The use of a constant spectrum,uniform temporal profile intense pulsed light source for long‐term hair removal in Asian skin

Phototherapy has become a treatment of choice in many areas of medicine. Light can deliver energy to tissue selectively, targeting specific structures in order to induce the desired therapeutic outcome. For the safe and effective removal of unwanted hair, the key optical parameters are wavelength, pulse duration and energy density, and can vary dependent upon skin and hair color. In recent years, the use of broad spectrum white light sources has proved to be safe and efficacious in the removal of hair with minimal short‐ or long‐term side effects. Whilst these highly flexible devices can achieve the desired results, there is scope for improvement. There are two key limitations to these devices: an inability to produce a ‘true’ long pulse matched to the thermal relaxation time of the hair structure and fluctuations in the output spectrum can lead to ineffective treatment with an increased risk of side effects. This paper describes an alternative approach to producing long pulse, constant spectrum optical pulses and presents clinical data showing improved efficacy in long‐term hair removal.     

以颞部受累为主的女性型脱发

报告1例以颞部受累为主的女性型秃发。患者女,66岁。双侧颞部脱发20余年。皮肤科检查:患者两侧颞部毛发稀疏明显,发质细软,头顶、额部及枕部毛发分布大致正常,拉发试验阴性。皮肤镜检查:患者两侧颞部可见毛干粗细不均,毛发直径异质性增加,毳毛样毛发的比例>50%,可见大量无毛干的毛囊开口,无断发、黑点征及惊叹号样发。患者的头顶部、额部及枕部毛发数量大致正常,毛发粗细一致,毛囊开口数量大致正常。诊断:女性型脱发。     

先天性颞部凹陷应用脂肪充填与生物代用品充填的比较

目的通过对自体脂肪充填和生物材料充填治疗颞部凹陷的比较,探讨患者更易接受的手术方法。方法比较自体脂肪充填和生物材料充填治疗颞部凹陷的不同方法。结果自体脂肪充填取材简单、安全、费用低,操作方便,外观饱满,手感柔软,但有部分因脂肪吸收而需再次充填。生物材料充填取材容易,可以一次成型,但费用较高,手感较硬,并且有排异反应的风险。结论自体脂肪充填治疗颞部凹陷既可减肥又可美容,不失为1种较好的易为患者接受的手术方法,而生物材料充填需患者慎重考虑。     

巨细胞动脉炎1例

报告1例巨细胞动脉炎。患者男，80岁。因头面部皮下结节伴疼痛1个月余入院。皮肤科检查；前额，双侧额部有条索状皮下结节，有轻微触痛，双眼视物模糊。皮损组织病理检查符合巨细胞动脉炎改变，给予糖皮质激素治疗后病情好转。     

颞中筋膜游离移植鱼尾纹祛除术

目的：评价颞中筋膜游离移植术在祛除鱼尾纹中的效果。方法根据颞部鱼尾纹的范围大小切取相应面积的颞中筋膜，游离移植入颞部鱼尾纹区域。结果使用颞中筋膜游离移植术可使眼轮匝肌收缩所产生的鱼尾纹最大限度的消失，随访5年无复发。结论在鱼尾纹祛除术中游离颞中筋膜移植于颞部鱼尾纹区域，能够达到祛除鱼尾纹的目的，术后效果满意、持久。     

Palmoplantar pustulosis with pustulotic arthroosteitis involving temporal osteomyelitis and meningitis

A 46-year-old man who had been suffering from palmoplantar pustulosis (PPP) for 3 years had anterior chest pain and left temporal pain from six months after the onset of his disease. A bone scan revealed abnormal uptake at the sternoclavicular joint and left temporal region. The head CT and MRI gave the diagnosis of temporal osteomyelitis with meningitis and myositis. His headache continued even after tonsillectomy and was effectively treated with cyclosporine A (3 mg/kg/day). Oral cyclosporine A was beneficial for the osteomyelitis and skin lesions. Sterile lytic bone lesions occurring most often at the sternocostoclavicular joint have been associated with PPP. However, there have been no reports of a PPP patient with temporal osteomyelytic involvement.     

Temporal arteritis presenting with scalp ulceration

We report the case of a 75-year-old-woman who presented with bilateral scalp ulcerations and blindness, accompanied by severe headache and scalp tenderness, due to bilateral temporal arteritis without systemic involvement. A biopsy taken from the border of an ulceration showed evidence of giant cell arteritis. She was treated with oral prednisone, 60 mg per day. The ulcerations healed in a few weeks but the vision loss was irreversible. This case highlights for temporal arteritis the importance of accurate and timely diagnosis as well as the need for prompt therapy with systemic steroids in order to avoid major complications, namely loss of vision. It also demonstrates that scalp necrosis and ulcerations are skin signs associated with a poor prognosis.     

