This document discusses post inflammatory scarring, specifically acne scarring. It defines different types of scarring such as hypertrophic, keloid, and atrophic scarring. It further classifies atrophic scarring into icepick, boxcar, and rolling scars. The document then discusses various treatment options for acne scarring including chemical peels, microdermabrasion, subcision, and skin needling. It provides details on how these procedures work and reviews studies showing their effectiveness in improving acne scarring.
cosderma chemical peels
we have wide range of chemical peels , glycolic, lactic, salicylic, TCA, jessner's, mandelic peel, yellow peel & many more combos are available
cosderma chemical peels
we have wide range of chemical peels , glycolic, lactic, salicylic, TCA, jessner's, mandelic peel, yellow peel & many more combos are available
A brief introduction to chemical peeling as a cosmetic procedure performed in the outpatient setting of dermatology clinics. It describes the concept of chemical peeling, materials used, indications, side effects, contraindications, how to perform it step by step at the clinic as well as post peeling precautions.
facelift without surgery can be done by
Botox
ultherapy
laser
threadlifts
LED
laser skin resurfacing
fillers
All these are age defying non surgical facelift alternatives
No risk of surgery is involved.These treatments encourages increased collagen production or remodelling of existing collagen.Supportive underlying tissues of the skin contract,resulting in tighter,more uplifted appearance of the skin.
Dr Sachdeva's Dental clinic and Facial aesthetic centre is one of the leading clinics performing facelift without surgery in Delhi. So hurry up and come book an appointment with us at Dr.Sachdeva’s Dental Institute, Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
THE ART OF NON SURGICAL SKIN REJUVENATION. MULTIPLE APPROACHESOsama Moawad
The sudden explosion in recent years of nonsurgical
rejuvenative techniques is patient-driven. The modern
patient, man or woman, desires quick, safe and pre-
dictable nonsurgical techniques that will confer some
form of facial rejuvenation and at the same time allow
them to get back to work or their social lives with a
minimum of downtime. By that is meant a modicum
of bruising and swelling for 2–3 days (i.e., over a week-
end) and not the 2–4 weeks of downtime and scars
that often accompany open surgical techniques.
Whilst nonsurgical techniques are not a substitute
for traditional rejuvenative surgery, the combination
of several nonsurgical tools and procedures has be-
come a powerful adjunct to or a temporizing substi-
tute for open surgery.
Micro Needling is a minimally invasive procedure that has little downtime, is safe on all skin types and will leave skin looking smoother and younger.
Micro Needling stimulates the bodies natural healing and will rejuvenate the skin and can reduce:
Lines & Wrinkles
Sun Damage
Skin Laxity
Acne Scars
Stretch Marks
Hair Loss and more
www.MDNeedlePen.com
Micro needling is a procedure that uses small needles to prick the skin which helps in generation of new collagen and makes the skin smoother,firmer and toned.It is also known as collagen induction therapy.It is used for the treatment of acne,wrinkles,scars, stretch marks,fine lines and other signs of ageing.As we age collagen content in our skin reduces and we lose our radiance. Micro needling is not a quick fix it might take weeks to months to show the desired results as it takes some time for the new skin to be formed.
Dr Sachdeva's Dental clinic and Facial aesthetic center is one of the leading clinics performing micro needling for anti ageing in Delhi. So hurry up and come book an appointment with us at Dr.Sachdeva’s Dental Institute, Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
Dermal fillers are an excellent choice for minimizing wrinkles and restoring youthful fullness to the face. However, with all the different options available, choosing the right dermal filler can be overwhelming. To help you find the right dermal filler for you Images Med Spa has created a guide to help you through your decision.
Chemical peels are used to improve and smooth the texture of skin by removing the outermost layer of skin.They can reduce freckles, age spots, dark patches and can give you a nourished and healthy skin.
Various peels can be used according to your requirements like glycolic acid, salicylic acid, lactic acid or carbolic acid.You will need to avoid sun for around 1 month and a little swelling might occur post treatment.They are ideal treatments for people with fair skin but shows good results even in people with dark skin.
Chemical peeling is done at Dr Sachdeva's Dental clinic and Facial aesthetic centre in Delhi. So hurry up and come book an appointment with us at Dr.Sachdeva’s Dental Institute, Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
The Hydrafacial is non-invasive, non-irritating skin resurfacing technology.
