COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE in .NET framework

Printer QR Code 2d barcode in .NET framework COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE

COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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Coagulation pathways in a vessel
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FIGURE 21-3 Coagulation pathway breakdown products of hemoglobin cause the color alteration in a bruise Hemoglobin breaks down to biliverdin (green), which in turn is metabolized to bilirubin (yellow) (Fig 21-5) When performing a cosmetic procedure with possible bleeding, it is helpful to ask patients about any history of bleeding disorders or usage of anticoagulant medications It is also important to advise patients to avoid certain medications 10 days prior to the procedure (Table 21-3) A list of these medications and supplements should be reviewed over the phone and faxed or mailed to the patient at the time the appointment is made so that when they arrive at their appointment, they will not have taken any of these products This practice will greatly decrease the amount of bruising that occurs if the staff is methodical about this warning NSAIDs including ASA are well recognized for their antiplatelet effects Other supplements such as garlic and ginkgo are also known for inhibitory effects on platelets1 In addition, green tea enhances the tendency to bleed by antiplatelet activity2 Vitamin E appears to exert its bleeding effect by inhibition of the intrinsic coagulation pathway3 Bruising may also be prevented or treated by using certain herbal supplements such as bromelain and arnica, which will be discussed briefly
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TABLE 21-2 Bruise Progression Scale (According to Changes in Color) 1 2 3 4 5 FIGURE 21-4 Fibrinolysis pathway Pink/Red Purple/Dark Blue Green/Dark Yellow Pale Yellow/Brown Hint of color
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Hemoglobin FIGURE 21-5 Color change in bruising
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Arnica
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Arnica, also known as leopard s bane or mountain tobacco, is an extract derived from several mountain plants, including Arnica montana, Arnica chamissonis, Arnica fulgens, Arnica cordifolia, and Arnica sororia It is widely used in homeopathic practice because arnica contains helenalin, a sesquiterpene lactone that is the major active ingredient conferring anti-inflammatory effects14 Helenalin has been shown to inhibit the activation of NF- B in T cells, B cells, and epithelial cells;14 NF- B is considered a transcription factor of several cytokines15 The exact mechanism of action of arnica in the treatment of bruises remains unknown; however, it has been proposed that arnica affects platelet function in vitro16 The clinical trials for treatment of ecchymoses with arnica are conflicting In a study of 200 patients who underwent a wisdom tooth removal or apicoectomy, subjects received arnica 3 days prior to the procedure and twice daily after the procedure in case of edema A 90% success rate with no swelling or ecchymoses was reported However, this study lacked a blinded control group Alonso et al evaluated 19 patients with facial telangiectasia in a double-blinded, placebo-controlled laser study17 Subjects were divided into pre- and posttreatment groups for treatment with pulsed dye laser The pretreatment group received topical arnica gel with vehicle on one side and vehicle only on the other side of the face for 2 weeks prior to laser treatment The posttreatment group followed the same regimen after the laser procedure No statistically
significant differences were noted in the prevention or accelerated clearing of the ecchymoses18 However, this study used a homeopathic formulation of arnica that contained very low amounts of arnica It is possible that a formulation with a higher amount of arnica would have showed success Another multicenter, randomized, double-blind, placebo-controlled study of 130 patients with phlebectomy also failed to show a difference among patients treated with arnica (pre- and postprocedure) compared to the control group19 However, in the author s experience, bruising seems to be prevented when the patient is advised to take four homeopathic arnica pills labeled with 30x dilution 4 to 6 hours prior to a cosmetic procedure High doses of oral arnica can be harmful, so patients should be warned not to exceed this dose Some people are sensitive to the compound helenalin found in arnica If they as develop a mild rash, they are likely helenalin-sensitive and should stop using arnica In the author s practice, arnica gel is applied to the treated area after every cosmetic procedure It is used to massage patients after Sculptra treatments (see 23) Patients are instructed to apply the arnica creams 3 times a day at home until bruises clear Donell Super Skin KDerm Gel and Boiron Arnica Cream are popular brands of topical arnica that are easily found in pharmacies and mass market outlets
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