The Aestheticians Journal March'23 issue

Management of Acne with Black Peels Digital Gangrene in Hansen’s Disease- An Atypical Presentation

Congenital Nasal Dermoid and Sinus Cysts: A Case Report

MUMBAI 2023 14th May'2023

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AESTHETICCONF, a 1 Day Conference, Hands on Workshop and Exhibition focused on practical learning experiences in Aesthetic Dermatology.

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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.

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AESTHETICCONF Mumbai 2023 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.

AESTHETICCONF Mumbai 2023 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.

Spend the day catching up and meeting with your fellow Dermatologists colleagues.

Aestheticconf Mumbai 2023 a must attend event.

For further detaills and to register for the conference and hands on workshop call us at +91 8779515551

Aestheticconf Mumbai 2023 a must attend event.

For further detaills and to register for the conference and hands on workshop call us at +91 8779515551

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MUMBAI 2023 13th November' 2023

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1 Day Conference, Hands on Workshop and Exhibition

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1. Only for Dermatologist. Please share your PG in Dermatology Credentials while registering. 2. Compulsory prior registration required. On the spot registration not available. 3. Hands On Workshops have limited seats and will be available on first come first serve basis on prior registration only. 4. Hands On Workshops may extend beyond stipulated time, causing them to overlap inadvertently. 5. Cancellations not permitted. No refunds will be made

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Published for the period of March -2023

Achieving Glowing, Healthy Skin

The skin is a complex and vital organ that requires attention and care. The skin is not only the largest organ in the body, but it is also one of the most visible. As a result, it can have a significant impact on our self-esteem and mental health. Achieving glowing, healthy skin requires a combination of good skincare habits, healthy lifestyle choices and a positive mindset. The constant pressure to have perfect skin can be overwhelming and can lead to feelings of inadequacy and low self-worth. It's important to remember that skin conditions are common and affect people of all ages, genders and backgrounds. Seeking treatment and care for skin conditions is important for both physical and mental health. In addition, taking care of our skin is essential for maintaining overall health and well-being. Good skincare habits, healthy lifestyle choices, and a positive mindset can all contribute to healthier, glowing skin. It's important to prioritize self-care and selflove, rather than comparing ourselves to unrealistic beauty standards. By focusing on healthy habits and positive self-talk, we can help support our skin and maintain overall health and well-being.

Remember, achieving glowing, healthy skin takes time and consistent effort. By incorporating skin care tips like cleanse and moisturize skin daily, exfoliate regularly, use sunscreen daily, stay hydrated, eat a healthy diet, get enough sleep, manage stress, avoid processed foods and sugar, exercise regularly into our lifestyle, we can help improve the health of our skin from the inside out, resulting in a glowing, healthy complexion.

- Dom Daniel Executive Editor & Publisher

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Digital Gangrene in Hansen’s DiseaseAn Atypical Presentation

Dr. Aditi Singh, MBBS, DDVL, FAGE

Congenital Nasal Dermoid and Sinus

Cysts: A Case Report

Dr. Sheetal Dandale, MBBS, MD, DDV, FCPS

Management of Acne with Black Peels

Dr. Fariya Rasheed, MD, DVL

Editorial Board

Dr. Sheetal Dandale

MBBS, MD, DDV, FCPS Consultant Dermatologist, Trichologist and Laser Surgeon Skinconsult Clinic, Mumbai

Dr. Aditi Singh

MBBS, DDVL, FAGE

Consultant Dermatologist and Aesthetician Dr Aditi Singh's Skin Clinic, Raipur Government District Hospital, Raipur

Dr. Fariya Rasheed MD, DVL

Consultant Dermatologist

Dr. Fariya Rasheed’s Skin Laser Hair Clinic Hyderabad, India

Digital Gangrene in Hansen’s DiseaseAn Atypical Presentation

Dr. Aditi Singh

MBBS, DDVL, FAGE

Consultant Dermatologist and Aesthetician

Dr Aditi Singh's Skin Clinic, Raipur Government District Hospital, Raipur

Abstract

Digital gangrene in upper limbs may be due to systemic sclerosis, trauma, connective tissue disorders or vasculitic disorders.[1] Leprosy as an infectious cause of gangrene, is rare and gangrene associated with leprosy is unusual except in the Lucio variant. Our patient presented with no features of connective tissue disease or vasculitis. She also tested negative for the serology done to rule out the same. Also, she did not show any classical clinical features of Lucio leprosy. Further, she was also pregnant at the time of presentation, confirmed by a positive Urine Pregnancy Test (UPT). We are reporting this case as it was a very atypical presentation of leprosy coupled with an uncommon subset of patient population: pregnancy. She is currently under follow up, and on Multi Drug Therapy for leprosy.

Keywords: leprosy, gangrene, pregnancy

Introduction

Leprosy is a chronic infectious disease caused by a type of bacteria, Mycobacterium leprae.