It is the only procedure that integrates cleansing, exfoliation, extraction & hydration simultaneously.
The Hydrafacial targets dehydration, skin texture, oiliness, congestion, comedones, fine lines and hyperpigmentation.
A brief introduction to chemical peeling as a cosmetic procedure performed in the outpatient setting of dermatology clinics. It describes the concept of chemical peeling, materials used, indications, side effects, contraindications, how to perform it step by step at the clinic as well as post peeling precautions.
facelift without surgery can be done by
Botox
ultherapy
laser
threadlifts
LED
laser skin resurfacing
fillers
All these are age defying non surgical facelift alternatives
No risk of surgery is involved.These treatments encourages increased collagen production or remodelling of existing collagen.Supportive underlying tissues of the skin contract,resulting in tighter,more uplifted appearance of the skin.
Dr Sachdeva's Dental clinic and Facial aesthetic centre is one of the leading clinics performing facelift without surgery in Delhi. So hurry up and come book an appointment with us at Dr.Sachdeva’s Dental Institute, Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
THE ART OF NON SURGICAL SKIN REJUVENATION. MULTIPLE APPROACHESOsama Moawad
The sudden explosion in recent years of nonsurgical
rejuvenative techniques is patient-driven. The modern
patient, man or woman, desires quick, safe and pre-
dictable nonsurgical techniques that will confer some
form of facial rejuvenation and at the same time allow
them to get back to work or their social lives with a
minimum of downtime. By that is meant a modicum
of bruising and swelling for 2–3 days (i.e., over a week-
end) and not the 2–4 weeks of downtime and scars
that often accompany open surgical techniques.
Whilst nonsurgical techniques are not a substitute
for traditional rejuvenative surgery, the combination
of several nonsurgical tools and procedures has be-
come a powerful adjunct to or a temporizing substi-
tute for open surgery.
Micro Needling is a minimally invasive procedure that has little downtime, is safe on all skin types and will leave skin looking smoother and younger.
Micro Needling stimulates the bodies natural healing and will rejuvenate the skin and can reduce:
Lines & Wrinkles
Sun Damage
Skin Laxity
Acne Scars
Stretch Marks
Hair Loss and more
www.MDNeedlePen.com
Micro needling is a procedure that uses small needles to prick the skin which helps in generation of new collagen and makes the skin smoother,firmer and toned.It is also known as collagen induction therapy.It is used for the treatment of acne,wrinkles,scars, stretch marks,fine lines and other signs of ageing.As we age collagen content in our skin reduces and we lose our radiance. Micro needling is not a quick fix it might take weeks to months to show the desired results as it takes some time for the new skin to be formed.
Dr Sachdeva's Dental clinic and Facial aesthetic center is one of the leading clinics performing micro needling for anti ageing in Delhi. So hurry up and come book an appointment with us at Dr.Sachdeva’s Dental Institute, Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
Dermal fillers are an excellent choice for minimizing wrinkles and restoring youthful fullness to the face. However, with all the different options available, choosing the right dermal filler can be overwhelming. To help you find the right dermal filler for you Images Med Spa has created a guide to help you through your decision.
Chemical peels are used to improve and smooth the texture of skin by removing the outermost layer of skin.They can reduce freckles, age spots, dark patches and can give you a nourished and healthy skin.
Various peels can be used according to your requirements like glycolic acid, salicylic acid, lactic acid or carbolic acid.You will need to avoid sun for around 1 month and a little swelling might occur post treatment.They are ideal treatments for people with fair skin but shows good results even in people with dark skin.
Chemical peeling is done at Dr Sachdeva's Dental clinic and Facial aesthetic centre in Delhi. So hurry up and come book an appointment with us at Dr.Sachdeva’s Dental Institute, Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
The Hydrafacial is non-invasive, non-irritating skin resurfacing technology.
It is the only procedure that integrates cleansing, exfoliation, extraction & hydration simultaneously.
The Hydrafacial targets dehydration, skin texture, oiliness, congestion, comedones, fine lines and hyperpigmentation.
Scar Revision in oral and Maxillofacial SurgeryPunam Nagargoje
A scar can be defined as a fault or blemish resulting from some former condition, wound, sore or burn. Scar formation is an inevitable consequence of wound healing in which the normal skin is replaced by a fibrous tissue.
• Mechanism
– Trauma
– Surgical
• Location & orientation
– Cosmesis
– Function.