Bilateral scalp necrosis with giant cell arteritis

We present a patient with bilateral scalp necrosis caused by giant cell arteritis (temporal arteritis). A 67-year-old woman, who had been treated with 5 mg of oral prednisolone every other day for polymyalgia rheumatica, developed painful egg-sized regions of necrosis on both of her temples. Doppler pulsemetory revealed bilateral obstruction of the temporal arteries. Biopsy revealed ischemic necrosis of the skin and necrotic angiitis of the temporal arteries with giant cell infiltration. Bilateral stenosis of the internal carotid arteries and moderate retinal bleeding were revealed by angiography. Daily administration of prednisolone (20 mg/day) with intravenous and topical limaprost alphadex markedly improved her condition. The ulcers reepithelized without surgical treatment. There are few reports of bilateral scalp necrosis. Rapid and complete obstruction of the temporal artery may result in this condition. Simultaneous development of two ulcerative lesions in the ventro-parietal cranial regions is thought to correspond to systemic arterial involvement, including involvement of the internal carotid arteries.     

Traumatic Aneurysm of the Temporal Artery: A Report of Five Cases

Five cases of traumatic aneurysm of the superficial temporal artery are reported. Four patients clearly stated that they had sustained traumatic injuries within 3 months prior to the appearance of the pulsating aneurysms; in the remaining case, more than two years had passed before the appearance of the nodule, and it was without pulsation. Color Doppler echography was very useful for observing the circulation in these aneurysms. Histologically, these cases were pseudoaneurysms composed of small vessels with internal elastic lamina and adjacent connective tissue proliferation, suggesting a break in the arterial wall.     

A case of temporal arteritis successfully treated with recombinant interleukin-2

An 80-year-old Japanese woman with temporal arteritis was treated with systemic recombinant human interleukin-2 (IL-2) (1 x 10(6) unit/day for six weeks). The presenting symptoms of headache and skin necrosis and abnormal laboratory findings, such as an elevated erythrocyte sedimentation rate and CRP, promptly improved without any serious side effects. Although the pathogenesis of temporal arteritis and the mechanism(s) of the beneficial effect of IL-2 on it still remain unknown, this preliminary study highly encourages further investigations.     

Temporal fossa defects: techniques for injecting hyaluronic acid filler and complications after hyaluronic acid filler injection

Facial changes with aging include thinning of the epidermis, loss of skin elasticity, atrophy of muscle, and subcutaneous fat and bony changes, all which result in a loss of volume. As temporal bones become more concave, and the temporalis atrophies and the temporal fat pad decreases, volume loss leads to an undesirable, gaunt appearance. By altering the temporal fossa and upper face with hyaluronic acid filler, those whose specialty is injecting filler can achieve a balanced and more youthful facial structure. Many techniques have been described to inject filler into the fossa including a “fanned” pattern of injections, highly diluted filler injection, and the method we describe using a three‐injection approach. Complications of filler in the temporal fossa include bruising, tenderness, swelling, Tyndall effect, overcorrection, and chewing discomfort. Although rare, more serious complications include infection, foreign body granuloma, intravascular necrosis, and blindness due to embolization into the ophthalmic artery. Using reversible hyaluronic acid fillers, hyaluronidase can be used to relieve any discomfort felt by the patient. Injectors must be aware of the complications that may occur and provide treatment readily to avoid morbidities associated with filler injection into this sensitive area.     

Giant cell (temporal) arteritis involving both external and internal carotid arteries.

A 76-year-old woman with giant cell (temporal) arteritis was described; she presented with a one year history of headache and tinnitus. Histopathological findings from a superficial temporal artery showed arteritis with granulomatous changes. Bilateral carotid arteriograms demonstrated the stenoses of both internal carotid arteries as well as the narrowing of the superficial temporal arteries. Although we dermatologists rarely encounter the disease in daily clinical practice, it is of clinical importance to perform cerebral angiography in patients suspected of temporal arteritis.     

Temporal triangular alopecia and a review of 52 past cases

Temporal triangular alopecia (TTA) is a circumscribed, non‐cicatricial form of alopecia confined to the frontotemporal region. The patient, a 15‐year‐old boy, was noticed at birth to have an alopecial area, sized 1.5 cm × 2.5 cm, in the right temporal region. Microscopic examination revealed miniaturized hair follicles accompanied by differentiated sebaceous glands. We have provided a synopsis of the past 52 cases. Of the 53 cases of TTA including our case, more than half (55.8%) were detected in childhood between the ages of 2 and 9 years, while 36.5% were detected at birth and only 3.8% (only two cases) in adulthood. There were three familial cases. Several congenital diseases were associated with the condition, for example, phakomatosis pigmentovascularis, Down syndrome and Dandy–Walker malformation. This information suggests that TTA can be recognized as a hamartomatous mosaic disease.     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.