A board certified cosmetic and reconstructive plastic surgeon in Los Angeles, California discussing plastic surgery of the eyes, face, ears, nose, breast, abdomen and thighs.
Antibiotic Therapy for HS Can Induce Antibiotic Resistance
A cross-sectional analysis of 239 patients with HS evaluated from 2010 to 2015 compared use of antibiotics to no antibiotics with respect to the development of bacterial resistance to antibiotics.
Tetracyclines and oral clindamycin were not associated with any significant antimicrobial resistance. Therefore they should be used in preference to Bactrim, Ciprofloxacin and topical Clindamycin to treat HS related infections. Fischer AH, Haskin A, Okoye GA. Patterns of antimicrobial resistance in lesions of hidradenitis suppurativa. JAAD. 2017;76(2)309-213.e2
There are different types of headaches including migraine, tension and cluster headaches. The causes of headache are as variable as the proposed treatments. Over the last 5 to 10 years plastic surgery in the treatment of headaches has become increasingly popular. This blog only deals with eyelid surgery and tension headaches.
Upper eyelid surgery can be cosmetic for the removal of excess skin or reconstructive to improve vision by removal of excess skin and/or eyelid ligament tightening . A cohort study of 108 eyelid skin removal only cosmetic blepharoplasty and 44 reconstructive skin removal with eyelid drooping blepharoptosis procedures (cosmetic and drooping eyelid surgery) treated between September 1, 2014 and September 1, 2015 were compared using Headache Impact Test-6 scores before and after surgery. The test scores are derived from questionnaires completed by patients. 35% of the skin only blepharoplasty and 64% of the visually impaired patients had tension headaches before surgery. The scores in the first group went from 56 to 46 and in the second group from 60 to 42 following surgery.
The conclusion is more patients with drooping eyelids affecting vision have headaches than patients who just want cosmetic upper eyelid surgery and though both groups have less severe headaches after surgery those whose vision was affected have more improvement. Additionally the more their vision was affected the greater headache severity they had before surgery and the more relief they had after surgery.
Lentigo maligna is a melanoma in situ that forms in sun exposed areas of skin, first described in 1892. Under the microscopic one sees a proliferation of atypical pigment cells in the superficial skin. They typically have a cloud like appearance with variable shades of brown coloring and start as a freckle that enlarges over a number of years. Historically they were called Hutchinson's freckle. More than half occur on the face or neck. They are more common in warmer climates with greater sunlight exposure and the majority occur after the 6th decade of life . If ignored long enough they will develop a vertical growth phase and begin to invade the deeper layers of skin, dermis. They are then malignant melanomas and are called lentigo maligna melanoma. At the time of presentation 10 to 20% of lentigo malignas have already invaded the dermis to some degree. Although melanoma represents a small portion of all skin cancers, it is responsible for the majority of skin cancer–related deaths.
The diagnosis of melanoma of the lentigo maligna
subtype is challenging, as the clinical presentation
is quite varied, ranging from a subtle
brown patch to tan/black or even amelanotic(almost normal skin color). These lesions pose significant treatment
challenges for clinicians because of significant
invisible to the eye surrounding extension, a predilection for cosmetically
and functionally sensitive areas, and a
naming system that is often confusing.
Obtaining a biopsy specimen from a clinically
suspicious lesion can present problems, given the lesions can be as large as 6cm in anatomically and cosmetically
sensitive areas. If the suspicious lesion is
small, an excisional biopsy of the entire pigmented
lesion to fat is recommended. However,
an excisional biopsy is rarely feasible, as most
lesions are too large with poorly defined margins to be completely
removed. In this setting, a small biopsy of the darkest,
or most palpable, or otherwise most visibly concerning
area of the lesion is recommended.