Ideal Scar
• Flat
• Narrow
• Good color match
• Parallel to or within skin crease, folds and RSTLs
The ideal scar is level with the surrounding tissues, has a favorable color match, is narrow, parallel to or lying within a RSTL, and sinuous without long straight unbroken lines. Not all scars are able to be improved by revision techniques and those that are already optimal may be made much worse if a poorly thought out attempt at revision is undertaken. Patients should be carefully counseled to assure that their expectations are realistic – if they expect the scar to be completely gone - I.e invisible – they need education or they are likely to be displeased
Strategies
• Prevention
– Incision planning
• Relaxed skin tension lines
• Facial subunits
– Careful surgical technique
Postop Wound care
• Steroid injection
• Antitension taping
• Excision
– Irregularization
– Reorientation
• Camouflage
– Cosmetics
– Dermabrasion
Timing
• Traditionally 6 to 12 months
• Perhaps earlier for those perpendicular to tension lines
• Dermabrasion 6 to 9 weeks
– High fibroblast activity
The timing of scar revision has traditionally been after the scar has had a period of maturation of 6 to 12 months.
This allows time for scar maturation and better defines what needs to be accomplished in the revision.
Many would argue that scars lying outside RSTLs and especially those perpendicular to RSTLs are likely to have a poor cosmetic outcome and early revision and reorientation can be considered.
Dermabrasion is frequently performed at 6-9 weeks post injury utilizing the high fibroblastic activity in the wound at that time to aid in favorable wound healing.
Wound Healing
• Inflammatory phase – hours
• Proliferative phase – days
• Remodeling phase – months
Cellular Activity in Wound
Healing
Wound Healing.
TYPES OF SCARS
Mature scar
Imature scar
Contractures
Linear hypertrophic scar
Widespread hypertrophic scar
Minor keloid
Major keloid
Ice pick scar
Rolling scars
Boxcar scars
Hypertrophic scar
Can regress
Oriented collagen
Confined to wound
Scant mucin No myofibroblasts
Scars to consider revision
Longer than 20 mm
• Wider than 1-2 mm
• Disturbing function
• Poor match to surrounding tissue
– Colour
– Depth
• Against RSTLs
Timing of Scar Revision
Generally, every scar will show improvement without revision for up to 1 – 3 years
Traditionally we wait 6 to 12 months
Allows time for the scar to mature
Perhaps earlier for those poorly positioned (perpendicular to tension lines) or those that are markedly uneven
Relevant anatomy
Hide i
Acne is one of the most common diseases with a point prevalence of up to 100% among adolescents and often persists into adulthood, with detrimental effects on self-esteem. Sixty percent of all acne cases are so-called ‘physiologic acne’, the other 40% are those that need continuous help by a specialist to prevent physical or psychological scarring
Know All About Microdermabrasion Treatment for Flawless Skinthenewyousocial
Nothing can prevent the signs of aging like pigmentation, age spots, scars. But these can be lighten effectively with advanced microdermabrasion treatment. For more details: http://goo.gl/M2PMQG
New modalities in antiaging by Dr. Juliana Ghaben Specialist Dermatologist . ...Spectronix Group
DR Juliana Ghaben http://www.drjulianaghaben.com spoke on new modalities on antiaging at CME for KAYA skin CLinics . She is Board certified in Aesthetic Medicine and a trainer with SPECTRONIX . She spoke on Carboxytherapy , SECRET MICROFRACTIONAL RF AND Q SWITCH ND YAG , ALL MACHINES COURTSEY ; SPECTRONIX . http://spectronixglobal.com/
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
2. POST INFLAMMATORY SCARRING
The term scarring refer to a fibrous process in which
new collagen is laid down to heal a full thickness injury.
It affects 30% of those with moderate or severe acne
vulagaris.
It is particulary common in nudolocystic acne, acne
conglobata or acne vulgaris.
It may also be a long term consequence of infantile
acne.
Acne has a prevelance of over 90% among adolescents
and persists into adulthood in approximatel 12-14% of
cases with psychological and social implication.
3. ACNE SCAR
Acne scars are permanent textural changes and indentations that
occur on the skin as a result of severe acne. The term scarring is not
used for the temoparary red and brown marks left early after acne
has occurred as these marks will almost improve without treatment.