The disease predominantly affects the skin and peripheral nerves. As per WHO, elimination of leprosy as a public health problem globally (defined as prevalence of less than 1 per 10000 population) was achieved in 2000. But it still remains an important public health problem in many parts of the world.[2] Leprosy presenting as digital gangrene is unusual [3] and this case is being reported due to its peculiar presentation and that too in a pregnant lady.

Case report

A 22 year old female patient presented to the Dermatology OPD of District Hospital, Raipur with the chief complaint of blackish discoloration of right index finger since 3 months. It was insidious in onset, associated with pain. She gave a history of an ulcer on the tip of the finger which was apparently surgically debrided at a peripheral hospital, but there was no improvement, after which she was referred to our centre. There was no history of similar complaints in any other parts of the body. She also gave history of an abortion at 7 months

of pregnancy, prior to the onset of blackish discoloration of the finger. She denied any complaints during pregnancy. There was no history of smoking, facial rash, photosensitivity, oral ulcers, joint pains or fever prior to onset of present symptoms. There was a history of 2 months of amenorrhoea along with the presenting complaints, which was subsequently confirmed to be another pregnancy by UPT.

She also complained of hypoesthesia in her right thumb and index finger and adjoining areas of palm since 3 months. There was no history of any other such patches on the body. There was no history of painful skin lesions in the past. There was no history of loss of hair from any part of the body. There was no family history of Hansen’s disease.

On examination, right finger showed blackish discoloration in the distal half, with a tapering end (possibly due to autoamputation) and an illdefined fibrotic hypopigmented patch on the dorsum of right thumb. Sensations were diminished in the right Median Nerve distribution on the palmar aspect of the right hand and right Ulnar Nerve thickened and non-tender. There were no other patches present elsewhere on the body.

Given the history and clinical presentation, we zeroed in on Hansen’s disease with peripheral vascular disease as a working diagnosis and got her evaluated accordingly.

Her Total Leucocyte Count (TLC), Differential Leucocyte Counts (DLC), Haemoglobin, Erythrocyte Sedimentation Rate

(ESR), Liver Function test (LFT), Renal Function Test (RFT), Urine Routine and Microscopy, Thyroid Function Test were all within normal limits. Anti-Nuclear Antibody (ANA), anti-double stranded DNA (anti-dsDNA), anti Phospholipid Antibodies (APLA), Anticardiolipin antibodies (ACLA) were all negative. Arterial Doppler of right upper limb was normal. Thus vascular and auto-immune causes of gangrene were ruled out. As mentioned earlier, UPT was positive. Slit-skin smears from lobes of both ears were 1+. A diagnosis of Hansen’s disease with pregnancy was made and she was started on Pauci-Bacillary Multi-Drug Therapy (PB-MDT). A B

Figure 1 (A&B): Blackish discoloration of right index finger

Digital Gangrene in Hansen’s Disease- An Atypical Presentation

Discussion

When the woman first presented to us in the Dermatology OPD, she was essentially a case of digital gangrene under evaluation. A concomitant history of 2 months amenorrhoea prompted us to test for pregnancy which came positive, and a history of abortion in recent past made us think of Anti Phospholipid Antibody Syndrome, which we ruled out by negative serology. At this point, digging deeper into the history we found that she had areas of hypoesthesia in the ipsilateral hand. Hence a differential diagnosis of peripheral vascular disease with Hansen’s disease was considered and work-up done accordingly. After getting the laboratory results, we ruled out vaso-occlusive disease and suspected Hansen’s disease. But Hansen’s disease presenting with gangrene is unusual.[3] This presentation prompted us to consider Lucio leprosy since it is the form of leprosy that presents with gangrene. However Lucio Leprosy is a variant of Lepromatous leprosy and is considered a necrotizing panvasculitis.[2] Clinically, our patient did not seem to have Lepromatous leprosy and in light of the fact that she refused for a skin biopsy, we could not confirm. Also, it did not seem like a classical presentation of Luciovariant of leprosy. Gangrene in leprosy (other than Lucio leprosy) is postulated to have various mechanisms.[1]

Vessel wall changes such as intimal thickening and medial infiltration, embolization of Virchow cells or nerve trunk hypertrophy due to the

lepromatous process can cause arterial occlusion in osteoligamentous channels. Other possible mechanisms may be vasospasm due to irritation of sympathetic fibres and lastly, the Lucio phenomenon.[4]

This case report highlights that gangrene as a clinical entity must be evaluated thoroughly and prompts us to be alert about the infectious cause of gangrene (leprosy) especially in the Indian scenario,where it is still a public health issue at large.

References

1. Singh S, Chand G, Charan S, Arora S, Singh P. Peripheral arterial disease and digital gangrene: a rare presentation of diabetic hand syndrome. J Clin Diagn Res. 2013Oct;7(10):2286-7.

