Basic chemical peeling: Superficial and medium-depth peels Lee, Kachiu C.; Wambier, Carlos G.; Soon, Seaver L. ...
Journal of the American Academy of Dermatology,
August 2019, 2019-Aug, 2019-08-00, 20190801, Letnik:
81, Številka:
2
Journal Article
Recenzirano
Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light–induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, ...increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly related to improved results and to the number of complications that can occur. Key principles for superficial and medium depth peeling are discussed, as well as appropriate indications for these treatments.
Upper eyelid skin excess is commonly treated using a surgical excision that is then sutured, resulting in a linear scar. Deep chemical peeling of the upper eyelids using the Baker Gordon formula has ...been described as a nonsurgical alternative to tighten upper eyelid skin with the advantage of lessening periorbital rhytides, although prolonged healing and hypopigmentation are risks. The goal of this study was to show the benefits of a less-invasive approach to periorbital rejuvenation that combines 89% phenol peeling with small, nonlinear excisions that heal by secondary intention.
Eight patients were chosen (mean age 59.6). All patients had thin to medium-thick skin, diffuse periorbital rhytides, and mild to moderate upper eyelid skin excess. Their eyelids were peeled using 89% phenol. Immediately after peeling, a scissor was used to make multiple small nonlinear excisions of upper eyelid skin that healed by secondary intention.
Patients were satisfied with the results, and no complications or scarring occurred.
Eighty-nine percent phenol peeling combined with multiple small upper eyelid skin excisions effectively tightens upper eyelid skin excess and lessens periorbital rhytides. The procedure has the advantage of not creating a linear scar and decreases the risk of prolonged healing and hypopigmentation, which is more likely with deeper peels.
Advanced chemical peels: Phenol-croton oil peel Wambier, Carlos G.; Lee, Kachiu C.; Soon, Seaver L. ...
Journal of the American Academy of Dermatology,
August 2019, 2019-Aug, 2019-08-00, 20190801, Letnik:
81, Številka:
2
Journal Article
Recenzirano
Once considered the standard for deep facial resurfacing, the classical Baker-Gordon phenol-croton oil peel has largely been replaced by formulas with lower concentrations of phenol and croton oil. ...The improved safety profile of deep peels has ushered in a new era in chemical peeling. Wrinkles can be improved and skin can be tightened with more subtle and natural results. No longer does a deep peel denote “alabaster white” facial depigmentation with complete effacement of wrinkles. Gregory Hetter's research showed that the strength and corresponding depth of penetration of the phenol-croton oil peel can be modified by varying the concentration of croton oil. This second article in this continuing medical education series focuses on the main historical, scientific, and procedural considerations in phenol-croton oil peels.
Chemical peels are applied to the face and neck to improve rhytides and the photoaged appearance of the skin. Peels can be applied to different skin depths depending on the types of chemicals, the ...volume of solution, and the amount of pressure or friction applied. If a peel is applied too superficially, rhytides will not be removed. If a peel is applied too deeply, scarring or hypopigmentation could occur.
To create face and neck depth maps for chemical peeling, which can guide safety when removing rhytides and improving the skin's appearance.
A multicenter retrospective review of records was conducted of patients who underwent phenol-croton oil peeling, from January 1, 2018, to December 31, 2018. Information was collected on facial and neck cosmetic units peeled, peel formula and strength used, outcomes, and complications.
A total of 410 patients received deep peels. Two depth maps were created that corresponded to the most common patterns of deep chemical peel applications.
Different areas of the face and neck are treated with different chemical peel application depths to safely improve rhytides and appearance. Depth maps are created to balance safety and efficacy.
Acne keloidalis: A novel presentation for tinea capitis Sterling, J. Barton, MD; Sina, Bahram, MD; Gaspari, Anthony, MD ...
Journal of the American Academy of Dermatology,
04/2007, Letnik:
56, Številka:
4
Journal Article
Recenzirano
Acne keloidalis is characterized by firm skin-colored papules on the surface of the neck and scalp. We report a case of tinea capitis in 60-year-old female which mimicked acne keloidalis. The lesions ...resolved following oral antifungal medication.
Candida albicans (CA) antigen immunotherapy for recalcitrant warts is a novel treatment that has had much success in the recent past. Although several side effects are well documented in the ...literature, we report a new adverse reaction to CA antigen immunotherapy for verruca vulgaris of the distal fingertip. Our patient received an intradermal injection of CA antigen solution into periungual warts located on the distal left thumb and distal subungual area of the left index finger. Within 24 hours, the patient reported pain, edema, and a purple hue to only the index finger. Incision of the finger demonstrated no hematoma or compartment syndrome. Although the etiology is unknown, we believe the condition was most likely due to edema and vascular compromise secondary to a vigorous delayed-type hypersensitivity reaction, possibly leading to cyanosis of the distal index finger. We report this case to make physicians who use intralesional CA antigen aware of a new possible complication at this anatomic location.
Safety planning for suicide prevention is an important quality metric for Zero Suicide implementation. We describe the development, validation, and application of electronic health record (EHR) ...programs to measure uptake of safety planning practices across six integrated healthcare systems as part of a Zero Suicide evaluation study.OBJECTIVESafety planning for suicide prevention is an important quality metric for Zero Suicide implementation. We describe the development, validation, and application of electronic health record (EHR) programs to measure uptake of safety planning practices across six integrated healthcare systems as part of a Zero Suicide evaluation study.Safety planning was documented in narrative notes and structured EHR templates using the Stanley Brown Safety Planning Intervention (SBSPI) in response to a high-risk cutoff score on the Columbia Suicide Severity Rating Scale (CSSRS). Natural Language Processing (NLP) metrics were developed and validated using chart review to characterize practices documented in narrative notes. We applied NLP to measure frequency of documentation in the narrative text and standard programming methods to examine structured SBSPI templates from 2010-2022.METHODSSafety planning was documented in narrative notes and structured EHR templates using the Stanley Brown Safety Planning Intervention (SBSPI) in response to a high-risk cutoff score on the Columbia Suicide Severity Rating Scale (CSSRS). Natural Language Processing (NLP) metrics were developed and validated using chart review to characterize practices documented in narrative notes. We applied NLP to measure frequency of documentation in the narrative text and standard programming methods to examine structured SBSPI templates from 2010-2022.Chart reviews found three safety planning practices documented in narrative notes that were delivered to at least half of patients at risk: professional contacts, lethal means counseling for firearms, and lethal means counseling for medication access/storage. NLP methods were developed to identify these practices in clinical text with high levels of accuracy (Sensitivity, Specificity, & PPV ≥ 82%). Among visits with a high-risk CSSRS, 40% (Range 2-73% by health system) had an SBSPI template within 1 year of implementation.RESULTSChart reviews found three safety planning practices documented in narrative notes that were delivered to at least half of patients at risk: professional contacts, lethal means counseling for firearms, and lethal means counseling for medication access/storage. NLP methods were developed to identify these practices in clinical text with high levels of accuracy (Sensitivity, Specificity, & PPV ≥ 82%). Among visits with a high-risk CSSRS, 40% (Range 2-73% by health system) had an SBSPI template within 1 year of implementation.This is one of the first reports describing development of measures that leverage electronic health records to track use of suicide prevention safety plans. There are opportunities to use the methods developed here in future evaluations of safety planning.CONCLUSIONSThis is one of the first reports describing development of measures that leverage electronic health records to track use of suicide prevention safety plans. There are opportunities to use the methods developed here in future evaluations of safety planning.
