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Modified and Advanced Injection Techniques
Published in Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh, Adapting Dermal Fillers in Clinical Practice, 2022
Yates Yen-Yu Chao, Sebastian Cotofana, Nicholas Moellhoff
Molding after the deployment of HA filler in tissue is an important part of the technique that redistributes the HA filaments. When the injection of HA is administrated too deeply, the effect of gap sealing is turned into one of stuffing under the whole thickness of the skin and becomes ineffective. Blanching of the skin comes from distension of the transparent foreign substance in a very superficial plane that expels the superficial circulation and causes blood displacement. The blanching is transient and usually lasts less than 10 minutes. It should be differentiated from the blanching reaction due to intra-arterial injection by the usual absence of pain, the extent of the blanching being limited to the route of the passing needle (progressively following the retrograde withdrawal movement of the needle), a gradual disappearance in minutes, and the changes occurring in a very superficial tissue plane.
Chronic erythematous rash on the face
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
This is a pale pink patch, which has been present since birth, situated on the nape of the neck, forehead or eyelid. Pressure over the area will cause blanching, showing that it is due to dilated blood vessels. Those on the face usually disappear during the first year of life; those on the nape of the neck do not, usually persisting throughout life. Often, the occipital patch is not noticed unless there has been hair loss at this site. No treatment is needed because it is usually covered by hair.
Battlefield Chemical Inhalation Injury
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
This substance is primarily active as a topical agent with local application producing skin necrosis at the site of contact. There is early blanching followed by erythematous changes surrounding the area of blanching. Within 30 min a wheal appears and within 24 hr the original area of blanching acquires brown pigmentary changes. Subsequently an eschar forms that will slough off in 3-4 weeks. Itching is typically persistent throughout this period. Healing may be delayed to more than 2 months (U.S. Dept, of the Army, 1968). Topical absorption of this material in one reported human case led to dyspnea, which was thought to be an early sign of toxic pulmonary edema (Tschanatschev, 1958).
Therapeutic advances in wound healing
Published in Journal of Dermatological Treatment, 2022
André Oliveira, Sandra Simões, Andreia Ascenso, Catarina Pinto Reis
Wisebands® (Wisebands, London, UK) device consists of a tension feedback control mechanism device, a polypropylene band and a metal surgical needle. Both the band and the needle are brought through the wound edges, down to the underlying soft tissue under the wound. A feedback tension control device holds the band and, by rotating a knob on the unit, a load is transferred to the wound edges in a controlled manner. When the tension exceeds 1 kg/cm2, the feedback control mechanism device releases and remains in the last safe position. It has been reported its benefits in complex wounds involving skin and soft tissues defects of various sizes and in various anatomical locations. However, minor wound complications such as pain, skin irritation or blanching, hematoma or neurapraxia can be caused. Other major complications have been detected such as wound infections or intractable pain when using this invasive device (136).
Adjuncts to pulsed dye laser for treatment of port wine stains: a literature review
Published in Journal of Cosmetic and Laser Therapy, 2021
Bing Wang, Xianglin Mei, Yanlong Wang, Xin Hu, Fuqiu Li
Endothelin is a bioactive peptide synthesized by endothelial cells that has vasoconstrictive effect, which is associated with the growth of various tumors. It can inhibit cell apoptosis and promote neovascularization. Endothelin receptor antagonists have been shown to exhibit antiangiogenic effects in animal models (47). Accordingly, some scholars speculated that the endothelin receptor antagonist, bosentan, may inhibit PDL-induced angiogenesis in PWS lesions. Under this assumption, it was used in combination with PDL to treat PWS. Four patients with refractory PWS received bosentan 1 day before the PDL treatment and continued it for 14 days. Three patients showed no or only slight improvement, whereas one patient showed a noticeable improvement at the treated area. At 6-month follow-up, the efficacy was maintained. Subsequently, this patient was continued to be treated, and the lesions also showed blanching. This result indicates that some PWS patients may benefit from systematically administered endothelin receptor antagonists to inhibit angiogenesis after PDL treatment (48).
Increasing knowledge and inclusivity – encompassing BAME in medical education
Published in Medical Teacher, 2021
Skin colour is a cause of disparity in healthcare and health outcomes for numerous reasons besides discrimination and poor access to healthcare. Inequality can occur if well-intentioned healthcare providers are ‘colour-blind’ (Penner and Dovidio 2016) – the act of discounting a patient’s skin colour because they believe doing so will help provide an equivalent level of care to all patients. But this method limits the relevance of skin colour to health and restricts health care professionals’ ability to provide personalised care. To illustrate, in dark-skinned patients, the blanching skin test has minimal value. In order to provide high-quality care for dark-skinned patients, healthcare professionals should not be using skin assessment protocols that have been founded for fair skin. It is crucial to expand the body of knowledge pertaining to appropriate methods of assessing skin colours along the entire continuum. There is no room for ‘colour-blindness’ in healthcare.