Acute Urticaria Description ■ Urticaria, or hives, is divided into acute and chronic forms based on the duration of the hives. ■ Acute urticaria, by definition, lasts for less than 6 weeks, whereas chronic urticaria lasts more than 6 weeks. ■ Urticaria is a common, pruritic, distinctive reaction pattern. ■ Transient, migratory, edematous, pink to red plaques vary in size and shape. Individual lesions typically last…
Acute Eczematous Inflammation Description ■ Acute eczematous inflammation is characterized clinically by erythema, edema, and vesiculation. Weeping or oozing of acute lesions is typical. Pruritus is often severe. History ■ There are multiple causes of acute eczema. They include allergic contact hypersensitivity to specific plant allergens, such as poison ivy, poison oak, or poison sumac, and many other allergens. ■ Nickel, topical medicaments (e.g., bacitracin, neomycin,…
The opening, timeless quotation from Henry Faxon, Assistant in Surgery at Harvard Medical School in 1933, resulted from a careful analysis of 314 cases from the peripheral circulatory clinic of the Massachusetts General Hospital. Unfortunately, this quotation is timeless in that only through a continual careful evaluation of past results and review of our colleagues' experience can sclerotherapy treatment be provided in an optimal manner. Varicose…
Basic Principles of Treatment Maintaining the Skin Barrier ■ The skin assists in fluid homeostasis and protects against infections, toxins, and harmful effects of ultraviolet radiation. ■ The outermost layer of the epidermis, the stratum corneum, provides this protection through an impermeable barrier made up of fatty acids, cholesterol, and ceramides cemented between tightly knit, protein-rich cornified cells. ■ Keratinocytes serve skin barrier functions by contributing…
When analyzing side effects and complications of sclerotherapy, one should remember that sclerosing agents are drugs that are injected into veins not to cure them but to obliterate them. In terms of safety of use and results, sclerosing agents are more comparable to a surgical tool than to an intravenous (IV) drug. However, their toxicity and allergenicity must be known. Bad results using these methods are…
General Mechanism for Producing Endothelial Damage Sclerotherapy refers to the introduction of a foreign substance into the lumen of a vessel, aiming to create venous wall damage leading to occlusion of the vessel ( Fig. 7.1 ). This procedure, when performed on telangiectasias, is referred to as microsclerotherapy. The mechanism of action for sclerosing solutions is that of producing endothelial damage (endosclerosis) that causes endofibrosis. The…
Historical Development The oldest known illustration of compression bandages dates back to the Neolithic Age (5000–2500 bc ) ( Fig. 6.1 ). The ancient Hebrews, Egyptians, Greeks and Romans used compression therapy for treatment of wounds and ulcers, as described in the Smith Papyrus (1650–1552 bc ) and in the Book of Isaiah (Isaiah 1 : 6), eighth century bc . Hippocrates wrote about compression treatment in the…
Before sclerotherapy is performed, the examiner must obtain a focused history and perform a meticulous physical examination, including inspection and palpation (level 1). This combination places the patient into a proper clinical classification, and this, in turn, will dictate therapy. For example, primary venous insufficiency is characterized by telangiectasias, reticular varicosities and varicose veins without the stigmata of chronic venous disease. In contrast, the latter has…
The term telangiectasia was coined in 1807 by Von Graf to describe a superficial vessel of the skin visible to the human eye. These vessels measure 0.1–1 mm in diameter and represent an expanded venule, capillary or arteriole. Telangiectasias that originate from arterioles on the arterial side of a capillary loop tend to be small and bright red and do not protrude above the skin surface. Telangiectasias…
Essentially, three components of the venous system of the leg act in concert: deep veins, superficial veins and perforating-communicating veins. Dysfunction in any of these three systems results in dysfunction of the other two ( Fig. 3.1 ). When the superficial veins are placed under high pressure they dilate and elongate to accommodate an increased blood volume. Their tortuous appearance is termed varicose , derived from…
Pathogenesis Chronic venous insufficiency, which must be semantically distinguished from venous disease or disorder, may be defined as relative impedance of venous flow back to the heart and may be responsible for clinical consequences. When this occurs in the lower extremities, the normal reabsorption of perivascular fluids by osmotic and pressure gradients is impaired, resulting in accumulation of perivascular and lymphatic fluid. This leads to edema…
Introduction The anatomy chapter in a modern text devoted to sclerotherapy is traditionally not the most fascinating aspect, as the anatomy rarely changes and is very similar to that described in older texts. Anatomy chapters are rarely consulted because readers believe they know the basics of venous anatomy, but they should be reviewed regularly, and as one uses duplex ultrasound, the importance of understanding anatomy increases…
Summary and Key Points The majority of fillers currently used are hyaluronic acid, Poly-L-lactic acid, or calcium hydroxyapatite-based. Adverse events range between immediate, early, and late onset events. An informed consent discusses the diagnosis, nature and purpose of intervention, risks and benefits, and alternatives. The standard of care is outlined based on the expert witness’s personal practice, the practice of others observed in their experience, medical…
Summary and Key Features The increasing popularity of soft tissue augmentation requires knowledge of reversal techniques. Adverse events due to filler injection can be totally or partially reversed depending on the filler type and timing. Nonpermanent fillers are much more forgiving and more easily corrected. Hyaluronidase can be considered a treatment “eraser” for many complications arising from the injection of hyaluronic acid, and small doses can…
Summary and Key Features Soft tissue fillers are generally very well tolerated. However, serious vascular complications, including blindness, can occur. When filler is injected into blood vessels, ischemic or embolic phenomena may result. It is important to understand the depth and location of vessels in all areas of injection, although variation does occur. Strategies to prevent vascular compromise are critical and include injecting slowly and with…
Summary and Key Features Permanent fillers comprise mostly synthetic materials that cause collagen deposition via fibroplasia as their mechanism of action. Permanent fillers are better at facial volumizing and deep structural augmentation than at “line filling.” Silicones, polyalkylimides, polyacrylamides, polymethylmethacrylate, and acrylic hydrogels are the most common permanent fillers worldwide. All cosmetic fillers, whether temporary or permanent, may induce adverse reactions. Permanent filler complications may be…
Summary and Key Features Soft tissue augmentation with temporary fillers continues to be among the most commonly performed cosmetic procedures. A large variety of temporary dermal fillers are in production, with an ever-increasing number coming to market. It is imperative that the aesthetic physician injecting dermal fillers has proper training in filler selection and use and understands the differences among products. Although generally safe, complications can…
Summary and Key Features There are a multitude of factors that contribute to skin aging, including volume loss, dyspigmentation, fine wrinkles, and changes in skin texture. A multifaceted approach targeting the various aspects of aging is often required to effectively rejuvenate the skin and ensure patient satisfaction. A combination of treatments with fillers, neurotoxins, and light- and energy-based devices is both safe and provides synergistic beneficial…
Introduction There are approximately 1.4 million self-identifying transgender individuals in the United States as of the year 2016. Many of these individuals suffer from gender dysphoria, a condition of psychological distress described by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-V ) as an incongruence between gender identity and sex assigned at birth. Transgender individuals may choose to pursue social, legal, medical,…
Summary and Key Features The most common techniques for filler injection include linear threading, bolus, serial puncture, fanning, and cross-hatching. A combination of techniques, as well as layering of various techniques and fillers, is often employed to address both volume defects and superficial wrinkles. The proper technique reduces side effects such as pain, swelling, and bruising and yields better results and happier patients. While injections with…