06. Removal of a dermal-epidermal patch on the face by means of timedsurgical mixed peeling
KEYWORDS: Dermal-epidermal patches, skin hyperpigmentations, mixed peeling , resorcin. solution, timedsurgical de-epithelialisation.
Dermal-epidermal patches on the face can easily be removed by means of timedsurgical mixed peeling. This consists of pulsed timedsurgical de-epithelialisation of the skin and the subsequent application of a saturated solution of resorcin in water for 20 seconds. Treatment is carried out under local anaesthesia. De-epithelialisation is performed with the edge of the angle of the EM10 Yellow electromaniple at a power of 2 Watts in the pulsed coagulation function specifically designed for de-epithelialisation Direct Pulsed, 4/9 hundredths of a second, Coag, 2 Watts, EM 10 Yellow (bent at an angle). As the electrode skims the surface of the patch in small movements, the epidermis detaches from the dermis. Timedsurgical de-epithelialisation is carried out on the entire visible surface of the patch, extending to about 1 mm beyond it. Electrical conductivity can be improved by moistening the skin with physiological solution. Once the electrode has skimmed the entire surface of the patch and the edges have been checked, the epidermis is removed by means of the same non-activated electrode. As the epidermis is removed, the dermis appears. There is no bleeding, since the procedure is carried out above the most superficial capillary network, the capillary-papillary plexus. Following de-epithelialisation, the dermis displays several pigmented spots. The operator now checks that the area has been completely de-epithelialized. Pulsed timedsurgical de-epithelialisation enables the dermis to be kept perfectly intact. The intact dermis absorbs the saturated solution of resorcin in water uniformly. This solution is applied with a cotton-wool bud, starting from the pigmented areas. On applying the solution, frosting immediately occurs. After about 20 seconds, the resorcin solution is washed off with physiological solution. The resorcin solution is then reapplied to the most pigmented areas, and is again washed off. After treatment, the patient delicately dries the area with a paper tissue. A few hours later, a thin crust forms. This drops off spontaneously after a few days, leaving the skin slightly red. Within a few months, the patch is no longer visible.
Before and after mixed timedsurgical peeling
Capurro S. (2008) Removal of a dermal-epidermal patch on the face by means of timedsurgical mixed peeling. CRPUB Medical Video Journal. Timedsurgery section. http://www.crpub.org
How does the resorcin solution act?
The saturated solution of resorcin in water has no effect on intact skin; it acts exclusively on de-epithelialized skin. Removal of the epidermis enables the resorcin to act uniformly on the entire area. During frosting, the resorcin solution exerts a toxic effect on the melanocytes. This reduction in the number of melanocytes makes resorcin the most interesting de-pigmenting agent.
How is the patient medicated?
After washing off the resorcin solution, the operator applies a solution of Betamethasone (e.g. a vial of Betametasone). Over the next few hours, the patient will dry off the area several times until a thin crust forms; this will drop off on its own. When the crust has dropped off, the area will be slightly red; this redness will disappear within a few months. During this time, the patient will apply a zinc oxide cream in the morning and at night.
How is the saturated resorcin solution made?
A little resorcin powder is placed in a dish and dissolved in a few drops of water. When a few granules of resorcin remain undissolved on the bottom, the solution is saturated.
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