatol Online J. 2018;9 (6):373-382. doi:10.4103/ idoj.IDOJ_280_18
Note - Stay tuned for Part III, coming in our January'2025 issue!
As the cold winter air sets in and the season of festive celebrations begins, many start to notice the effects of the chill on their skin dryness, flakiness, and a dull complexion becoming all too common. With parties and gatherings in full swing, achieving glowing, hydrated skin becomes even more essential for feeling confident and radiant. This month, expert tips and treatments from Dermatologists are shared to replenish the skin's moisture, restore its natural glow, and ensure a flawless complexion, ready to shine and embrace every celebration with confidence.
FESTIVE SKIN CARE Recommendations
As we approach the festive season, it’s essential to ensure that your skin are ready to shine. The festive celebrations can be demanding on our beauty routines, with long days, late nights, and frequent styling. Here are some tips and treatments to help you maintain healthy and glowing skin during the festive season:
Skin Care Tips:
1. Hydration is Key: During the festive season, our skin can often become dehydrated due to long hours and makeup applications. I recommend incorporating a hyaluronic acid serum into your routine, followed by a moisturizer with ceramides to lock in moisture and restore your skin barrier. Drinking plenty of water and staying hydrated from the inside is also crucial.
2. Exfoliation for Radiance: Exfoliating 1-2 times a week can help remove dead skin cells, leaving your skin smooth and glowing. Opt for gentle chemical exfoliates like AHAs (alpha hydroxy acids) or enzymebased exfoliates rather than harsh physical scrubs. This will brighten your skin and allow for better absorption of festive makeup.
3. Brightening Masks: To get that instant festive glow, apply clay mask or sheet masks infused with AHA, vitamin c, niacinamide or hydrating masks with hyaluronic acid before any major event for a quick pick-me-up.
4. Sunscreen is a Must: No matter the occasion, don’t forget your sunscreen. A broad-spectrum SPF 40 is essential, especially if you’re spending time outdoors during daytime festivities. This will help prevent UV damage and pigmentation, keeping your skin even-toned and protected.
5. Boost with Nutraceuticals: For an internal glow, consider adding collagen supplements and antioxidants (such as vitamin C and E) to your routine. These nutraceuticals protect the skin from oxidative stress and enhance overall skin radiance.
Dr. Chytra V. Anand MBBS, MD, Founder & President Kosmoderma Healthcare
Founder : HealthQ Lifesciences Beauty IQ Lifesciences, Karnataka
In-Clinic Treatments for a Festive Glow:
For those who want an extra boost before big events, there are a few inclinic treatments that can help you achieve that perfect festive glow.
1. Hydra Facial: This is a quick and effective treatment for deep cleansing, exfoliating, and hydrating the skin. It gives an instant glow and smooth texture, making it perfect for pre-festive preparations.
2. Chemical Peels: Glycolic or salicylic acid peels are great for reducing pigmentation, refining skin texture, and brightening the complexion. A peel done a week before the festivities can enhance your glow and help smooth make up application.
3. Laser Toning: If you’re looking to reduce pigmentation and improve skin tone, laser toning with Q-switched lasers is a great option. It helps lighten dark spots and evens out the skin tone. This is a great quick fix
4. Microneedling with PRP (Platelet-Rich Plasma): For those looking for more rejuvenation, microneedling combined with PRP can enhance collagen production, reduce fine lines, and improve skin texture, giving you radiant skin for the festive season. This has a 5 day downtime so plan accordingly.
5. Exosome Therapy: One of the latest treatments in skin rejuvenation, exosome therapy helps boost collagen production and repairs skin at a cellular level, making it a fantastic option for a glowing, youthful look. Remember, the key is to focus on maintaining your skin health while embracing the festive spirit!
Dr. Madhuri Agarwal
MBBS, MD (SKIN & V.D.), D.D.V. (MUM), Founder & Medical
Director Yavana
Aesthetics Clinic, Mumbai
The common skin concerns in festive season are sudden breakouts of acne, dull and dry skin or pigmentation, patchy tired skin and dark circles due to munching on sugary festive sweets, processed fried food, irregular sleep patterns and alcohol intake or aerated drinks. For prevention one should not miss on their regular skincare routine but try and improvise it according to the weather and incorporate certain serums with actives due to heavy makeups. One should also be particular about ones diet and sleep patterns for better results.
The effective tips for festive season are:
1) A regular skin care regime can help to achieve healthy glowing skin like using cleanser, a chemical exfoliate twice a week, use vitamin C in the morning if suitable for the skin, use sunscreen regularly, use of retinols and peptides or anti acne serums at night. A consistent routine will help to curb the pigment build-up.
2) Protect skin from UV rays for outdoor events by applying broad spectrum sunscreen with SPF 30-50 PA ++++. This gives maximum coverage and reduces chances of pigmentation. Use it as a base in case you are using makeup. Also carry sunscreen with you in order to reapply. One can also use oral glutathione which is an antioxidant and protects skin from free radical damage. Oral sunscreens can be started preferably one month in advance for better results. This should be done in consultation with a Dermatologist.
