Seemingly healthy skin in atopic dermatitis: observations with the use of high‐frequency ultrasonography,preliminary study

Background: Atopic dermatitis (AD) is a chronic, relapsing skin disorder which is strictly determined by the epidermal barrier function. In previous studies, there is conclusive evidence that normal‐looking, nonlesional skin presents meaningful barrier function defect and a sub‐clinical eczematous skin reaction. Aim: The authors intended to visualize nonlesional AD skin with the use of high frequency ultrasonography to show that the normal‐looking, nonlesional skin may present significant abnormalities in USG examination. Methods: We have performed analysis with the use of high‐frequency 20 MHz skin sonography in the cases of 15 AD patients of the Department of Dermatology, Medical University, Poznań, Poland. The clinical score has been evaluated on the basis of W‐AZS index and EASI. The results were presented in the form of ultrasonographic images. Results: High frequency ultrasonography revealed an echopoor band within nonlesional skin of six (40%) examined AD patients and in all cases within skin lesions. Conclusion: Our results indicate the significant role of skin ultrasonography in the complete clinical evaluation of patients with AD, which may serve as an element in selection of the most appropriate topical treatment. An echopoor band beneath the echo entry within nonlesional skin of some AD patients may reflect subclinical eczematous reaction and the readiness for the development of typical skin lesions. For this purpose, we suggest to name an intact skin in AD as seemingly healthy skin.     

Usefulness of high‐frequency ultrasonography in the assessment of cutaneous lesions in children with hematologic malignancies

High‐frequency ultrasonography is a bedside tool increasingly used for the assessment of skin lesions, but there have been few reports about its importance in children with skin signs of hematologic disease. We present three cases to highlight the usefulness of high‐frequency ultrasonography in assisting with the diagnosis of these skin lesions.     

Imaging of the skin and subcutaneous tissue using classical and high‐frequency ultrasonographies in anti‐cellulite therapy

Background: The development of ultrasonography allowed for skin imaging used in dermatology and esthetic medicine. By means of classic and high‐frequency ultrasonographies, changes within the dermis and subcutaneous tissue can be presented. Objective: The aim of this study was to show the possibilities of applying classic and high‐frequency ultrasonographies in esthetic dermatology based on monitoring various types of anti‐cellulite therapies. Methods: Sixty‐one women with cellulite were assigned to two smaller groups. One group was using anti‐cellulite cream and the second group was a placebo group. The ultrasound examination was carried out before the initiation and after the completion of the treatment and evaluated epidermal echoes, the thickness of the subcutaneous tissue and the dermis, dermis echogenicity, the length and surface area of the subcutaneous tissue fascicles growing into the dermis, and the presence or absence of edemas. Results: After the completion of the treatment, a statistically significant difference was observed. The most useful parameters were as follows: the thickness of the subcutaneous tissue, echogenicity, the surface area and length of the subcutaneous tissue, as well as the presence of edemas. The discussed changes were not observed in the placebo group. Conclusion: Classic and high‐frequency ultrasonographies are useful methods for monitoring anti‐cellulite therapies.     

External vascular compression by hyaluronic acid filler documented with high‐frequency ultrasound

We present a case report of a hyaluronic acid filler‐induced complication documented using high‐frequency ultrasound. We regard the scientific value of the case as indicating the benefit that ultrasound provides for the management and documentation of this complication. This technology has been becoming increasingly widespread in the care of patients who experience unwanted effects of hyaluronic acid filler because it can be used for the high‐resolution visualization of skin layers as well as the differentiation of filler types and their relationships with adjacent tissues (via gray scale or B‐mode ultrasound) and blood vessels (via color Doppler ultrasound). In addition, it was possible to conclude that external vascular compression causes clinical repercussions, a fact that is often questioned by some dermatologists. This questioning is based on the vast vascularization and anastomosis of arteries of the face, which should permit compensation for vascular compression. However, in this case, there was no doubt that compression caused a region of low output with the clinical manifestation of peri‐oral pallor. Ultrasound was used to document the compression of a vessel by the filler; after application of hyaluronidase, increased vessel lumen and clinical reversal of hypoperfusion in the affected area were observed.     

