Re: Another Interesting Article on Rhinophyma

[Guest guest]

I have been reading the Cutanix discussions. What is Cutanix and where do I

get it?

Thank you.

Kathy D.

Another Interesting Article on Rhinophyma

> Hi,

>

> I found another interesting article on rhinophyma, in the April 2002

> issue of Dermatology Times.

>

> Here's the link if you want to look at the photos (make sure to copy

> and paste both lines into your browser):

>

> http://www.dermatologytimes.com/dermatologytimes/article/articleDetail

> .jsp?id=14999

>

>

>

> Here's the text --

>

>

> Techniques should preserve resected tissue for pathologic evaluation

>

> April 15, 2002

> By: a Moyer

> Dermatology Times

>

>

>

>

>

> Dr. Lopardo

>

> New Orleans - Rhinophyma resection needs to be performed in a way

> that allows for postoperative histopathologic study, according to

> A. Lopardo, MD, speaking here at the 60th annual meeting of the

> American Academy of Dermatology.

>

> Dermatologists often treat rhinophyma by using destructive methods,

> he and his co-investigators reported in a poster session here.

> However, because rhinophyma patients are at increased risk of basal

> cell carcinoma (BCC), he recommends the use of techniques that

> preserve the resected tissue for pathologic evaluation.

>

>

> Rhinophyma in 63-year-old patient, treated by shaving technique using

> local anesthesia.

>

> " I have a special interest in the treatment of rosacea, " Dr.

> said. " An increasing number of clinical findings of basal cell

> carcinoma in rhinophyma led me to research these simultaneous

> pathologies. Because of the increasing incidence of rhinophyma,

> dermatologists should be aware of new diagnostic and surgical

> techniques for this condition, in order to help these patients

> achieve a better quality of life. " He is a practicing dermatologist

> in Buenos Aires, Argentina, where he has previously served as

> associate professor of dermatology and pharmacology at the University

> of Buenos Aires.

>

> Careful planning

> Because of the possibility of finding a cutaneous carcinoma within a

> rhinophyma, the dermatologist should plan for a careful

> histopathologic study of the resected tissue, with multiple sections,

> he said. If a malignancy is found, the dermatologist always faces the

> task of assessing whether the resection has been complete and with

> clear margins, or whether further evaluation is warranted. Therefore,

> he prefers techniques such as decortication, because such techniques

> make a histopathologic assessment feasible.

>

>

> Tissue resected with shaving technique.

>

> To illustrate his point, Dr. Lopardo reported on a case in which a 65-

> year-old male patient with rhinophyma had a subclinical BCC. The

> lesion had not been previously diagnosed but instead was found when

> the excessive tissue was removed by shaving. As a result of using

> this technique, the dermatologist was able to preserve tissue to be

> sent to the pathologist so that the patient's BCC could be diagnosed.

>

> The reason for the overlap in rhinophyma and BCC may be due to

> several immunological factors, Dr. Lopardo said. For example, Demodex

> Folliculorum, a mite that usually inhabits the follicular apparatus,

> is found in large numbers in rosacea. As dermatologists know, sun

> exposure is implicated in both rosacea and BCC.

>

>

> Immediate post-operative.

>

> Bolstered regeneration

> Multiple therapeutic procedures have been described in the literature

> for the treatment of rhinophyma. Dr. Lopardo stressed that

> dermatologists should choose a method that preserves the sebaceous

> glands' fundus, in order to allow for epidermal regeneration.

>

>

> Epidermal regeneration completed 10 days after surgery.

>

> " Some clinicians perform a resection that encompasses the entire

> depth of the skin, and close the wound with sutures or cover it with

> a skin implant, " he said. " Others carry out a subcutaneous resection

> of the lesion, and use the nasal skin surplus as a graft or implant.

> Other methods have been described for the destruction of the

> hypertrophic tissue, such as radiotherapy, dermabrasion, cryosurgery,

> electro-coagulation. " In addition, various lasers have been pressed

> into service, including the argon laser alone or combined with

> surgical resection, carbon-dioxide laser, and neodymium-YAG (Nd-YAG)

> laser. Some surgeons also use cryosurgery along with radiofrequency.

>

>

> Preoperative (left) and 40 days postoperative. (Photographs courtesy

> of A. Lopardo, M.D.)

>

> The typical treatment involves the tangential excision of the

> hypertrophic tissue, so that sebaceous glands funds are preserved.

> This method is called either " decortication " or " shaving. " In order

> to control the subsequent diffuse bleeding, Dr. Lopardo suggested

> either applying pressure with gauzes impregnated with epinephrine, or

> by applying fibrin sealers topically.

>

> " Once hemostatic control is achieved, the wound should be treated

> with topical bacteriostatics or with temporary skin [grafts], until

> epidermic regeneration is achieved, " Dr. Lopardo said. He noted that

> re-epithelialization has usually commenced by the tenth postoperative

> day.

>

>

>

>

> --

> Please read the list highlights before posting to the whole group

(http://rosacea.ii.net/toc.html). Your post will be delayed if you don't

give a meaningful subject or trim your reply text. You must change the

subject when replying to a digest !

>

> See http://www.drnase.com for info on his recently published book.

>

> To leave the list send an email to

rosacea-support-unsubscribe

>

>