Two main cause of acne scar formation:
Increase tisssue formation
• Eg. Hypertropic scars, keloids
Loss or damage of tissue
• 3 primary acne scar-icepick, rolling, boxcar
4. HYPERTROPHIC SCARS
Hypertrophic and keloidal scars are associated with excess collagen
deposition and decreased collagenase activity
Hypertrophic scars are typically pink, raised and firm, with thick
hyalinized collagen bundles that remain within borders of the original site
of injury
Keloids form a reddish-purple papules and nodules that proliferate
beyond the borders of the original wound. Histologically, they are
characterized by thick bundles of hyalinized acellular collagen arranged
in whorls.
Hypertrophic scars and keloids appear predominantly on the back,
shoulders, sternal region and over the jaw angles
5.
6. ATROPHIC SCARS
Atrophic scars occur predominantly on the face. Atrophic acne
scars are more common than keloids and hypertrophic scars with
a ratio 3 : 1. They have been subclassified into ice pick, boxcar,
and rolling scars . With atrophic scars, the ice pick type represents
60%–70% of total scars, the boxcar 20%–30%, and rolling scars
15%–25% .
7.
8. ACNE SCAR MORPHOLOGICAL CLASSIFICATION
Acne Scars Subtype Clinical Features
Icepick Icepick scars are narrow (<2mm), deep, sharply marginated
epithelial tracts that extend vertically to the deep dermis or
subcutaneous tissue.
Rolling Rolling scars occur from dermal tethering of otherwise
relatively normal-appearing skin and are usually wider than 4
to 5mm. Abnormal fibrous anchoring of the dermis to the
subcutis leads to superficial shadowing and a rolling or
undulating appearance to the overlying skin.
Boxcar
Shallow <3mm diameter
>3mm diameter
Boxcar scars are round to oval depressions with sharply
demarcated vertical edges, similar to varicella scars. They
are clinically wider at the surface than icepick scars and do
not taper to a point at the base.
Deep
<3mm diameter
>3mm diameter
They may be shallow (0.1–0.5mm) or deep (≥0.5mm) and
are most often 1.5 to 4.0mm in diameter.
9. QUALITATIVE SCARRING GRADING SYSTEM
Grades of
Post Acne
Scarring
Level of
disease
Clinical features
1 macualr These scars can be erythematous, hyper- or hypopigmented flat marks.
They do not represent a problem of contour like other scar grades but of
color.
2 mild
3 moderate Moderate atrophic or hypertrophic scarring that is obvious at
social distances of 50cm or greater and is not covered easily by
makeup or the normal shadow of shaved beard hair in men or
body hair if extrafacial, but is still able to be flattened by manual
stretching of the skin (if atrophic).
4 severe Severe atrophic or hypertrophic scarring that is evident at social
distances greater than 50cm and is not covered easily by makeup
or the normal shadow of shaved beard hair in men or body hair if
extrafacial and is not able to be flattened by manual stretching of
the skin.
Mild atrophy or hypertrophy scars that may not be obvious at social
distances of 50cm or greater and may be covered adequately by makeup
or the normal shadow of shaved beard hair in men or normal body hair if
extrafacial.
12. CHEMICAL PEELING
Effective therapeutic for scars treatment.
Chemical peeling is recommended to treat skin aging, dyschromias,
wrinkles, and acne scars are the major clinical indications for facial
chemical peeling . (Ghersertieh et al, 2003).
Salicylic acid, glycolic acid, pyruvic acid, trichloroacetic acid are all
hydroxy acid used as peeling agents.
The choice of concentration depends on :
peeling agent used
On the skin areas treated
Severity of the acne scaring
13. dhudu
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• Best peeling agent.
• It is β-hydroxy acid agent has a lipophilicity.
• Combination of salicylic acid with resorcinol and lactic acid in 95% ethanol is
known as Jessner’s peels.
• The most efficacious concentration for acne scars is 30% in multiple
sessions, 3–5 times, every 3-4 weeks
Salicylic acid
• Glycolic acid is an alpha-hydroxy acid,
• It increases dermal hyaluronic acid and collagen gene expression by
increasing secretion of IL-6.
Glycolic acid
• Pyruvic acid is an alpha-ketoacid
• Strong antimicrobial effect.
• 40-70% pyruvic acid used to treat moderate acne scar.
• promote collagen synthesis and formation of elastic fibers.
