Prevention of complications in dermatosurgery

Dermatosurgery has become ever more popular and important in recent years, mostly due to the increasing prevalence of skin malignancies. It also encompasses a wide variety of methods to remove or modify skin tissue for numerous cosmetic reasons. Nowadays, many dermatologists provide complete dermatologic care for their patients, including surgery. Therefore, it is important to be aware of the possible complications and to be able to manage them properly. Complications in cutaneous surgery are not very often, but they can be serious and worrisome including bleeding, infections, allergic reactions, syncope, wound dehiscence, necrosis, and others. In this article special attention is given to bleeding, which is the most common complication in this field. The best way to reduce the number of possible complications is to recognize patients at risk. Thus, complete history and physical examination are required before performing any dermatosurgical operation.     

Pre‐ and perioperative aspects of dermatosurgery

Dermatosurgery occupies an exceptional position among all surgical disciplines. Above all, this includes the fact that, with very few exceptions, the vast majority of surgical interventions can be performed under local or regional anesthesia, usually in smaller procedure rooms that are spatially separated from larger operating suites. Thus, peri‐ and postinterventional patient monitoring is the responsibility of the dermatosurgeon and his team. Though inherently smaller, this team still has to observe numerous perioperative requirements that – in larger surgical specialties – would be attended to by a host of various specialists working in concert. Said requirements include hygienic aspects, knowledge concerning pre‐ and intraoperative patient monitoring, managing surgical site infections, adequate postsurgical pain management, as well as detailed pharmacological knowledge with respect to common local anesthetics and the toxic and allergic reactions associated therewith. Not only does this require interdisciplinary collaboration and shared responsibility for the patient. It also necessitates the development and implementation of quality‐oriented and evidence‐based guidelines that, in the dermatosurgical setting, usually extend far beyond the scope of the specialty per se. The objective of the present CME article is the condensed presentation of interdisciplinary aspects relating to the most important perioperative issues.     

Corrective camouflage in pediatric dermatology

Many dermatologic diseases, including vitiligo and other pigmentary disorders, vascular malformations, acne, and disfiguring scars from surgery or trauma, can be distressing to pediatric patients and can cause psychological alterations such as depression, loss of self-esteem, deterioration of quality of life, emotional distress, and, in some cases, body dysmorphic disorder. Corrective camouflage can help cover cutaneous unaesthetic disorders using a variety of water-resistant and light to very opaque products that provide effective and natural coverage. These products also can serve as concealers during medical treatment or after surgical procedures before healing is complete. Between May 2001 and July 2003. corrective camouflage was used on 15 children and adolescents (age range, 7-16 years; mean age, 14 years). The majority of patients were girls. Six patients had acne vulgaris; 4 had vitiligo; 2 had Becker nevus; and 1 each had striae distensae, allergic contact dermatitis. and postsurgical scarring. Parents of all patients were satisfied with the cosmetic cover results. We consider corrective makeup to be a well-received and valid adjunctive therapy for use during traditional long-term treatment and as a therapeutic alternative in patients in whom conventional therapy is ineffective.     

Corrective cosmetics-need, evaluation and use

A comprehensive discussion of the need for, history, evaluation, and use of corrective cosmetics should also address image and its psychological impact, the attributes of an effective and acceptable concealer, and the methods of application.     

Corrective cosmetics are effective for women with facial pigmentary disorders

Visible facial lesions are a common and burdensome skin problem. This study examines the impact of corrective cosmetics in women with severe facial pigmentary disorders. Enrollment consisted of 73 women with one or more of the following conditions: acne, dermatosis papulosis, hypopigmentation, lentigines, melasma, rosacea, vascular proliferations, or other facial scars. The corrective cosmetic (Dermablend) was applied at the initial visit, at which time instructions and a supply of product were provided. Assessments were conducted at baseline, 2-week, 4-week, and 3-month follow-up visits on 63 patients using the Skindex-16. The corrective cosmetic was well tolerated. There was improvement in Skindex-16 scores after application of the corrective cosmetic, which continued at each follow-up visit and after adjustment for baseline confounders using multiple regression analyses. At 3 months, there was a 30% improvement in Skindex-16 score (P < .001). The corrective cosmetic was well tolerated and represents a valuable option that dermatologists can offer to patients with these conditions.