2. Nunzie E, Ortega Cabrera LV, Macanchi Moncayo FM, Ortega Espinosa PF, Clapasson A, Massone C. Lucio Leprosy with Lucio's phenomenon, digital gangrene and anticardiolipin antibodies. Lepr Rev. 2014 Sep;85(3):194-200.

3. Akerkar SM, Bichile LS. Leprosy & gangrene:a rare association; role of antiphospholipid antibodies. BMC Infect Dis. 2005 Sep21;5:74.

4. El-Anany G, Nada H, Nagui N, Shalaby S, Sany E, Elmongy N, Nada A.Finger gangrene: an unusual presentation of leprosy .J Egypt Womens Dermatol Soc 2019;16:68-70.

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Congenital Nasal Dermoid and Sinus Cysts: A Case Report

Dr. Sheetal Dandale

MBBS, MD, DDV, FCPS

Consultant Dermatologist, Trichologist and Laser Surgeon Skinconsult Clinic, Mumbai

Introduction

Congenital nasal dermoid and sinus cysts (NDSCs) are rare congenital malformations. They are the most common type of congenital nasal midline lesions.1

Other types include nasal meningoencephaloceles and gliomas. The incidence of dermoid cysts and fistulas in the midline of the nose is 1/20,000 to 1/40,000.1 NDSCs constitute approximately 11% of dermoid cysts in the head and neck, 1% of dermoid cysts in the whole body, and 61% of median lesions in children.

Herewith we describe a rare case of NDSC in an Indian adult female.

Case Report

An otherwise healthy 41-yearold female presented with an asymptomatic swelling over her nasal dorsum of 10 years duration. She reported a life-long history of a dorsal nasal pit, from which she also noted the growth of hair from within the pit.

The patient denied a history of nasal infection or abscess. She had never sought any type of medical attention for the pits.

On examination, the area around the middle nasal vault was skin coloured and swollen. A midline punctum and a sinus was present without any discharge. On probing, the sinus tract was ending on the nasal bone.

Based on this clinical presentation, the diagnosis of nasal dermoid sinus cyst was made.

In this case, we successfully performed the external rhinoplasty approach. This approach offers a good surgical exposure and an excellent cosmetic effect.2 1

Discussion

In 1817, Cruvelier first described a nasal dermoid cyst when he identified a hair-containing sinus tract of the nasal dorsum in a child.

A nasal dermoid typically presents as a midline mass, and may be located anywhere from the base of the collumella, along the nasal dorsum, to the nasoglabellar region.3 It is typically a noncompressible mass that does not transilluminate and has a negative Furstenberg sign (i.e. there is no enlargement with compression of the jugular veins).

A sinus opening with intermittent discharge of sebaceous material is frequently encountered. Local infection is common, but infection related to intracranial extension (e.g. meningitis and brain abscess) is rare. Hair protruding through a cutaneous punctum over the nasal dorsum is pathognomonic for a nasal dermoid.4 The mean age of presentation varies from 14 to 34 months,3,5 but reports of nasal dermoids presenting in adults exist in the literature.6,7,8

There are some reports about male predominance.9

Intracranial extension varied from 5 to 45% in several recently published series.3,4, 9, 10

Nasofrontal dermoid sinus cysts have a unique embryological origin. A midline basal frontal dermoid associated with a dimple or sinus opening on the nasal dorsum with or without protruding hair and sebaceous discharge is the classical presentation.

The first report about NDSC was published by Bramann in 1890.11

There are lots of theories like sequestration, trilaminary and prenasal, about NDSCs.

The most accepted theory is Pratt’s prenasal theory.12

Pratt described the common embryologic pathway of gliomas, encephaloceles and nasofrontal dermoid sinus tract.11,5

The nasal bones are separated from the adjacent cartilaginous nasal capsule by a Prenasal space (Fig. 1).

1 (b)

Figure 1 (a&b): Asymptomatic swelling over nasal dorsum

Figure 2: Successfully performed the external rhinoplasty

Figure 3: Removed dermoid sinus cyst

Figure 4: After surgery completely cured with excellent cosmetic effect

Figure 5: Prenasal space — a potential space extending from the brain to the nasal tip

Congenital Nasal Dermoid and Sinus Cysts: A Case Report

Faulty regression of the embryologic neuroectodermal tract pulls skin elements into the prenasal space, resulting in a dermoid cyst or sinus. The sinus tract may form anywhere along the course of the diverticulum, from the columella to the anterior cranial fossa. The lesion may be extranasal, intranasal, or a combination of the two. The majority of nasal dermoids are confined to the superficial nasal area. Intracranial extension most often communicates through the foramen cecum or the cribriform plate to the base of the frontal fossa with extradural adherence to the falxcerebri. There are rare reported cases of involvement of the brain parenchyma.3

Imaging is a crucial component in the evaluation of nasal dermoids since intracranial extension has been reported in up to 45% of cases.