Pyruvic acid
• it causes protein denaturation, well-known as keratocoagulation
• It is mixed with 100 mL of distilled water to create the desired concentration.
• TCA in a percentage of 10%–20% results in a very light superficial peel with
no penetration below the stratumgranulosum
• use of highconcentration (65% and 100%) trichloroacetic acid (TCA) applied
locally in the atrophic acne scars, known as Chemical Reconstruction Of
Skin Scars (CROSS)
Trichloroacetic
acid
• Iontophoresis is a non invasive method able to enhance transdermal drug
delivery using a small electrical current applied by a iontophoretic chamber
containing a similarly charged active agent and its vehicle
• iontophoresis with 0.025% tretinoin gel in atrophic acne scars
Tretinoin-
iontophoresis
CHEMICAL PEELING AGENTS
14. RESULT
• Philip et al., found that high concentration
trichloroacetic acid (TCA), icepack scar may respond
well.
• 53 adult patients with atrophic acne scars, 70% TCA
applied locally every two weeks using a chemical
reconstruction of skin scars therapy (CROSSS therapy)
resulted in good or excellent.
• 16 patients treated with 100% TCA, showed excellent
result.
• So high-strength TCA is thought to cause remodeling of
the dermal collagen.
15. TCA Cross: patient before
the treatment
TCA Cross: patient after
the treatment
16. MICRODERMABRASION/DERMABRASION
Microdermabrasion and dermabrasion are facial resurfacing
techniques that mechanically ablate damaged skin in order to promote
reepithelialisation
Microdermabrasion removes the outer layer of the epidermis,
accelerating the natural process of exfoliation .
Dermabrasion, with respect to microdermabrasion, completely
removes the epidermis and exposes the papillary or reticular dermis,
inducing remodeling of the skin’s structural proteins
Microdermabrasion is usually painless, it does not require anesthesia
All microdermabraders include a pump that generates a stream of
aluminum oxide crystals with a hand piece and vacuum .
sodium chloride, sodium bicarbonate, or magnesium oxide crystals are
used.
It shouldn’t be used to treat deep scars
Dermabrasion is performed under local or general anaesthesia. It
usually uses highspeed brush, diamond cylinder, fraise, or manual
17.
18. SUBCISION
Subcision is a nonoperative technique to manage depressed scars
by percutaneously releasing scar bands within the dermis and
subcutaneous tissue.
The entire area to be subcised is marked and local anesthetic is
administered.
a needle is used to release the fibrous septa within the scar,
resulting in the formation of new connective tissue underneath the
scar.
Then sharp hypodermic needles, usually 19 to 21-G, were used.
Bleeding and nodule formation are the main side effects.
Schematic demonstrating subcision. A
hypodermic, tribevelled, or filter needle is
inserted into the subdermal plane and
rotated in a fanning motion to undermine
the scar, disrupting fibrous attachments
19. RESULT
Cunliffe et al., showed that in a study of 40 patients
undergoing subcision for rolling scars, the overall degree of
improvement was rated 51%.
Subcision is adequate stand-alone treatment, improved
result was achived when it is combined with other
modalities. In a split-face, single-patient trial of subcision
alone versus subcision and the nonablative 1320nm
neodymium-doped:yttrium aluminum garnet (Nd:YAG) laser
at two week intervals, the combination treatment was
superior.
21. PERCUTANEOUS COLLAGEN
INDUCTION BY SKIN
NEEDLING
Skin needling is a recently proposed technique that involves using a
sterile roller comprised of a series of fine, sharp needles to puncture
the skin.
facial skin must be disinfected, and then a topical anaesthetic is
applied. 90 minutes after anaesthetic cream application, patients can
undergo the skin needling session.
The procedure consists of rolling a performing instrument on the
cutaneous areas affected by acne scars, several times, at least four-six
times, in four directions: horizontally, vertically and diagonally right and
left.
The needles penetrate about 1.5 to 2mm into the dermis.
More recently, Fabbrocini et al. have proposed the combined use of
skin needling and PlateletRich Plasma (PRP).
the combined use of skin needling and PRP is more effec tive in
improving acne scars than skin needling alone .
22. RESULT
Fabbrocini et al.,2009 found that eight week after the first session of skin
needling, all patients had smoother facial skin and slight reduction in
lesion severity. Eight week after the second session of skin needing, the
improvement in the acne rolling scar was evident. In total patients (20
female, 12 male) patient with acne rolling scars were enrolled.