Water‐based correction fluid is a useful skin marker for determination of the tumor margin of basal cell carcinoma under high‐frequency ultrasound

We propose a new method to determine the appropriate preoperative surgical margin of basal cell carcinoma (BCC) by using water‐based correction fluid as a skin marker showing the tumor position on the skin under high‐frequency ultrasound (HFUS). After a provisional evaluation by dermoscopy, an approximately 2‐mm dot of water‐based correction fluid is applied to the tumor margin. The ultrasound waves are blocked by the dot of correction fluid, and a low‐signal column is observed under the dot of correction fluid. The dots of correction fluid are moved and located as near as possible to the tumor margin, which is shown as a solid hypoechoic area by the HFUS. After confirming that the dots of correction fluid are applied to the circumferential margin, we draw a line in the gaps between the dots. Before the operation, the dots of correction fluid are removed by forceps, and a line for the tumor margin is drawn where the dots were. The surgical margin is set just outside of this line with the use of a measuring device. Water‐based correction fluid is thus a useful skin marker under HFUS to determine the circumferential surgical margin of BCC.     

“Assessment of chronic sclerodermoid Graft‐versus‐Host Disease patients,using 20MHz high‐frequency ultrasonography and cutometer methods”

The development of an adverse graft‐versus‐host disease (GvHD) is a major complication of stem cell transplantations, which are widely used to cure increasing number of hematologic malignancies. Patients with chronic GvHD are at risk of joint contractures secondary to sclerodermatous skin changes. Several clinical scores or serologic markers have been used to assess skin sclerosis in scleroderma patients. Evaluation of sclerotic skin changes using biometric tools remains to be challenging. The purpose of this study was to illustrate and exemplify ultrasound measurement and measurement of skin elasticity of five chronic sclerodermoid GvHD patients. There is still a substantial lack of studies using objective and non‐invasive methods helpful in assessment of patients with skin involvement of GvHD. Although ultrasound is not the ideal method, it is worth emphasizing that it is still useful, non‐invasive, and repeatable device in monitoring patients suffering from GvHD. It should also be added, that it seems to be advisable to repeat USG examination at an interval of 3 months after the treatment. In addition, skin echogenicity may be a more sensitive parameter than skin thickness in assessment of cGvHD patients.     

Prospective study on combination diode laser and radiofrequency energies (ELOSTM) for the treatment of leg veins

OBJECTIVE: To evaluate the Polaris LV, electro‐optical synergy (ELOS) technology, which combines diode laser (915?nm) and radiofrequency (RF) (1?MHz) energies, for the treatment of leg veins.

METHODS: A total of 25 patients (Fitzpatrick I–IV) with a total of 35 sites (0.3–5.0?mm vessel diameters) were treated with up to three sessions at 4‐ to 10‐week intervals. Polaris LV settings included: 80–140?J/cm² of laser light, 80–100?J/cm³ of conducted RF, and pulses of 100–300?ms. Vessel clearance was graded by both the treating and an independent physician.

RESULTS: At 1 and 6 months after the final treatment, approximately 77% of treatment sites exhibited 75–100% vessel clearance, and 90% had 50–100% vessel clearance. No treatment sites had less than 25% vessel clearance. Transient dyschromic side effects were common.

CONCLUSIONS: The Polaris LV ELOS system is effective and safe in treating leg veins, including telangiectases, venulectases, and reticular veins.     

High‐voltage electrical injury: Modified surgical technique for optimal defect closuring of extra‐large cranial defect

Electrical burns are group of traumatic injuries with a mortality rate of 3–15%. High‐voltage induced extensive electric burns are rarely seen in the cranial area, compared to upper and lower limbs, but extremely difficult for treatment, due to the limited flexibility in this area. The spectrum of therapeutic interventions in electrical burns in general, evolving initial necrectomy, decompression, and aggressive debridement with early skin coverage is usually not enough in cases of extensive cranial defects. The performance of a suitable flap combined with skin graft in donor site, and further implantation of expander is challenging in this area. We present a case of a high‐voltage induced extra‐large cranial injury in a 38‐year‐old man, treated with modified single large rotation flap and a split skin‐thickness graft technique, for optimal defect closuring with satisfied aesthetic result.