Computed tomography (CT) and magnetic resonance imaging (MRI) scans are the gold standards in radiographic evaluation of nasal dermoids.

Complete surgical excision of nasal dermoid cyst and any associated sinus tract is essential for cure. Recurrence rates of 50–100% have been reported in cases in which dermal components were incompletely removed.4,13 Any surgical approach for removal of nasal dermoid cysts should adhere to the following four tenets: permit access to all midline lesions and allow for medial and lateral osteotomies; allow repair of skull base defects or cerebrospinal fluid leak; facilitate reconstruction of any nasal deformity; and result in a cosmetically acceptable scar.13

The midline vertical incision continues to be the most popular and straightforward technique for removal of the cyst.

Conclusion

Although nasal dermoids are rarely encountered, their potential for local bony atrophy and distortion of the nose, as well as serious infections such as meningitis and brain abscess, warrant early recognition, accurate diagnosis, and prompt treatment. A thorough understanding of the embryogenesis of midline nasal congenital lesions is important when the diagnosis is not obvious on physical examination alone. Manipulation of a midline nasal mass prior to excluding or confirming any central communication may result in cerebrospinal fluid leak or infection. Imaging of the midface and brain is essential for accurate diagnosis, assessment for any intracranial extension, and appropriate surgical planning. Complete excision of the cyst and its tract is the only cure. Any residual ectodermal elements result in a high rate of recurrence and complicated infections.

References

1. Hughes GB, Sharpino G, Hunt W, et al. Management of the congenital midline nasal mass—a review. Head Neck Surg 1980;2:222–33

2. Locke R, Kubba H. A case of a nasal dermoid presenting as a median upper lip sinus. Int J Oral MaxiofacialSurg 2011;40:985–7. [PubMed] [Google Scholar]

3. Rahbar R, Shah P, Mulliken JB, et al. The presentation and management of nasal dermoid: a 30-year experience.

4. Wardinsky TD, Pagon RA, Kropp RJ, et al. Nasal dermoid sinus cysts:

association with intracranial extension and multiple malformations. Cleft palate Craniofac J 1991; 28:87–95

5. Penslar JM, Bauer BS, Naidich TP. Craniofacial dermoids. PlastRenconstrSurg 1988; 82:953–959

6. Hacker DC, Freeman JL. Intracranial extension of a nasal dermoid sinus cyst in a 56-year-old man. Head Neck 1994; 16:366–371.

7. Vaghela HM, Bradley PJ. Nasal dermoid sinus cyst in adults. J LaryngolOtol 2004; 118:955–962.

8. Post G, McMains KC, Kountakis SE. Adult nasal dermoid sinus cyst. Am J Otolaryngol 2005; 26:403–405

9. Denoyelle F, Ducroz V, Roger G, Gara-bedian EN. Nasal dermoid sinus cysts in children. Laryngoscope 1997;107:795-800

10. Van Aalst JA, Luerssen TG, Whitehead WE, Havlik RJ. ‘Keystone’ approach for intracranial nasofrontaldermoid sinuses. PlastReconstrSurg 2005; 116:13–19. Excellent discussion of the intracranial/ extracranial approach to dermoids pathology

11. Hanikeri M, Waterhouse N, Kirkpatrick N, et al. The management of midline transcranial nasal dermoid sinus cysts. Br J PlastSurg 2005;58:10431050.

12. Emel CT, Ömer TS, Güleser SAO, Hakan K. The management of rare nasal mass – nasal dermoid sinus cysts: open rhinoplasty. Rare Tumors. 2009 Dec 28;1(2):e40.

13. Posnick JC, Bortoluzzi P, Armstrong DC, Drake JM. Intracranial nasal dermoid sinus cysts: computed tomographic scan findings and surgical results. PlastReconstrSurg 1994; 93:745–754.

Congenital Nasal Dermoid and Sinus Cysts: A Case Report

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Management of Acne with Black Peels

Dr. Fariya Rasheed MD, DVL

Consultant Dermatologist

Dr. Fariya Rasheed’s Skin Laser Hair Clinic

Hyderabad, India

Introduction

Acne is a common dermatological condition that occurs when the skin pores become blocked with oil, dead skin cells, and bacteria. It is an inflammatory skin disorder of the pilosebaceous unit with multifactorial pathogenesis, sometimes it has a chronic course and it is self – limiting.1,2 There are multiple factors have been attributed to acne predisposition and individual variations in the severity of skin symptoms have been observed.3 The major pathogenic factors include hyperkeratinization, obstruction of sebaceous follicles resulting from abnormal keratinization of the infundibular epithelium, stimulation of sebaceous gland secretion by androgens, and microbial colonization of pilosebaceous units by propionibacterium acnes, which develop perifollicular inflammation.4