Conclusion
Study confirms that skin needling has an immediate effect in improving
acne rolling scars and have advantage over other procedures.
24. Application of PRP on the skin immediately
before the treatment with the microneedles.
25. PUNCH EXCISION TECHNIQUES
Punch excision is mainly indicating for ice-pick or
boxcar scars.
According to diameter, depth and shape of scar, a
biopsy punch of appropriate size is used to excise
the scar and, then, closure or elevation or grafting
is possible options to perform.
26. RESULT
Grevelink et al demonstrated that excellent result may be
achived when punch excision is combined with concurrent
co2 laser resurfacing.
21 patients with skin type i-iii with mild to severe facial acne
scarring were treated with a combination off laser skin
resurfacing and punch excision of acne scars.
There was a range of clinical improvement by the
independent assessor of 25-50% in skin type I, 50-70% in
skin type II, and 50-75% in skin type III. There was a patient
subjective improvement of 25-50% for skin type I, 50-75%
for skin type II and75-100% for skin type III.
27. TISSUE AUGMENTING AGENTS
Augmentation is a further alternative for management of acne
scarring.
Several filler materials used.
An ideal filler material has to be hypoallergenic and safe, painless
and easy to inject, inexpensive and long lasting.
Hyaluronic acid is the recommended one.
Dermal filler classification
Filler class Average clinical
efficacy
Examples
Temporary 3–18 months Hyaluronic acid and
collagen
Semipermanent Up to 24 months Poly-L-lactic acid and
calcium hydroxylapatite
Permanent Many years if not
lifelong
Silicon, polyacrylamide,
polymethacrylate, and
hydroxyethylmethacrylat
e
28. RESULT
Richard et al., Used the HA-based filler Matridex, CaHA
and the polyalkylimide Bioalcamid. In total 27 patient were
enroolled in 12 month study. At 12 month evaluation 6
patients (22%) showed 75% improvement, 14 patient (48%)
showed between 50% improvement and 5 patients (18%)
showed a 25% improvement in treated atropic scars.
29. LASER TREATMENT
There are two main types of laser treatments – ablative and
non-ablative. Ablative (or wounding) lasers remove thin
layers of skin. Non-ablative (non-wounding) lasers stimulate
collagen growth and tighten underlying skin. Although non-
ablative laser resurfacing is less invasive and requires less
recovery time, it is less effective than ablative laser
resurfacing for deeper scars.
30. ABLATIVE (WOUNDING) LASERS
Ablative lasers are the “gold standard” for the treatment of box car
scars.
There are two types of ablative lasers, fractional ablative and fully
resurfacing.
If fully ablative, CO2 lasers are best employed on lighter skin types,
whilst erbium lasers have a wider safety threshold for darker skin
types. Fractional CO2/Erbium lasers have a higher safety profile
than fully ablative lasers and can be used in all skin types.
Fully ablative lasers such as CO2 or
Erbium can effectively reduce acne scars.
31. FRACTIONAL NON-ABLATIVE (NON-WOUNDING)
LASERS
Variable wavelengths of fractional laser devices have been shown to improve acne
scarring. They are best used for atrophic and rolling scars.
These lasers can cause some temporary redness but do not actually break the skin
surface.
The advantages of non-ablative fractional lasers are rapid recovery times, the ability
to treat darker skin types and higher safety profile.
Recovery time following fractional laser treatment ranges between 3 to 8 days.
Most people will benefit from a series of fractional laser treatments (2 to 5). Darker
skin types will usually require more treatments compared with lighter skin types.
Fractional laser resurfacing can reduce scars
33. RESULT
Alster et al., showed a mean improvement of 81.4% in 50 patients
with moderate-to-severe acne scars, used ablative co2 and
Er:YAG lasers.
Weiss et al., 500 acne scar patints were treated with the 1540nm
fractionated laser, with a median improvement of 50-75% after
three treatments.
Mahmoud et al., used second-generation erbium doped 1550nm
laser in study of 29 pateint. 18 patients achived 50-75%
improvement in acne scarring.
Chapas et al., showed that 13 patients with acne scarring
received 2 0r 3 monthly treatments with fractional co2, resulting in
a mean scar depth improvement by topographic analysis of
66.8%.
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