3) There is tendency to use heavy makeup during festivals hence it is very important to thoroughly remove makeup without being lazy. Sleeping with makeup causes clogging of pores resulting in breakouts and dull looking skin. The breakouts can cause dark spots in skin of colour.
4) Dietary precautions like avoiding high salt food and hard alcoholic drinks. Keep yourself hydrated and balance diet with green vegetables to avoid skin concerns.
5) There are variety of Medifacials available in Dermatology clinics these days which are very effective in terms of treatments and for immediate glow in women of colour.
6) For prior preparations, Dermatology clinics have treatments like skin boosters to give glow and radiance to skin. There are procedures like MNRF and laser rejuvenation, as well gentle peels.
Dr. Sudha Vani
MD- Dermatology, Senior Dermatologist & Cosmetologist. Associate Professor Department of DVL, Osmania Medical College, Hyderabad.
Get Your Glow On! Festive Mood is on!
As the festive season approaches, glowing skin becomes the ultimate desire for many of us. With over 25 years of Dermatological expertise, I’m thrilled to share with you the latest trends and treatments that will keep your skin happy, healthy, and glowing throughout the festivities.
Unlock Your Glow with Our Expert Treatments
This festive season, treat yourself to some of the most effective and cutting-edge skin treatments to achieve a truly radiant and youthful glow. Here are a few expert treatments that will have your skin glowing like never before:
• Dermal Needling Device: The Dermal Needling Device, also known as microneedling, uses advanced microchannelling technology to create tiny channels in the skin. This process helps infuse your skin with revitalizing serums, promoting hydration, combating pigmentation, and stimulating collagen production for
rejuvenation. It’s perfect for giving your skin the boost it needs to look fresh, radiant, and youthful.
• Laser Toning: For smoother skin with an even tone, Laser Toning is the perfect solution. It helps reduce the appearance of pores while giving your complexion a smoother, clearer, and more balanced look. This treatment works well to target uneven skin tones and imperfections, providing you with a flawless appearance.
• Skin Boosters: Enhance your skin’s hydration and overall nourishment with our Skin Boosters treatment. Packed with hyaluronic acid and essential nutrients, skin boosters deliver intense hydration to your skin, making it look plump, healthy, and radiant. It’s the ultimate way to give your skin that refreshing, youthful glow that’ll last through the season.
Benefits of These Treatments:
• Achieve radiant, glowing, and smooth skin.
•Boost your confidence with a complexion that’s glowing with health.
•Step into the festive season with a rejuvenated, youthful appearance.
•Customizable to suit your specific skin concerns, whether it’s hydration, pigmentation, or skin texture.
Pamper Yourself This Festive Season!
This festive season, remember that your skin will truly appreciate the care you give it. By combining professional treatments with simple yet effective skincare habits, you can achieve glowing, healthy skin that’s perfect for any celebration. As the season unfolds, take the time to pamper your skin, ensuring it stays radiant, smooth, and rejuvenated. With the right treatments and skincare tips, you’ll not only look your best for every event but also step into the festive mood with confidence, knowing your skin is glowing with hydration and vitality. Whether preparing for holiday photos, special occasions, or simply embracing the festivities, your skin will shine with a natural, radiant glow, leaving you ready to celebrate with ultimate confidence.
MUMBAI 2025
AESTHETICCON, a 1 Day Conference, Hands on Workshop and Exhibition focused on practical learning experiences in Aesthetic Dermatology. Brought to you by “The Aestheticians Journal” serving you since 2010 with 12 years in print and digital publications and over a 100 educational workshops and conferences.
1 Day Conference, Hands on Workshop and Exhibition AEESTHETICCON Mumbai 2025 is just the event for you with practical insights shared in the Conference, tips while training in the Hands on workshop and interaction with product and device manufacturers. Spend the day catching up and meeting with your fellow Dermatologists colleagues.
In ammatory and non-in ammatory acne/Blackheads /Rough texture, ne lines and Wrinkles/Enlarged pores/Skin ageing
REFRESH PEEL
Super cial glycolic acid peel
Suitable for an anti-ageing and skin rejuvenation e ect. Removes the upper layers of the epidermis
Main Ingredients:
Glycolic acid, Kojic acid
Indications:
Ageing skin, Photo damaged skin, rough texture, ne lines and wrinkles enlarged pores, dull, sallow skin color
PEEL BLENDER
PEEL Blender is a new invention in the chemical peeling industry. It is a special product that has to be mixed with GLOW ,PURE or REFRESH Peel for tailoring of peel strength and acid pH.
Why Microspheres?
The microspheres encapsulate the active ingredients and releases it gradually over time. Reduces potential skin reactions and systemic exposure.
Microspheres protects sensitive active ingredients against UV light, humidity, oxidation, and so forth.
The microsphere technology allows for a slower release of tretinoin into the skin over time, results in reduced irritation in comparison to some other tretinoin formulations.
Microspheres possess smooth surfaces that gently remove dead skin cells, dirt and impurities.