It is a chronic inflammatory disorder of the pilosebaceous unit that can present in a wide range of severity, from mild comedonal acne to severe inflammatory cystic acne. The

clinical presentation of acne can vary, and can be found on the face, chest, and back.4 The characteristic lesions of acne vulgaris include open (blackheads) and closed (whiteheads) comedones, inflammatory papules, pustules, nodules, and cysts. These lesions can lead to scarring and pigmentary changes, which can have a significant impact on a person's self-esteem and quality of life.5

When assessing the severity of acne, it is important to consider the distribution of the lesions (e.g. on the face, chest, upper arms), the type and number of lesions (e.g. comedones, papules, pustules, nodules), and the presence or absence of scarring.6

Grading system for acne can be helpful to determine the type and severity of the acne (Table 1), the Global Acne Grading System (GAGS) and Acne Severity Index (ASI) are among the most commonly used grading systems. In this system, comedonal acne refers to non-inflammatory acne, such

as blackheads and whiteheads, inflammatory acne includes papules and pustules, and is characterized by redness and swelling, cystic acne, also known as nodulocystic acne, is a severe form of inflammatory acne that involves large, painful cysts and nodules.5, 7

Acne scars are a common concern for many people who have had acne. They occur when the skin does not heal properly after inflamed acne lesion has resolved. The scars are caused by inflammation in the skin, which can damage the collagen and elastin fibers in the skin. There are several types of acne scars, including atrophic scars (depressed scars), hypertrophic scars (raised scars), and keloid scars (raised scars that extend beyond the boundary of the original wound). The type and severity acne scars will determine the best treatment options.8

There are several types of acne scars, including atrophic scars (depressed scars), hypertrophic scars (raised scars), and keloid scars (raised scars that extend beyond the boundary of the original wound). It's important to note that acne vulgaris is a chronic condition that tends to have fluctuating periods of improvement and exacerbation, and therefore requires long-term management. The management of acne vulgaris is tailored to the individual patient and can include topical and oral medications, as well as lifestyle changes. The type and severity of acne scars will determine the best treatment options. Effective treatment of acne vulgaris typically involves a combination of topical and oral medications, as well as

lifestyle changes such as maintaining a healthy diet, avoiding harsh skin care products, and practicing good hygiene. Some common treatment options include topical treatments such as retinoids and hydroquinone, chemical peels, laser resurfacing, and microneedling, subcision and punch excision, scar revision surgery etc.7

It is recommended to visit a dermatologist for an accurate diagnosis and treatment plan, as treatment options depend on the type and severity of the acne, as well as the individual's needs and preferences.

It's important to note that the best treatment for acne scars is individualized and depends on the type and severity of the scars, as well as the patient's goals and preferences. The presented are some cases with acne (grade 2-3).

Table 1- Grading severity of acne5

Grade Severity

Clinical findings

I Mild Open and closed comedones with few inflammatory papules and pustules

II Moderate Papules and pustules, mainly on face

III Moderately severe Numerous papules and pustules, and occasional inflamed nodules, also on chest and back

IV Severe Many large, painful nodules and pustules

Management of Acne

There are many treatment options are available to manage the acne. The treatment for acne aims to reduce its severity and recurrences of skin lesions as well as to improve patient’s skin appearance. The treatment approach is always depends on the severity of the acne, the treatment preferences, age of the patient, adherence and response to previous therapy.5 The current effective strategies of management recommended by the global alliance are directed toward one or more pathogenic factors and include topical and systemic antibiotics and retinoids, benzoyl peroxide, azelaic acid, salicylic acid and oral antiandrogens, depending on the severity of the disease.2

Topical therapies which are considered as the first-line treatments include retinoids (eg: tretinoin, adapalene), benzoyl peroxide, azelaic acid and combination with systemic agents such as oral antibiotics like doxycycline and minocycline. Hormonal therapies such as combination oral contraception [COC] or spirolactone, isotretinoin are prescribed for severe acne conditions.9

A wide range of other therapeutic options are also available to manage the acne and chemical peels are considered to be an effective treatment option for acne management. Chemical peel is a skin resurfacing procedure which helps to regenerate normal skin through the application of exfoliative agents. It is a well known technique which is being used for acne vulgaris as well as for other skin disorders such as photodamage, pigmentary disorders and

Management of Acne with Black Peels

Management of Acne with Black Peels

scars.7, 10 It is a procedure where a chemical substance is applied to the skin causing controlled destruction of the epidermis with or without part of the dermis which leads to skin regeneration and remodelling. Chemical peels are generally classified on the basis of their depth of skin penetration into superficial, medium and deep peels.7

Chemical peeling, also known as chemexfoliation or chemical exfoliation, is a skin resurfacing procedure that uses chemicals to cause controlled destruction of the epidermis with or without part of the dermis, leading to skin regeneration and remodeling. It has been used for the treatment of acne vulgaris and other skin disorders for decades.

