Fitzpatrick Skin Types
Chemical Peels
Dermabrasion
Lasers
Non-Surgical Skin Resurfacing Potpourri
100
How many Fitzpatrick skin types are there?
There are 6 Fitzpatrick skin types.
100
What are some superficial chemical peels?
Mandelic acid, lactic acid, pyruvic acid, salicylic acid, glycolic acid, Jessner solution
100
What is used for dermabrasion?
A wire brush or diamond fraise (a gritty burr type thing)
100
Why should supplemental oxygen be avoided when treating a pt with carbon dioxide laser for facial resurfacing?
Supplemental O2 use during carbon dioxide laser treatments can cause operating room fires. Several papers have shown that a nasopharyngeal oxygen delivery can decrease oxygen levels in the operative field when it is required, but the best way to decrease the level of oxygen on the field is not to use it.
100
Your deep peel pt has a history of cold sores. What are you going to do?
Patients with a history of orolabial HSV should begin prophylactic antiretroviral therapy 1 to 2 days prior to peeling and should continue it until full reepithelialization has occurred, generally 10 to 14 days post-treatment
200
What Fitzpatrick skin type is someone with red hair and pale eyes who always burns and never tans?
Fitzpatrick skin types 1.
200
What effect does a deep chemical peel have on pre-cancerous skin lesions?
Deep phenol peels have specifically demonstrated efficacy in treating precancerous lesions, and have demonstrated the ability to induce a complete clinical response when analyzed histopathologically.
200
What is used for microdermabrasion?
Microdermabrasion uses aluminum oxide microcrystals, and only treats the upper layer of skin.
200
A pt has a tattoo of kermit the frog, with green ink that you would like to remove with laser. What laser would you use?
Green tattoo ink responds effectively to treatment with a 755-nm Q-switched alexandrite laser.
200
Topical tretinoin has what effect on the stratum corneum? Does it thin it, or thicken it?
Topical tretinoin thickens the stratum corneum, making it more compact and this making the skin smoother.
It also increases hyaluronic acid, increases epidermal thickness, increases mucin, and decreases melanin.
300
Why do Fitzpatrick skin types matter for chemical peels and deep laser resurfacing?
Fitzpatrick skin types 1-3 are unlikely to develop post-inflammatory hyperpigmentation. Skin types 4-6 are more likely to develop post-inflammatory hyperpigmentation.
300
Which of the following substances is NOT contained in Jessner's solution?
A) Ethanol, B) Glycolic Acid, C) Lactic Acid, D) Resorcinol, E) Salicyclic Acid
B) Glycolic Acid
300
Is dermabrasion more appropriate to treat a normal tattoo or a traumatic tattoo? Why?
Dermabrasion is more appropriate to treat a traumatic tattoo. Because traumatic tattooing involves the embedding of particulate matter within the superficial epidermis, dermabrasion can be used to uproot and remove the debris.
300
You are planning ablative laser resurfacing on a pt with Fitzpatrick skin type III. Which complication of laser resurfacing should you particularly warn this patient about?
Hyperpigmentation is the most common adverse effect of laser resurfacing. It occurs in 36% of patients and is most common in people with Fitzpatrick skin Types III to VI. Treatment consists of hydroquinone and tretinoin.
300
Does glycolic acid require neutralization?
Yes, glycolic acid must always be neutralized as soon as the clinical endpoint of erythema is reached. You can use sodium bicarb or water to neutralize.
400
What characterizes a Fitzpatrick IV skin type?
Hardly ever burns, tans very easily. Often seen in people of East Asian origin (Chinese, Japanese) or Southeast Asian origin (Indian, Pakistani)
400
Does liquid soap increase OR decrease the depth of phenol peels?
Liquid soap DECREASES the depth of penetration of phenol peels because it increases surface tension and thus decreases penetration and absorption of phenol.
Antibiotic ointment and taping INCREASE penetration by providing a vapor barrier.
400
Which of the following is the beneficial effect of pretreatment with tretinoin prior to facial skin resurfacing?
Tretinoin results in increased transit rate of keratinocytes through the epidermis. Use of tretinoin as a pretreatment prior to resurfacing allows for a more uniform skin layer. This can allow a more even distribution of treatment throughout the treatment area.
400
Your pt has persistent erythema 2 weeks after she underwent full-face carbon dioxide laser resurfacing. What topical treatments is most recommended to decrease this patient's postoperative erythema?
Erythema following laser resurfacing is an anticipated consequence of therapy. Posttreatment erythema is more severe and of longer duration with carbon dioxide laser resurfacing when compared to the fractionated carbon dioxide or Er:YAG laser. Postoperative topical application of ascorbic acid has been shown to decrease the duration as well as the severity of erythema. Topical therapy with ascorbic acid should be applied following reepithelialization.
400
A solid white frost is the clinical endpoint of a deep chemical peel. What does the solid white frost indicate (as opposed to the white frost with surrounding pink hue characteristic of a medium peel)?
The deep white frost indicates the endpoint for the depth of skin penetration with a deep rhytid chemical peel such as the combination Jessner/35% trichloroacetic acid solution. This indicates that the peel has penetrated into the upper reticular dermis. There is no pink hue because at this level there is vasospasm of the capillaries in the papillary dermis. This depth of penetration is for moderate and deep rhytides. This is a transient phenomenon. Capillary refill should return within 20 to 40 minutes.
500
What time of skin resurfacing could you consider for a pt with type VI skin type?
superficial or medium depth peels, erbium non-ablative fractional laser, low-power (1927-nm) fractional laser
500
What is this plant and why is it relevant to peels?
Croton oil is an oil prepared from the seeds of Croton tiglium. It is a caustic exfoliatiant and is used in combination with phenol in peels.
500
Dermabrasion should be limited to what histological depth of skin?
Dermabrasion should be limited to the papillary dermis. Injury to the reticular dermis (and especially through the reticular dermis) increases risk of adverse scarring.
500
What laser would you choose to treat a capillary malformation on a cheek?
Pulsed-dye laser (585 nm). The chromophore for the pulsed-dye laser at a wavelength of 585 nm is oxyhemoglobin. Thus, this laser is best suited to treat vascular lesions.
500
A pt presents to the ED with ringing in his ears, nausea, disorientation, and rapid breathing after undergoing a peel at an OSH. What chemical peel was likely used?
This patient is presenting with symptoms of salicylism or salicylic acid toxicity, a rare side effect of salicylic acid peels. Symptoms can include: rapid breathing, tinnitus, hearing loss, dizziness, abdominal cramps and central nervous system reactions. In general, salicylic acid peels are safe when used in more modestly sized areas (less than 20% TBSA) and have minimal complications.