Chemical peels can be used to treat various skin conditions, such as acne vulgaris, photodamage, pigmentary disorders, and scars. Different types of chemical peels are available and vary in strength and depth of penetration, which determines the degree of skin injury and the recovery time. For acne vulgaris, chemical peels are helpful to improve the texture and color of the skin, reduce the appearance of acne scars, and improve the overall appearance of the skin.

Management of acne with Black Peels

Black peels are a type of chemical peel that uses a combination of chemicals to remove the top layers of skin, causing it to peel off. It is a new chemical composition based on black acetic acid mixed with jasmonic acid, salicylic acid, potassium iodide and biosulfur. It is often used to improve the appearance of acne scars,

as well as to treat other skin conditions such as sun damage, age spots, and uneven skin tone. Black acetic acid have been numerous pharmacological effects like anti-tumor, antioxidant, antihypertensive. The specific type of black peel and the strength of the peel used will depend on the severity of the acne scars and the individual's skin type and goals for treatment. They work by removing the top layers of skin, which can help to smooth out the texture and tone of the skin.7, 10,11 Potassium iodide (KI) is also important composition of black peel which was empirically used for deep fungal infection and severe vacuities-induced wound. It can be used as a topical treatment for some skin conditions as it works against infection and as an anti-bacterial and anti-fungal agent. Jasmonic acid and salicylic acid are plant secreting acid that are released to defend themselves when they are attacked or damaged. Jasmonic acid activates the expression of protease inhibitors which can stop the attack of the harmful insects. Both jasmonic acid and salicylic acid play an important role in the pathogen defence response and also have the anti-inflammatory effect as well as the exfoliating property which can induce a beneficial response of the living layers of skin by correcting a number of signs associated with skin impairment. Biosulfur is useful in acne as it helps to kill bacteria on the skin, which results in an improvement in acne, pimples, seborrhoea and psoriasis conditions. It acts as a keratolytic and also has germicidal action.12

They may cause side effects

such as redness, swelling, and peeling of the skin, and there is a risk of complications such as scarring, hyperpigmentation, or infection.

It is important to carefully follow the post-treatment instructions provided by healthcare provider to ensure proper healing and to minimize the risk of complications. It is also important to protect the treated skin from the sun, as it will be more sensitive to UV rays after the peel.13

Result

We got the good result in the age group of the patients are 21 -27 years who presented acne (grade 2 – 3) in our clinic. Diagnosis was done on the basis of typical clinical presentation and then used the black peels option to manage the acne and acne scars.

The pictures are taken before treatment and after the treatment effects on patients using black peel. The pictures are taken between the two consecutive sessions of the therapy.

The face of the patient was thoroughly prepared for the peeling session. Chemical peeling is the widely used procedure in the management of acne vulgaris and in this study patients were subjected to the black peel which contains black acetic acid, jasmonic acid, salicyclic acid and potassium iodide which was used topically for the course of 2 treatment sittings.

Following some cases showed good result after treatment.

Management of Acne with Black Peels

Patient 1

Before treatment After treatment

Before treatment After treatment

Patient 2

Before treatment After treatment

Before treatment After treatment

Before treatment

After treatment

Patient

Patient 4

Patient 5

Discussion

Acne is the common skin condition with the prevalence of 35% - 90% in the adolescent age. It peaks between the age of 14 and at the beginning of the third decade also it persists in 20% men and 35% women.2

Multidisciplinary investigations into the pathogenesis of acne vulgaris have significantly progressed over last few years. Studies of the etiology of acne from the perspectives of sebaceous gland biology, sebum, genetics, keratinization,

differentiation, hair cycles, immunology, bacteriology, and wound healing have elucidated its pathogenesis. This has led to the development of new therapies and paved the way for advanced technologies that enable the further evolution of acne vulgaris treatment. 14

Chemical peeling is a widely used procedure in the treatment of acne and acne scars. Black peel can be used as promising and hopeful alternative treatment for acne vulgaris.15

To analyze efficacy and safety of Azelaic peel (20% Azelaic acid peel), black peel (Acetic acid 8% peel), Kojic acid peel (12% kojic acid peel), Lactic acid peel (90% lactic acid peel), Mandelic acid peel (35% mandelic acid peel) in treating patients of acne vulgaris between grade I to III. The study was conducted which included a total 120 patients. Patients in each arm were subjected to respective chemical peels at an interval of 15 days for a total of 6 sessions. Last visit was finished at 12th week. Evaluation was done

Patient 6

by dermatological assessment for acne including counting the number of comedones, papules and pustules. Patients with progress report at the end of 12 weeks the overall reduction rate observed was 60.4%, 72.4%, 24.1%, 35.2% and 50.1% with Azelaic peel, Black peel, Kojic acid peel, Lactic acid peel and Mandelic acid peel respectively. The study thus concluded that the efficacy of black peel is highest in the treatment of acne vulgaris between grade I to III in Indian patients.11

Peels cause controlled destruction of a part or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions which is followed by regeneration of new epidermal and dermal tissues. A series of chemical peels can lead to significant improvement over a brief period, leading to patient satisfaction and maintenance of clinical results.15

Conclusion

Acne can be mild or severe, and while it is not a serious health risk, it can cause physical discomfort and have a negative impact on a person's self-esteem and quality of life. To help prevent acne, it is important to keep the skin clean and moisturized, and to avoid picking at or squeezing pimples, which can cause them to become infected. Understanding the multiple diverse, interdependent and complicated etiological factors of acne and the biology of sebaceous glands is an extremely important part.

Superficial to medium depth chemical peels are more useful adjuvant therapies in acne. It effectively targets the different factors involved in

the development of this skin condition and enhance the effects of other topical formulations. The benefits and its complications varies among racial groups, and special attention should be given when dealing with dark-skinned patients. However, it is important to note that the benefits and complications of chemical peels may vary among racial groups, and special attention must be paid when dealing with darkskinned patients. Darker skin types are more susceptible to hyperpigmentation, so it's important to use the appropriate strength of peel and to follow post-treatment instructions to avoid complications. It is important to consult with a qualified professional, such as a dermatologist, to determine if chemical peels are appropriate for you and to ensure proper technique and aftercare is followed.

Reference

1.Sutaria AH, Masood S, Schlessinger J. Acne Vulgaris. [Updated 2022 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm. nih.gov/books/NBK459173/

2. Bhat YJ, Latief I, Hassan I. Update on etiopathogenesis and treatment of Acne. Indian J Dermatol Venereol Leprol. 2017 May-Jun;83(3):298-306. doi: 10.4103/0378-6323.199581. PMID: 28195079.

3.Heng, A.H.S., Say, YH., Sio, Y.Y. et al. Gene variants associated with acne vulgaris presentation and severity: a systematic review and meta-analysis. BMC Med Genomics 14, 103 (2021). https://doi.org/10.1186/s12920-02100953-8

4. Toyoda M, Morohashi M. Pathogenesis of acne. Med Electron Microsc. 2001 Mar;34(1):29-40. doi:

10.1007/s007950100002. PMID: 11479771.

5. Kraft J, Freiman A. Management of acne. CMAJ. 2011 Apr 19;183(7):E4305. doi: 10.1503/cmaj.090374. Epub 2011 Feb 28. PMID: 21398228; PMCID: PMC3080563.

6. Alsulaimani H, Kokandi A, Khawandanh S, Hamad R. Severity of Acne Vulgaris: Comparison of Two Assessment Methods. Clin Cosmet Investig Dermatol. 2020 Sep 28;13:711-716. doi: 10.2147/CCID. S266320. PMID: 33061511; PMCID: PMC7532287.

7. Samargandy S, Raggio BS. Skin Resurfacing Chemical Peels. 2022 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 31613532.

8. Fabbrocini G, Annunziata MC, D'Arco V, De Vita V, Lodi G, Mauriello MC, Pastore F, Monfrecola G. Acne scars: pathogenesis, classification and treatment. Dermatol Res Pract. 2010;2010:893080. doi: 10.1155/2010/893080. Epub 2010 Oct 14. PMID: 20981308; PMCID: PMC2958495.

9. Eichenfield DZ, Sprague J, Eichenfield LF. Management of Acne Vulgaris: A Review. JAMA. 2021 Nov 23;326(20):2055-2067. doi: 10.1001/ jama.2021.17633. PMID: 34812859.

10. Castillo DE, Keri JE. Chemical peels in the treatment of acne: patient selection and perspectives. Clin Cosmet Investig Dermatol. 2018 Jul 16;11:365-372. doi: 10.2147/CCID. S137788. PMID: 30038512; PMCID: PMC6053170.

11. Karia U, Parghi M, Padhiar B, Shah B. A study of efficacy and safety of newer chemical peels for acne vulgaris grade 1 to grade 3. IP Indian J Clin Exp Dermatol 2022;8(3):180-185.

12. Kumar R, Sachan P, Singh SK, Gupta AK, Mohan L.A prospective

observational study on efficacy of black acetic acid combination peel in patients of facial nodulocystic acne.Int J Res Dermatol2019;5:673-7.

13. Nikalji N, Godse K, Sakhiya J, Patil S, Nadkarni N. Complications of medium depth and deep chemical peels. J Cutan Aesthet Surg. 2012 Oct;5(4):254-60. doi: 10.4103/09742077.104913. PMID: 23378707; PMCID: PMC3560165.

14. Kurokawa I, Nakase K. Recent advances in understanding and managing acne. F1000Res. 2020 Jul 29;9:F1000 Faculty Rev-792. doi: 10.12688/f1000research.25588.1.

PMID: 32765835; PMCID: PMC7391011.

15. Kontochristopoulos G, Platsidaki

E. Chemical peels in active acne and acne scars. Clin Dermatol. 2017 MarApr;35(2):179-182. doi: 10.1016/j. clindermatol.2016.10.011. Epub 2016 Oct 27. PMID: 28274356.

Picosecond lasers for tattoo removal could benefit from enhancements, expert says

Picosecond lasers are a type of laser technology used in various medical and aesthetic procedures, including tattoo removal, skin rejuvenation, and treatment of pigmented lesions. They deliver energy in extremely short pulses, measured in picoseconds (trillionths of a second), which can break down pigments or other targeted tissues with high precision and minimal damage to surrounding tissues. When picosecond lasers hit the market about 10 years ago, they became a game-changer for tattoo removal, boasting the delivery of energy that is about three fold faster than with nanosecond lasers. However, picosecond lasers are far from perfect even in the hands of the most experienced clinicians, according to researchers. It took a long time for these lasers to come to the market, and they are still fairly expensive and require a lot of maintenance, they noted.

Today, most clinicians use Q-switched nanosecond and picosecond lasers for tattoo removal, though appropriate wavelengths need to be selected based on the tattoo ink color. Tattoo ink particles average about 0.1 mcm in size, and the thermal relaxation size works out to be less than 10 nanoseconds, with shorter pulses better at capturing the ink particles that are smaller than average. Black is the most common tattoo color dermatologists treat. “For that, we can typically use a 1064, which has the highest absorption, but we can also use many of the other wavelengths,” they said. “Other colors are less common, followed by red, for which we would use a 532-nm wavelength.”

Researcher underscored the importance of setting realistic expectations during consults with patients seeking options for tattoo removal. Even with picosecond laser technology, many treatments are typically required and “a good patient consultation is key to setting proper expectations,” they said. The clinical endpoint to strive for during tattoo removal is whitening of the ink, which typically fades about 20 minutes after treatment. That whitening corresponds to cavitation, or the production of gas vacuoles in the cells that were holding the ink. This discovery led to a technique intended to enhance tattoo removal. In 2012, researcher and colleagues published results of a study that compared a single Q-switched laser treatment pass with four treatment passes separated by 20 minutes. After treating 18 tattoos in 12 adults, they found that the technique, known as the “R20” method, was more effective than a single-pass treatment (P < .01).

Researcher suggests that consuming collagen-dense foods can directly benefit skin or joint health

Collagen is a protein that is naturally produced by the body and is a key component of the skin, hair, nails, and connective tissues. As we age, our natural production of collagen decreases, which can lead to wrinkles, sagging skin, and joint pain.

Researcher suggests that consuming collagen-dense foods can directly benefit skin or joint health. We produce less collagen as we age. External factors can slow down our collagen production, including smoking, sun exposure, lack of sleep/exercise, and alcohol consumption. Though human studies are lacking, some trials have found that collagen supplements may improve skin hydration and elasticity. “Maybe there’s some benefit, but the digestive process breaks collagen down into amino acids.

Some over-the-counter supplement that aims to relieve moderate hair thinning or strengthen hair to prevent breakage, and is physician-formulated with medical-grade ingredients that target root causes of thinning such as stress, lifestyle, hormones, and nutrition. As for biotin, we now know that high levels of biotin can actually cause hair loss. If you have advanced hair loss, supplements may not work for you. There is no hair regrowth supplement that can bring back a dead hair follicle. Platelet-rich plasma injections have been shown to stimulate hair growth, but only if the follicle is miniaturized, not if it’s totally gone.

In a review of healthy adults, the composition of microbial communities was found to be primarily dependent on the physiology of the skin site, with changes in the relative abundance of bacterial taxa associated with moist, dry, and sebaceous environments, the researcher reported. “The microbiome is the genetic material of all the microbes that live inside the body, including bacteria, fungi, protozoa, and viruses. The more diverse the microbiota is, the healthier it’s considered. That diversity is enriched through a diet full of various vegetables and fruits.

Ingredient

Almond Oil, Light Liquid Paraffin, Vitamin E Acetate, Aloe Vera Gel - D, Glycerine, Liposomal vit C, Aquaxyl, Shea Butter.

What is it ?

AQUAXYL™ offers the 3D hydration hydraconcept for circulation of moisture throughout all skin layers and boosting of hyaluronic acid.

What does it do?

AQUAXYL™ can limit water loss through its barrier which is reinforced in 24 hours. this barrier retains water through its essential lipids.

INGREDIENTS:

Caprylic Capric Triglyceride, Glycerin, Propylene Glycol, Avena Sativa (Oat)

Ker nel Flour, Butyrospermum Parkii, Aloe Barbadensis Leaf Extract, Tocopheryl Acetate, Simmondsia Chinesis (Jojoba) Seed Oil, Helianthus Annuus (Sunflower) Seed Oil, D-Panthenol, Cocos Nucifera (Coconut) Oil.